Drug purchasing analytics software can be an effective tool for identifying high-cost medications in a health-system, according to a new study.

Christy Norman, PharmD, the interim director of pharmacy at the Georgia Regents Health System in Augusta, used the software (McKesson Pharmacy Spend Trend Analytics) to identify 50 medications that accounted for the bulk of the system’s medication expenditures (poster 3-012). The analyses helped Dr. Norman and her colleagues to develop seven initiatives that led to a 7% reduction in drug spending.

“Many of the changes were simply formulary decisions that required P&T [pharmacy and therapeutics committee] approval and some re-education of pharmacists, nurses and physicians, along with ongoing evaluation of compliance,” Dr. Norman said.

The change that had the highest cost impact did require operational changes. After evaluating the literature and comparing outcomes with a variety of kidney transplant induction agents, the team determined that using alemtuzumab (Campath, Genzyme) would be the most cost-effective treatment, when compared with the hospital’s traditional induction agent thymoglobulin. “Thymoglobulin is roughly $670 per vial and alemtuzumab is free from the manufacturer when used for induction,” Dr. Norman noted.

She added that cost-savings were also due to improved outcomes. “Monitoring of [those] outcomes is ongoing, but so far we have had a decrease in the number of acute rejection episodes since switching to Campath,” she said.

Table 1. Savings Summary of Initiatives
Initiative Annual Savings in Purchase Dollars, $
Transplant medication optimization 546,044
Antibiotic/antifungal initiatives: Expansion of antimicrobial stewardship program Carbapenem therapeutic interchanges Targeted antimicrobial monitoring 478,289
Thrombin waste reduction 170,374
Optimization of anesthetic inhalation agents 57,732
IVIG therapeutic interchange 50,335
Total annual savings 1,302,774
IVIG, intravenous immunoglobulin

The change resulted in a $546,000 reduction in drug spending over a one-year period, Dr. Norman said. But she stressed that the savings would not have accrued without staff training that helped make the switch a success. “The operating room [OR] staff was educated on preparing alemtuzumab and administering IV push in the OR immediately before surgery,” she explained. “This required additional training because the hazardous medication had not been previously handled by the OR.”

Another high-impact move was the decision to purchase thrombin in 5,000-unit vials, rather than 20,000-unit vials. Dr. Norman said significant amounts of unused thrombin in the 20,000-unit vials were being regularly discarded before the change. The switch to smaller vials reduced this waste as well as $170,000 of drug spending over the one-year period, Dr. Norman reported.

Several other initiatives helped the 632-bed hospital’s pharmacy shave $1,302,774 off its drug spending over the one-year period. For example, the hospital switched from carbapenem to meropenem (Merrem, AstraZeneca) for certain infectious disease indications. “Although carbapenem is available as a generic, because of contracts with our [group purchasing organization], we continued to purchase the branded product at a lower cost,” Dr. Norman said.

Re-Education Needed

Other initiatives included re-educating physicians on the proper indications for use and dosing of IV immunoglobulin, expanding their antimicrobial stewardship program and targeting the efficient use of inhaled anesthetics. On the latter program, “we worked with Anesthesia on a ‘low-flow’ protocol and standardized the specific anesthetic gas used for most procedures done in our ORs.”

Pharmacies considering revamping their own drug purchasing programs should gradually roll out initiatives, starting with those that have a high impact but require the least amount of effort, Dr. Norman recommended.

“For those initiatives that do require practice changes, identifying a physician to champion the change makes the transition much smoother,” she advised.

Dr. Norman reported no conflicts of interest. She presented the data at the 2013 Midyear Clinical Meeting of the American Society of Health-System Pharmacists.