1. stream (3b)Topic: (improving management of high cost drugs)One Strike Only Presenter: Professor Michael DooleyHospital: Bayside Health 9-10 May 2006Melbourne

2. KEY PROBLEMS • Cost of new drugs increasing dramatically with many >$3,000 per pt per month. • Usage governed by formal approval process through a Drug & Therapeutics Advisory Committee (DTC). • However, key problems included increasing expenditure relating to: • Multiple “once off” approvals occurring outside the DTC process • Limited audit and review process once drugs approved and initiated • Audit process retrospective consequently not able to influence current prescribing • Evaluation of costs impacts of new drugs unsophisticated

3. INNOVATIONS IMPLEMENTED • “One strike only” process for new high cost drugs that does not enable multiple “once off approvals”. • DTC approvals constrained in duration & patient numbers that also incorporates formalised review of actual clinical outcomes • DTC approval process that includes formal approval by Finance Committee for those >$50,000 p.a • Prospective “live” database review of all high cost drugs approved • Initiation of costing studies for high costs drugs

4. RESULTS • Substantial reduction in expenditure on “once off ” drug approvals (approx 50% ) • High cost drugs now approved by DTC require clinician presentation of actual clinical outcomes at six month point for further approval • Formal clinical costing studies of new high cost drugs underway One example of improved prescribing: liposomal amphoterin usage

5. HOW WE DID IT • Timeframe: 3months from review of existing process to full implementation of new systems • Resources Used: DTC, senior medical & pharmacy management, clinical pharmacists, Drug Information service for independent literature review • Key Success Factors: Change in senior executive management, “fresh eyes”, clinical pharmacists “gate-keeping” prescribing with senior management support

6. LESSONS LEARNT • Instigate a “one strike” high cost drug policy • Engage senior executive support and ownership • Utilise Drug Information Service for independent review of submissions • Approve new drugs for a limited timeframe and make clinicians present actual outcome data for ongoing access for more patients • Understand and analysis drug costs and potential off-sets/revenue • Engage pharmaceutical industry to support costing studies