When physicians and administrators at Christiana Care Health System in Wilmington, Del., saw how many newly approved specialty and orphan drugs had price tags in the tens of thousands of dollars, they decided in 2011 to form a committee that uses a 20-point scoring system to decide if a drug should be listed on the system's formulary.
All drugs that cost more than $10,000 for a course of treatment—about 5% of the medications dispensed through the system's inpatient and outpatient settings—are now assessed by the medication value subcommittee, which includes 12 physicians, administrators, nurses, pharmacists and finance executives.
The subcommittee looks at a wide range of factors, including the drug's efficacy and risk and the financial impact on the patient and the healthcare system. A group of five community leaders, including a local high school teacher, a pastor and a community activist, also evaluate factors such as a drug's tolerability, cost and safety to provide input on quality-of-life issues. Of 27 drugs assessed by the subcommittee, 17 ended up on the system's formulary list.
The panel's scoring system assesses both inpatient drugs that are reimbursed as part of a diagnosis-related group and outpatient drugs. About one-tenth of Christiana Care's supply costs are generated by drug costs, which are going up about 7% each year, said Teresa Corbo, Christiana Care's vice president of pharmacy services.
“It sends a message to drug developers that you have to prove that your drug is really valuable to patients,” said Dr. Mitchell Saltzberg, a cardiologist who chairs the formulary committee. “We just don't approve everything.”