The High-Cost Drug Guidelines Solution
, (for bundles of 5 individual drug guidelines) allows you to select from the list available guidelines. This Solution, developed by Partners HealthCare, achieves control of pharmaceutical expenditures across a hospital or health system and streamlines the criteria for drug use system-wide.
Each Guideline consists of Clinical Expert and Pharmacy & Therapeutics committee input from academic and community hospitals on an 8- to 15-page PDF document, which includes:
- An abstract
+ Detailed criteria for drug use
+ Evidence-based clinical and economic review
- One hour consultative call or webinar with Solution champion
- Guideline Updates for 12 months
Extended Updates also available
Industry research has shown that implementing guidelines before or at the time a new drug is available is highly recommended to maximize cost-avoidance opportunities.
Drugs Guidelines currently available include:
Ceftaroline, Denosumab: Prevention of Skeletal-Related Events, Doripenem, Dronedarone, Intravenous Iron Products: Focus of Ferumoxytol, Methylnaltrexone in Opioid-Induced Bowel Dysfunction, Regadenoson, Stress Ulcer Prophylaxis, Telavancin
Below you will find a series of questions and answers that will guide you through the objectives, implementation, outcomes and lessons of Partners Healthcare's High-Cost Drugs Guidelines Solution.
The Partners High-Cost Drug Guidelines Solution manages the introduction of new high-cost medications and existing medications by streamlining the development and implementation of system-wide prescribing guidelines. In addition, the High-Cost Drug Guidelines Solution helps identify and coordinate the implementation of cost-saving opportunities. At Partners, this Solution resulted in cost savings for existing drugs estimated at $3.7 million and an $800,000 cost avoidance for new drugs in a single fiscal year.
The High-Cost Drug Guidelines Solution developed by Partners HealthCare offers an independent review of evidence, guideline approval by pharmacy and therapeutics committees and consensus on use by leading clinical experts.
How are the components of High-Cost Drugs Guidelines Solution used?
The High-Cost Drugs Guidelines Solution forecasts and manages the introduction of new high-cost medications and existing medications by streamlining the development and implementation of system-wide prescribing guidelines. The Solution consists of drug-specific guidelines which include criteria for use plus a review of clinical and economic evidence.
What makes this Solution desirable?
- Independent Review of Evidence
- Consensus on Use by Leading Clinical Experts
- Approval by Pharmacy & Therapeutics Committees
How was the Solution developed?
Partners Healthcare's Center for Drug Policy was established in August 2007 at the recommendation of the system-level Pharmacy Cost Management Committee, to provide the analytical resources to control the rate of growth of pharmaceutical expenditures across the system of hospitals.
The guideline development process occurred in two phases. While the Center for Drug Policy performed the majority of work in the guideline development process, a working group of pharmacy leadership and clinical experts from each hospital played an integral role in providing their expertise and comments. In phase I, the Center for Drug Policy developed an evidence-based clinical and economic review of the drug. The guideline includes a recommendation for formulary status: formulary non-restricted; formulary restricted; non-formulary but available on a case-by-case basis; and non-formulary, not available. Following a request for formulary addition, the guideline development process entered Phase II. The Partners Center for Drug Policy recruited at least one expert from each hospital where the guideline is relevant. Once the experts reached consensus on clinical content – a process which can require multiple iterations of review, in-person discussion, and conference calls – the guideline was presented at Pharmacy & Therapeutic committees where a formulary request had been received. Comments from the Committees may have been incorporated into the guideline, with approval from clinical experts.
Were there any organizational considerations?
Implementation of the guidelines is performed at an individual hospital level, facilitated by the local pharmacy department and clinical experts who participated in guideline development. Tools for implementation have included targeted email communications, development of order sets, changes in the computer physician order entry system, and education. In addition, the Center for Drug Policy hosted a continuing education program for pharmacists that covered the content of selected guidelines with presentations delivered by clinical experts involved in guideline development.
Which Benchmark/Pertinent Metrics are recommended to use with this Solution?
- Drug Expenditures
- Medication Use Evaluation to Assess Guideline Adherence
- Benchmarking drug use at hospitals against similar hospitals nationwide using a Clinical Data Base/Resource Manager, such as the University HealthSystem Consortium.
Any advice to other hospitals and health systems in preparation to launching this Solution?
- Verify agreement from local clinical experts and Pharmacy and Therapeutics Committees.
- Secure ability to implement guideline locally via development of order sets, changes in the computer physician order entry system, and/or education.
What is the best way to measure and sustain Solution success?
- Monitoring drug expenditures at least quarterly
- Assess guideline adherence as needed
- Benchmark use with similar hospitals nationwide