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This paper describes a potential strategy for implementing a Drug Utilization Review (DUR) program aimed at reducing hospital drug expenditures. The importance of this type of program is underscored by the spiraling rise in health care expenditures and the influence of a new drug technology on this rise. The program described here consists of a utilization review program for high cost drugs for which a lower cost alternative exists. An initial retrospective usage and cost analysis must be undertaken to identify those drugs which should be reviewed initially. As the DUR program progresses, additional drugs can be added to the review program. Once the drugs to be reviewed are identified, the first step is to develop usage criteria. This can be accomplished through a review of the literature and consultation with medical and other specialists. Appropriate medical administrative staff approval and endorsement of the criteria should be obtained utilizing various committee structures and other input. The pharmacy staff must also be inserviced on the approved drug usage criteria. After the criteria are finalized, staff pharmacists will contact a DUR pharmacist daily upon receipt of any physician orders for the review drugs. This pharmacist will then compare the prescribed drug use to the approved criteria and contact the prescriber when the usage appears questionable. A lower cost therapy will then be recommended when appropriate. In order to assess the impact of this intervention strategy on drug expenditures, the cost of the initially prescribed therapies must be compared to the recommended therapies. Data should also be obtained on overall drug usage and expenditures to detect shifts in therapy and drug costs. The success or failure of this concurrent DUR program will be highly dependent upon a team approach and cooperation. A program of this type could have a significant impact on hospital drug expenditures in those hospitals where it can be successfully implemented. |
