Economic Outcomes Associated with Safety Interventions by a Pharmacist-Adjudicated Prior Authorization Consult Service

Abstract

BACKGROUND: The establishment of a formulary management system ensures that health care professionals work together in an integrated patient care process to promote clinically sound, safe, and cost-effective medication therapy. Pharmacists have a foundational role within this system. A pharmacist-adjudicated prior authorization drug request (PADR) consult service has the potential to optimize drug therapy by decreasing medication misuse, minimizing adverse drug events (ADEs), and preventing medication errors. OBJECTIVES: To (a) determine cost avoidance associated with pharmacistadjudicated PADR safety interventions within the Durham Veterans Affairs Health Care System and (b) evaluate cost savings associated with pharmacist-adjudicated PADRs not approved due to a safety intervention, evaluate cost avoidance and direct cost savings based on clinical specialty of pharmacist adjudicating PADR, and characterize severity of avoided ADEs. METHODS: Pharmacist-adjudicated PADRs not approved between July 1, 2016, and June 30, 2017, because of safety interventions were retrospectively reviewed. Cost avoidance was determined by multiplying the probability of ADE occurrence in the absence of PADR safety intervention by the estimated cost avoided based on the type of intervention. Direct cost savings was calculated by totaling the cost of requested medications not approved for each PADR and subtracting the cost of recommended alternative therapies and cost of pharmacist PADR review. All potential ADEs avoided were reviewed by a panel of 3 clinical pharmacists to validate ADE classification and ADE probability and severity scores. Descriptive statistics were used for all analyses.RESULTS: Of the 910 PADRs that were not approved during the study period, 96 met inclusion criteria.

The Physician and Administrator-Reported Cost of Drug Utilization Management to Physician Practices: A Cross-Sectional Survey

“…Data show that these techniques can save patients hundreds of dollars each year through generic and therapeutic substitution [ 30 ]. Drug utilization management is also associated with reductions in adverse drug events and improved safety and outcomes for patients [ 31 ].…”

Physician perceptions of drug utilization management: Results of a national survey

“…By encouraging generic and therapeutic substitution, these techniques can save patients hundreds of dollars each year [ 18 ]. Studies have also shown that it can reduce the number of adverse drug events and improve safety and outcomes for patients [ 19 ]. However, although drug utilization management is designed to ensure patient safety and the use of cost-effective medicines, it does impact physician practices.…”

Financial impact of medication reviews by clinical pharmacists to reduce in-hospital adverse drug events: a return-on-investment analysis

“…Studies have also assessed the cost savings association with using less expensive drugs, promoting generic or biosimilar drugs, substituting parenteral drugs for oral forms, optimizing treatment duration, and enhancing medication management [ 20 – 29 ]. Additionally, studies measured cost avoidance through pharmacist-led interventions, such as patient-tailored activities to improve adherence or optimize drug therapy on wards [ 9 , 20 – 23 , 30 – 42 ].…”