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E-DRUG: Useful references

Dear E-Druggers:

I recently posted a request for help in finding information about reference
based pricing.  In response Leesette Turner from South Africa sent along a
large number of abstracts that she had retrieved from a MEDLINE search.
These are the ones, not necessarily to do with reference based pricing,
that I think may be most interesting to e druggers.

Joel Lexchin
________________________________________________________________________________
Author
  Curtiss, FR.
Institution
  Reimbursement and Res., HPI Health Care Serv. Inc., 10960 Wilshire Blvd.,
Los Angeles, CA 90024.
Title
  Pharmacy management strategies for responding to hospital reimbursement
changes.
Source
  American Journal of Hospital Pharmacy.  40(Sep): p 1489-1492.  1983.
Abstract
  Pharmacy management strategies for responding to hospital reimbursement
changes are described.  On the assumption that the Medicare prospective
payment system and other fixed rate reimbursement systems will force
hospital pharmacists to reduce
their operating expenses, several methods of reducing drug use and drug
costs, rather than payroll costs, are described. These methods include:
(1) reduced price per unit purchased, (2) increased use of bid prices, (3)
decrease in the size and dollar value of drug inventory, (4) drug formulary
restrictions, (5) prescribing sanctions, (6) physician education on the
relative costs of alternate therapies, (7) drug use review, (8) use review
applied to drug serum assays, (9) controlled access of drug industry
representatives to hospital physicians, and (10) dispensing and drug
distribution efficiencies.
It is suggested that physicians resistance to pharmacist intervention in
drug prescribing and drug use review should be anticipated; however,
pharmacists should expect the support of hospital administrators in efforts
to control drug use. (4 refs.) (Modified author abstract)


Author
  Kurtzman, M.  Heltzer, N.  Counts, R.
Institution
  School of Pharmacy, Univ. of New Mexico, Taos, New Mexico 87571.
Title
  Model for the development of rural pharmaceutical services.
Source
  American Journal of Hospital Pharmacy.  34(Feb): p 163-166.  1977.
Abstract
  The Central Pharmacy of Presbyterian Medical Services (PMS), a nonprofit
corporation operating a rural comprehensive health care system in New
Mexico, is discussed.  PMS Central Pharmacy provides pharmaceutical
services to a 34-bed acute care hospital and 24 widely scattered clinics
for ambulatory patients. The financial base, administration, development of
a formulary, purchasing,
prepackaging of medications, and consulting services of the PMS Central
Pharmacy are described. Central Pharmacy acts as a drug wholesaler for PMS;
the gross margin between acquisition cost and average wholesale price
covers 90% of the cost of the pharmacy operation. In addition, the clinics
pay a fee and travel expenses for pharmacist consultation. Seven clinics
employ drug technicians who are trained and supervised by Central Pharmacy.
It is concluded that this system may serve as a model for the development
of pharmaceutical services in other rural areas or in poverty-stricken
urban areas. (5 refs.) (Author abstract)


Author
  McAllister, JC.
Institution
  Dept. of Pharm., Duke Univ. Med. Ctr., Box 3089, Durham, NC 27710.
Title
  Bid solicitation and contract negotiation.
Source
  American Journal of Hospital Pharmacy.  41(Jun): p 1164-1172.  1984.
Abstract
  The process of soliciting bid prices for drug products and of negotiating
contracts with pharmaceutical vendors is discussed.  The primary purpose of
bid purchasing is to obtain drugs at the lowest
price and to have these prices remain fixed for a predetermined period of
time. A successful bid purchasing process depends on the institution's
implementation of a formulary brand standardization policy, prior
identification of acceptable vendors and drug products, and establishment
of drug evaluation criteria. Manual and
computerized systems for organizing bid request data are described.
Bid evaluations should maintain the confidentiality of bid and contract
prices. Selection of winning bids is based on lowest price or, in cases
where prices are identical, on selected vendor characteristics or services.
Negotiation of unacceptable bid prices should be conducted with a thorough
knowledge of the needs and goals of the institution and the vendor.
Procedures for establishing contracts and the timing of various  phases of
the bid process are discussed.
It was concluded that an optimal bid purchasing system is achieved only
when the system is carefully planned and designed and when each prospective
vendor is given an equal opportunity to establish a
contractual relationship with the institution. (11 refs.) (Abstract by
Zerihun Abate.)


Author
  Harper, JM.
Institution
  Munroe Regional Medical Center, 131 SW 15th Street, Ocala, FL 32670, USA.
Title
  Pharmacy directed intervention of H2 antagonist usage.
Source
  ASHP Midyear Clinical Meeting.  25(Dec): p P-284D.  1990.
Abstract
  Contractual agreements between the vendor and the Voluntary Hospital
Association (of which this hospital is a member) offered special pricing
for cimetidine if it was promoted by the hospital as the preferred agent.
At that time, the H2 antagonist usage was cimetidine 20%, and ranitidine
80%. Preliminary analysis indicated that the hospital could save
approximately $18,000 per year by developing a formulary that specified
cimetidine as the agent of choice. The pharmacy reviewed and compared the
safety and pharmacokinetic profiles of both drugs and recommended
cimetidine as the preferred agent.  Staff limitations mandated that a
simple implementation method be found and used. A pharmacy intervention
form, printed on a removable fluorescent label, was developed. These labels
were prepared by pharmacists as each new ranitidine order was entered on
the patient's medication profile.  These forms were affixed to the front of
the patient's chart by pharmacy technicians as they delivered the
medication cassettes to the nursing unit. The label contained a
recommendation from the Pharmacy and Therapeutics Committee that cimetidine
be used instead of ranitidine because of efficacy and cost parameters. The
pharmacy also drastically reduced the patient charge for cimetidine and
notified all physicians of the significant difference in price.  A dramatic
shift in prescribing patterns occurred within two months, from  20%
cimetidine and 80% ranitidine to 60% cimetidine and 40% ranitidine.  Chart
review of 52 patients demonstrated patients in the cimetidine-phenytoin
group did not develop cimetidine induced toxicities.  The H2 antagonist
formulary was effectively implemented with a simple intervention form. This
formulary change has saved the hospital $18,000
during the first year. (Author abstract)

Author
  Dickson, M.
Institution
  Coll. of Pharm., Univ. of South Carolina, Columbia, SC, USA.
Title
  Pricing of pharmaceuticals: international comparison.
Source
  Clinical Therapeutics.  14(Jul-Aug): p 604-610.  1992.
Abstract
  Types of policies and regulations used for pricing prescriptions in
various countries are discussed, including product price control,
reference pricing, profit control, and no control. (7 refs.) (Abstract by
Ellen Katz Neumann.)

-----
Joel Lexchin MD
121 Walmer Rd.
Toronto, Ontario
CANADA M5R 2X8
Phone:  (416)-964-7186
Fax:  (416)-923-9515

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