Skip to main content

Strategies for the Clinical and Financial Management of Drug Utilization

  • Chapter
  • First Online:
Utilization Management in the Clinical Laboratory and Other Ancillary Services

Abstract

With the focus in healthcare around improving quality while reducing costs the clinical and economic management around the use of medications in the inpatient and outpatient settings is critical. In September 2014, drug expenditures increased 12.2 % overall, 13.3 % in clinics, and 4.0 % inpatient. Projections for 2015 are expected to increase by 9 %. Therefore, a variety of drug utilization strategies should be implemented across the healthcare sector including more deployment of pharmacists into direct patient care roles, clinical decision support, and electronic order sets. Meanwhile, specialty medications, used to treat diseases, such as rheumatoid arthritis, cystic fibrosis, Crohn’s disease, and cancer, have quickly been infused into the market resulting in strong patient outcomes but high expense and fragmentation of care. Retail and mail-order pharmacy services remain unchanged but home infusion is growing due to lower associated total cost of care. Managed care and government programs continue to evolve with healthcare cost constraints utilizing formulary management, restricted networks, rebate agreements with manufacturers, and prior authorization methodologies.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Schumock GT, Li EC, Suda KJ, et al. National trends in prescription drug expenditures and projections for 2015. Am J Health Syst Pharm. 2015;72:e19–38.

    Article  Google Scholar 

  2. American Academy of Managed Care Pharmacy. AMCP guide to pharmaceutical payment methods. Executive summary. Version 3. http://www.amcp.org/WorkArea/DownloadAsset.aspx?id=16476. Accessed 21 Aug 2015.

  3. American Society of Health-System Pharmacists. ASHP guidelines on the pharmacy and therapeutics committee and formulary system. Am J Health-Syst Pharm. 2008;43:1272–83.

    Google Scholar 

  4. Weant KA, Bowers RC, Reed J, et al. Safety and cost-effectiveness of a clinical protocol implemented to standardize the use of crotalidae polyvalent immune fab antivenom at an academic medical center. Pharmacotherapy. 2012;32:433–40.

    Article  PubMed  Google Scholar 

  5. Food and Drug Administration. Facts about generic drugs. http://www.fda.gov/drugs/resourcesforyou/consumers/buyingusingmedicinesafely/understandinggenericdrugs/ucm167991.htm. Accessed 21 Aug 2015.

  6. Food and Drug Administration. FDA approves first biosimilar product Zarxio. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm436648.htm Accessed 21 Aug 2015.

  7. Giguere A, Legare F, Grimshaw J. Printed educational materials: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2015;3. doi:10.1002/14651858.CD004398.pub3.

  8. Delory T, De Pontfarcy A, Emirian A, et al. Impact of a program combining pre-authorization requirement and post-prescription review of carbapenems: an interrupted time-series analysis. Eur J Clin Microbiol Infect Dis. 2013;32:1599–604.

    Article  CAS  PubMed  Google Scholar 

  9. Sonstein L, Clark C, Seidensticker S, et al. Improving adherence for management of acute exacerbation of chronic obstructive pulmonary disease. Am J Med. 2014;127:1097–104.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Flood KL, Carroll MB, Le CV, et al. Polypharmacy in hospitalized older adult cancer patients: experience from a prospective, observational study of an oncology-acute care for elders unit. Am J Geriatr Pharmacother. 2009;7:151–8.

    Article  PubMed  Google Scholar 

  11. Selvan MS, Sittig DF, Thomas EJ, et al. Improving erythropoietin-stimulating agent administration in a multihospital system through quality improvement initiatives: a pre-post comparison study. J Patient Saf. 2011;7:127–32.

    Article  PubMed  Google Scholar 

  12. Sturm H, AustvollDahlgren A, Aaserud M, et al. Pharmaceutical policies: effects of financial incentives for prescribers. Cochrane Database Syst Rev. 2011;10:CD006731.

    Google Scholar 

  13. O’Neal BC, Couldry RJ, Wilkinson ST, et al. Leveraging drug-utilization and external benchmarking data to drive change in prescribing behaviors. Am J Health Syst Pharm. 2012;69:1916–22.

    Article  PubMed  Google Scholar 

  14. American Pharmacists Association. Specialty pharmacy: a unique and growing industry. 2013. Retrieved from American Pharmacists Association http://www.pharmacist.com/specialty-pharmacy-unique-and-growing-industry.

  15. U.S. Food and Drug Administration. A brief overview of risk evaluation and mitigation strategies. n.d. Retrieved from U. S. Food and Drug Administration: http://www.fda.gov/downloads/AboutFDA/Transparency/Basics/UCM328784.pdf.

  16. Academy of Managed Care Pharmacy. Maintaining the affordability of the prescription drug benefit: how managed care organizations secure price concessions from pharmaceutical manufacturers. n.d. Retrieved from Academy of Managed Care Pharmacy: http://www.amcp.org/WorkArea/DownloadAsset.aspx?id=9299.

  17. National Home Infusion Association. Infusion FAQs. n.d. Retrieved from National Home Infusion Association. http://www.nhia.org/faqs.cfm.

  18. Centers for Medicare and Medicaid Services. Linking quality to payment. n.d. Retrieved from Medicare.gov. https://www.medicare.gov/hospitalcompare/linking-quality-to-payment.html.

  19. U.S. Office of Personnel Management. OPM.gov. n.d. Retrieved from Frequently Asked Questions. https://www.opm.gov/faqs/QA.aspx?fid=fd635746-de0a-4dd7-997d-b5706a0fd8d2&pid=162b86b1-5da8-45dc-ab32-3385f17e3460.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Christopher Fortier .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Fortier, C., Reddy, P., Thompson, N., Pulvemacher, A. (2017). Strategies for the Clinical and Financial Management of Drug Utilization. In: Lewandrowski, K., Sluss, P. (eds) Utilization Management in the Clinical Laboratory and Other Ancillary Services. Springer, Cham. https://doi.org/10.1007/978-3-319-34199-6_25

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-34199-6_25

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-34197-2

  • Online ISBN: 978-3-319-34199-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics