SPONSORED CONTENT by Comprehensive Pharmacy Services
Editor’s note: This is the final installment of a four-part series on transforming pharmacy services across the continuum of care. The first article introduced the new role of pharmacies and pharmacists in hospitals and health systems. Part 2 explored the strategy of provider-owned outpatient retail pharmacies. Part 3 examined telepharmacy—using remote pharmacists to handle orders after hours and fill gaps in local resources.
After years of consistent 4 to 8 percent annual growth in prescription drug spending, 2014 and 2015 have ushered in a new concept, drug cost hyperinflation. Some very expensive and heavily promoted new treatments for chronic liver disease, hepatitis C, cancer, multiple sclerosis and autoimmune disorders came on line. Add to that, new aggressive pricing from drug companies on long-established generics and you have a scenario for hyperinflation of drug costs. For example, on Feb. 10, 2015, Valeant Pharmaceuticals International bought the rights to a pair of life-saving heart drugs. The same day, their list prices rose by 525 percent and 212 percent, respectively.And a number of drugmakers abandoned generics in competitive situations, giving the remaining firms free range to sharply increase prices.
There is a silver lining in the gloom, however. Though pharmacy will likely remain a cost center for hospitals and health systems, “There’s just a tremendous opportunity for savings almost everywhere you look,” said Len Gray, PharmD, division vice president, health system clinical services, Comprehensive Pharmacy Services (CPS), a national provider of hospital pharmacy management and consulting services. That opportunity hinges on a provider’s willingness to invest in some form of data analytics and, just as importantly, act on those findings. A widespread absence of information technology systems that support and track interventions add to the challenges care providers face.
Dr. Gray cites as a prime example of a savings opportunity the anticoagulant bivalirudin, given to patients prior to a percutaneous coronary intervention (PCI). Though it went generic recently, it still costs hundreds of dollars per case. Another blood thinner, heparin, has been used in procedures for many years. It costs about $3 a dose. There’s been a battle in the industry for years over bivalirudin, but the evidence has recently become clearer that heparin can be used safely and effectively, saving millions of dollars annually.
Using CPS’ Rx-Clinical Analytics platform, a hospital pharmacy manager can ensure heparin is used in all PCIs. Along with improvement opportunities, the system provides clinical decision support materials to validate purchasing changes and discussions in pharmacy and therapeutics meetings. The system also provides continuous financial evaluation of ongoing clinical initiatives and serves as a communication and documentation platform for the healthcare providers responsible for clinical program implementation.
“Most hospitals are tracking pharmacy data today, and some will likely look at a half dozen cases of drug comparisons each year. The difference is that we have a database of hundreds of such comparisons and a system to ensure follow-through to use the most cost-effective intervention,” For instance, in the cardiac cath lab where we know tirofiban, which has a much lower cost to the patient, can have a better outcome than other cardiac cath lab choices. It is also much easier to administer from a nursing perspective. This is a win-win-win for the facility, nursing and ultimately for the patient,” said Marvin Finnefrock, PharmD, CPS’ vice president of clinical and purchasing services.
A central feature of the system is its ability to track antibiotic utilization by drug and clinical use—critically important given how often these drugs are inappropriately prescribed, with high dollar costs and an incalculable impact on public health. Overuse of antibiotics and a lack of drug manufacturer investment in research and development have resulted in a dramatic reduction in drug efficacy and the rise of drug-resistant superbugs such as MRSA (methicillin-resistant Staphylococcus aureus). The federal government now has a mandate to limit antibiotic use in both inpatient and outpatient settings through new stewardship programs.
Rx Clinical Analytics recently provided an opportunity for improvement to a health system manager responsible for clinical pharmacy services in multiple facilities. The program flagged the purchase of acyclovir ointment and cream at several hospitals in the health system, products the Centers for Disease Control and Prevention has identified as providing minimal clinical benefit to patients with the herpes virus. The data analytics system presented supporting documentation and recommended an alternative oral systemic treatment as an effective, and less costly, solution. Acyclovir costs several hundred dollars per tube, whereas oral systemic treatments cost pennies per day.
Based on pre-defined rules, the system evaluates a facilities purchases and automatically populates the suggestion queue for the facility, letting the user know opportunities for outcome and/or cost improvement exist. Pharmacy staff at each facility were presented with concise decision support materials through a direct user interface and related links to further information. In addition, a financial evaluation was performed, and the cost-saving opportunity associated with the switch in drugs was displayed. Ongoing tracking of the clinical initiative is available for continuous review at each facility.
The alternative treatment recommendation was shared by the pharmacist with all medical staff committees responsible for the use of medication within the health system. In addition, pharmacists document their progress in the program, noting successes or roadblocks with the medical staff adopting the recommended alternative treatment. All facility and system pharmacy managers can view the documentation, so a consistent process is facilitated across the system with additional support or direction provided as needed.
Naturally there is resistance to stop using a drug that has been used for a long time. “The data gives us a chance to meet with that practitioner and show him or her the clinical data on efficacy and cost, along with his or her own usage patterns for that drug,” Dr Finnefrock said. “I like to say, ‘I’m not coming to you as a representative for the drug or as part of the hospital administration, but as a trusted adviser. Let’s sit and talk through this.’”
To further ensure improvement initiatives are followed through, CPS has developed a mobile app for the C-suite. “If you are in a meeting and someone asks what’s going on with antibiotic overuse, you can reach for your iPad or smart phone and immediately call up predetermined metrics such as cost of antibiotics per patient day,”Dr. Finnefrock said. “The data is easily accessible and understandable, which can be very powerful in the moment.”
The savings opportunities from pharmacy data analytics are substantial. “Typically our clients will see a 4 to 15 percent savings—pretty significant when pharmacy drives 10 to 15 percent of hospital spending overall,” Dr. Gray said. A mid-size hospital that purchased CPS analytic tools with CPS pharmacy management support experienced $11.4 million in savings over a four-year period.
Hospital pharmacies are generating a lot of data these days. You need focused data analysis platforms, coupled with best practices and clinical resources to ensure change is widely adopted. In order to address drug cost hyperinflation, hospitals need to be aware that the status quo will not alleviate this burden. Focused pharmacy analytics can help reduce and prevent further escalation of un-warranted drug cost increases.