VHA consultants strive to improve pharmacy position in member hospitals

Managing high-cost, high-risk drugs always will be a challenge

A national health cooperative is using a team of in-house consultants to help increase the efficiency of pharmacy departments in member hospitals.

The program has resulted in a typical 10-to-1 return on investment (3-to-1 guaranteed) for the hospitals that use the service — by getting member hospitals more involved in clinical pharmacy and improving the position of the pharmacy departments.

VHA, based in Irving, TX, presently has more than 1,400 hospital members. The consulting team has helped at least 100 of the hospitals so far, often working four or five engagements at one time.

The pharmacy consultants look not only at cost, but at quality and at getting the hospital pharmacy involved in patient-focused care, says Bruce Weiner, RPh, MS, FASHP, a senior director who oversees VHA’s pharmacy consulting services.

Weiner has been working with VHA for four years to form the pharmacy consultant team. He has hired a former director of pharmacy who specializes in operations; he also has clinical pharmacists on board who have worked in hospital pharmacy for more than 10 or 20 years.

The team approaches the pharmacy department and director as partners, Weiner says. The director is consulted before and throughout the evaluation process. "We don’t want to run the pharmacy. We want to work with them to make their pharmacy better."

Although the pharmacy team offers a variety of consulting services, about 75% of the requests involve evaluating the hospital’s formulary. "Sometimes, the director of pharmacy will have a new clinical pharmacy coordinator, and wants to give that person a road map to focus on," Weiner says. The consultants then look at the whole formulary and set the goals for the clinical coordinator.

The entire process, from initial on-site hospital visits to the presentation of recommendations, usually takes about 10 weeks, more if the hospitals need help implementing the findings. Some of the service can be duplicated across hospitals, but the team also has to tailor its approach to the different specialties each facility offers.

Standardizing the drugs

One important service regarding the formulary is to help hospitals plan and implement standardization and utilization programs for their most commonly used drugs. The consultants found that hospitals often were purchasing multiple drugs that were similar in chemical composition and had the same clinical purpose.

The team also helps member hospitals benchmark their pharmacy purchasing patterns with other VHA members and examine drug costs in hospital departments that have high drug usage, such as intensive care units, the VHA says.

Weiner estimates that the consultant team can help hospitals save between 10% and 30% on the drugs they buy most often.

Here are the following nine drug product categories that VHA says commonly represent more than 60% of most hospital pharmacy budgets:

  • Glycoprotein IIb/IIIa inhibitors
  • 5HT3 receptor antagonists
  • Low molecular weight heparins
  • Anticoagulants
  • Antibiotics
  • Antifungals
  • Oncolytics
  • Oncology adjuvants
  • Critical care medications

The process of evaluating a formulary never ends, Weiner says. "Although we identify opportunities to reduce costs, new drugs are being introduced every year that further increase the pharmacy budget and as such, serve as new challenges."

There are always the "low-hanging fruit" that go from trade name to generic and result in significant cost savings, he continues. However, then there are the drugs such as nesiritide (Natrecor) that has expensive reimbursement issues that may result in reduced payments to hospitals.

"Pharmacists need to be creative in ways to assure appropriate utilization of that very expensive drug," he says. "It’s important to state that although we’ve identified specific areas to reduce costs, in the future the challenge will be to find ways to reduce costs of those new high-cost, high-technology drugs."