药品价格上涨仍然是围绕管理和降低云顶集团40011官网成本的全国性对话中的一个主要话题. 就像病人可能会发现自己难以负担急需的药物一样, 医疗保健领导者必须经常做出艰难的操作决策,以吸收或减轻其组织内的药品价格上涨.
While price increases largely remain within the control of drug makers, 云顶集团40011官网正在采用几种方法来处理与这些费用上升有关的负担和影响.
Approach One: Introduce Alternative Therapies
对于云顶集团40011官网和患者而言,药品价格上涨都可能造成实质性的负面影响. A University of Chicago report 由美国医院协会委托进行的一项调查发现,药品价格的变化明显超过了医疗保险支付率的更新, 2015年至2017年,每次入院的平均药物支出增长了近19%. Of the executives surveyed, 三分之二的人表示,这些变化对业务预算产生了中等或严重的影响. In order to offset expensive pharmaceutical costs, health system leaders are forced to reduce costs elsewhere, often in the form of staffing reductions or delays in replacing equipment.
这些挑战促使医院领导在可行的情况下寻求成本更低的替代药物,以帮助降低成本. The case studies below provide examples of alternatives for high-cost, commonly purchased drugs, 哪些有可能在不影响临床结果的情况下为医院节省大量资金.
Example One: Clevidipine as an Alternative for Sodium Nitroprusside
Known as the “hyperinflation drug,” sodium nitroprusside, despite its generic status, increased its wholesale price to as high as $900 per vial from 2013 to 2017. As a result, 一些医院开始研究治疗心脏手术患者围手术期高血压的其他治疗等效药物. A team of pharmacy staff, cardiac surgeons, anesthesiologists, and intensivists at Englewood Hospital, 这是新泽西州一家拥有520张床位的社区教学医院,每年进行300多例心脏手术, 确定了克利夫地平作为一种可接受的治疗选择并且能够达到大约300美元,这主要是因为按每瓶计算,克利夫地平的采购成本不到硝普钠的10%. Similarly, Cleveland Clinic achieved savings of over $8 million 通过调整药物订购选择和从硝普塞切换到治疗替代硝酸甘油,没有任何主要的患者安全或临床结果问题.
Example Two: Dobutamine as an Alternative for Isoproterenol
The cardiac drug isoproterenol’s price per milligram skyrocketed from $26.20 to $1,790.11 over a three-year period. 而克利夫兰诊所的云顶集团40011官网无法在电生理测试中找到可接受的异丙肾上腺素替代品, 他们确实开始使用多巴酚丁胺作为子宫肌瘤切除术患者术中检测异丙肾上腺素的替代品. In doing so, the organization realized over $580,000 in annual cost savings. Similarly, the cardiovascular service line at Atrium Health’s Sanger Heart & Vascular Institute generated initial costs savings to the tune of $380,000 by substituting dobutamine for isoproterenol in ablations, 经电生理云顶集团40011官网评估,诊断表现无变化.
Example Three: Ziextenzo and Udenyca as Alternatives for Neulasta
The list price of Neulasta, a biologic used to treat neutropenia in chemotherapy patients, 自2002年获得FDA批准以来增长了近两倍,现在代表了 a $4 billion annual cost burden in the United States. 诺华公司最近发布了一种生物仿制药Ziextenzo,定价为1000美元 37% discount to Neulasta. Another biosimilar, Udenyca, has been formulated and approved by the FDA with cost reform in mind. 从2009年到2018年,乌登尼卡的消费者价格指数仅上涨了27%, compared to Neulasta’s 132% growth over the same time period. 癌症治疗的费用对患者和提供者来说是一项重大负担, 这些新的替代方案可能代表着成本更低的治疗选择,可能对患者和整个医疗保健行业产生积极影响.
Approach Two: Implement Pharmacy- and IT-Focused Strategies
In addition to introducing alternative drug therapies, 供应商可以利用几种以运营为中心的方法来提高效率并节省成本.
Collaborate with pharmacists. 医疗保健组织可以通过创建循证处方和药剂师作为临床团队成员的更深入参与,帮助确保患者获得高价值的药物选择. 临床药剂师可以向医疗云顶集团提供者传授更便宜但同样有效的治疗方案, 可能会启动关于替代疗法或新方案开发的对话. 药剂师-云顶集团40011官网合作的其他重要成果可能包括减少处方的变化,建立某些药物的使用标准和在各种临床情况下的药物方案, 这反过来又有助于控制与个人处方偏好相关的可变成本. Moreover, 在电子健康记录(EHR)中使用控制机制有助于降低成本和减少非处方处方做法.
Implement real-time benefit tools (RTBTs). 提供者通常只有有限或不准确的药品费用信息来帮助他们作出与药品有关的决定. 新的RTBTs在开处方时为提供者提供成本透明度和临床决策支持. For example, RxRevu 是否有这样一种工具可以集成到Epic和Cerner的电子病历系统中,为处方云顶集团40011官网提供成本数据, evidence-based alternatives, prior authorizations, and patient copay information in real time. 这种rtbt经常导致选择成本较低的药物作为首选药物.
Improve inventory management. Minimum and maximum stocking levels, reorder points, 重新订购的数量应建立并在例行计划中进行审查,并在必要时进行修订, especially for high- and medium-cost products. One North Carolina cancer hospital was able to reduce drug waste costs 94% from FY 2011 to FY 2018 through the implementation of a drug vial optimization strategy within its infusion and inpatient pharmacy. As highlighted by this example, 减少静脉注射药物浪费和确保适当的库存管理都是减少不必要的药品支出的有效方法. Additional opportunities include:
- Developing an IV-to-oral switch program.
- Limiting batch sizes.
- Reducing the time between preparation of IV doses and actual administration.
Moreover, by tracking and auditing IV mixture waste, 医院领导层可以确定常见的情况,并制定必要的解决方案来解决这些问题.
希望减轻药品成本上升对医疗系统运营资金的影响? Contact ECG’s Performance Transformation team to continue the conversation.
Published July 23, 2020