Post on 25-Jul-2020
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
5
Drug Ownership
Navigate competitive generic manufacturers
Many companies correlate higher prices with
better quality drugs
6
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
5
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.”
16
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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