Managing High Cost

Medications

Presented By Joseph Pinto, R.Ph, M.S., MHA

Senior Director of Clinical Operations at Mount Sinai Downtown

Immediate Past President of the NYS Council of Health-System Pharmacists

and Past President of the NYC Society of Health-System Pharmacists

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Key Objectives

1. Discuss the impact that High Cost Medications

have on the hospitals/health systems ability to

manage costs

2. Describe methods for managing high cost

medications

3. Understand the use of data in managing costs

4. Explore the benefits of medication utilization

management initiatives

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RISING DRUG COSTS AND

HOSPITALS/HEALTH SYSTEMS

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Inpatient Drug Spending Trends

Source: AHA-FAH Drug Survey; 2012-14

AHA Annual Survey 4

The price of drugs (not utilization) is a major contributor to increased spending

Spending impacts patient access to care

Contributing Factors to High Drug Costs

1. Drug ownership

2. Shortages

3. Drug delivery

methods

4. Cost-related

medication

nonadherence

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Drug Ownership

Navigate competitive generic manufacturers

Many companies correlate higher prices with

better quality drugs

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Drug Shortages

Anticipate changes

Identify hyperinflation early via market surveillance

Consider group purchasing

Have an action plan for supply dilemmas7

Drug Delivery Methods

Device changes due to medical discoveries

Source Stein and Thiel, J Aerosol MPDD 8

Timeline of Therapeutic Aerosols

1950 1980 2018

1962, Medihaler Duo

– first combination

MDI therapy with

CFCs

1970, Autohaler –

rugged pocket size

device is made

1968, CFC Albuterol is

delivered by MDI and

DPIs

2000, Suspension

of Albuterol via

Ventolin HFA

1956, Inhaled

epinephrine via

DPI nebulizer

1987, Montreal Protocol signed

eliminating CFCs in MDIs

1990, Move

from using

CFCs to HFAs 2011, Last

CFC MDI is

phased out

of U.S.

Market

2005, Soft

mist inhaler -

Respimat

Inhalation

spray

introduced

Patient Non-Adherence to Drug Therapy

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METHODS FOR MANAGING

HIGH COST MEDICATIONS

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The Role of Pharmacy Leadership

1. Review and update operational procedures

2. Maintain an open line of communication

3. Optimize collaboration among various disciplines

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Responsibilities of Pharmacy Leadership

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Develop quantifiable measures and

deliverables

Strive to prioritize value-based

contracting with drug manufacturers

Minimize waste and go LEAN

Remain aware of current laws and

regulations

◦ USP Compliance

◦ Drug pricing programs such as 340B

Effective Communication Strategies

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Consider utilizing a pharmacy bulletin or

electronic correspondence to

communicate

Provide support to front line clinical

pharmacy staff

◦ Serve as a resource

◦ Encourage attendance of continuing education

and trainings

Walk-the-talk: position your team to

succeed

Planning the Flow of Success

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Set Quarterly Goals

Plan and Prepare

Weekly Objectives

Share Progress

Provide Feedback

Disseminate Regular Reports and Updates

1

2

3

4

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Quarterly Weekly Daily As Needed

Adopted from www.weekdone.com

Utilize PPP Reporting

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Progress

Plans Problems

Adopted from www.weekdone.com

Progress. Highlight team accomplishments and tasks that have been completed successfully

Plans. Identify goals and objectives that must be prioritized

Problems. Brainstorm solutions to challenges in real-time

“When it comes to working

toward a more collaborative

system, it’s all about the

alignment of incentives.

We need to demonstrate

efficacy and then give the

physicians a reason to care

about prescribing the most

cost-effective treatment.”

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Doug Chaet

Chief Managed Care Officer, Sentara

Healthcare and Chairman, American

Association of Integrated Healthcare

Delivery Systems

USING DATA TO MANAGE

HIGH COST DRUGS

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Capture Quality Metrics

Practice effective Monitoring and

Evaluation (M&E)

Consider the use of pharmacy

analytics software

◦ Discharge counseling and follow-up

Embrace pharmacy’s role in

population health with PHM

analytics

◦ Work to reduce avoidable

readmissions

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REPORT

LEARN

SHARE

ACT

REVIEW

Adopted from blog.pharmapodhq.com

Monitoring & Evaluation (M&E)

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Set and track SMART performance

goals◦ Specific (S): clear performance target established

◦ Measureable (M): team can view progress in real-time

◦ Appropriate (A): target is in line with scope of work

◦ Realistic (R): target is tangible and achievable

◦ Time-bound (T): specific time frame is outlined and

understood

Adopted from Management Sciences for Health

Pharmacy Analytics Software

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DRUG UTILIZATION

MANAGEMENT INITIATIVES

AND COST

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Moving Towards New Models of Care

Population health impact on volume distribution

Growing demand due to the aging population

Increased prevalence of chronic diseases

Shift of care must not impede patient care

22Source: HSG Advisors

Multi-Disciplinary Collaboration

Active involvement of all staff to implement medication utilization management initiatives

◦ CPOE, MTM

and CDTM

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Physician and clinical pharmacy relationship

◦ Rounds, renal dose adjustment and pharmacokinetic monitoring

Work as a unit to identify cost-effective treatments

Pharmacy and Therapeutics Committee

Select various thought leaders and clinical experts

◦ Pharmacy leadership

◦ Medical chiefs

◦ Physician specialists

Establish core guidelines and protocols

◦ Seek to enhance patient safety and increase

standardization

Evaluate clinical evidence and project financial

impact of new/current medications

Consider alternative options for Formulary List

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Timeline of Approval

25Source: R Durvasula et al.

Formulary Management

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Various

strategies

P&T can

mandate

Key Takeaways

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#1: Prioritize collaboration

#2: Avoid compromising

patient safety and quality of

care

Source: Managed Healthcare Executive 28

References American Society of Health-System Pharmacists. ASHP guidelines on medication

cost management strategies for hospitals and health systems. Am J Health-Sys Pharm.

2008; 65:1368-84.

Briesacher et al. Patients At-Risk for Cost-Related Medication Nonadherence: A

Review of the Literature. JGIM. 180: 864-871.

Durvasula R et al. Standardized Review and Approval Process for High-Cost

Medication Use Promotes Value-Based Care in a Large Academic Medical System.

American Health & Drug Benefits. 2018; 11(2):65-73.

Flannery AH et al. Managing the Rising Costs and High Drug Expenditures in Critical

Care Pharmacy Practice. Pharmacotherapy. 2017; 37(1): 54-64.

Management Sciences for Health. Information Management: Monitoring and

Evaluation. 2012; 48.11.

NORC at the University of Chicago. Final Report: Trends in Hospital Inpatient Drug

Costs: Issues and Challenges. 2016; 10-11.

Stein SW, Thiel CG. The History of Therapeutic Aerosols: A Chronological

Review. Journal of Aerosol Medicine and Pulmonary Drug Delivery. 2017;30(1):20-41.

Weekdone: Weekly Planning + Quarterly Objectives

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