Impact of a pharmacistimplemented, endocrinologist-guided, testosterone formulary restriction on reducing inappropriate prescribing of testosterone

Abstract

Objective: The purpose of this study is to evaluate the effectiveness of a testosterone restriction protocol in a large integrated health system. Method(s): A medication use evaluation, performed on a random sample of 70 patients using testosterone, identified inappropriate prescribing and monitoring. This evaluation was presented to the facility's Pharmacy and Therapeutics Committee, which recommended that testosterone be restricted. Restriction criteria were developed by a clinical pharmacy specialist based on: The Endo- crine Society's Testosterone Therapy in Adult Men With Androgen Deficiency Syndromes clinical practice guidelines; testosterone product labeling; restriction criteria from other regions of the health system; and expert guidance from a local endocrinologist physician. Patients are phased in to the restriction as their current prescription runs out of refills. Patients who have had sufficient baseline evaluation are allowed to remain on testosterone as long as they do not have contraindications to therapy. Patients without sufficient baseline evaluation are required to stop testosterone for at least 3 months before being considered for re-evaluation. To order testosterone, prescribers are required to complete an electronic consult which describes the restriction criteria and prescribing considerations. This alerts the clinical pharmacy specialist to review the request and the patient's chart. Result(s): Since implementation, the use of testosterone has decreased from 3.87% (n = 1,017) of all patients at baseline to 1.06% (n = 280) of patients. Prescribers have requested testosterone for 240 patients. Results of the clinical pharmacist review of the 240 requests are: approved 81 (33.8%); denied 110 (45.8%); waiting for records 11 (4.6%); referred to endocrinology 5 (2.0%); and pending review 33 (13.8%). Full analysis comparing pre- and post-restriction characteristics (diagnostic, safety, and monitoring) is forthcoming.