Strategies for the clinical and financial management of drug utilization

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.