420/330

My summer has boiled down to two courses, 420 and 330. (Makes me wish I actually paid attention in those classes, j/k...) Working with Nathan is like a whirlwind of everything I learned in the last year condensed into 9-10 hours a day. My first major assignment combined all we learned in 420 and 330, John Clark would be so proud Dean Welage not so much.

Johns Hopkins owns their own Managed Care Organization. This hospital also services a disproportionate share of low-income and patients without insurance. Which means the Hopkins Medical Center is authorized to purchase drugs under the 340B pricing guidelines. The hospital is also involved with a high level of charity care in which the hospital takes on all costs of treating a patient without coverage or assists patients with their medical bills. This all seems simple but there is a lot more to it that I don't care to explain at the moment, by the end of my first day I think I had 340B somewhere in all of my sentences. Moving on, the managed care organization wanted to increase their charity work for the Fiscal Year 2011 (which for Hopkins begins in July 2010) and therefore needed to decrease their spending on drugs. Here is where I come in...

In order to save money on prescription drugs I was tasked with reviewing their drug formulary and looking for cost saving options. The only bit of advice I was given by Nathan was to review five classes of drugs: PPI, Statins, Diabetes, ARB's, and Pain Management. The first thing I do is identify each drug for each class, for each class there was at least 6 meds regularly used in their formulary. Next I had to find the price per pill for each drug under the 340B pricing. A side note, 340B pricing is a minimum of 49% discount some brand names were so cheap I couldn't believe it, $0.01 for a bottle of 100 Prevacid 30mg??? So now I have multiple drugs under each category of varying strengths and I have their price per pill under 340B purchasing. Here's where the 330 comes into play, now I need to research the comparative efficacy of each of the drugs in the class. This was a serious headache and I found myself channeling all of my EBM knowledge into this tasks, I had to not only research the task on sites like PubMed, Micromedex and UpToDate, but also appraise the articles for their validity.

Long story short for the five classes: PPI to Omeprazole, Statin's to Simvastatin/Lipitor 80mg, Diabetes to Actos, ARB's to Cozaar, and Pain Management was inconclusive. With the following changes I then had to apply my formulary adjustments to the total spend of the pharmacy for the first three quarters, then annualized for a full year of spending. With this I could show the managed care organization how much money they would have saved this year if they used my proposed formulary. The formulary adjustment equated an 6.5% savings per year which doesn't seem like much, but when compared to an annual spend of $200k in drugs, the costs savings add up.

I then prepared a presentation of my project to be presented today for the Johns Hopkins Charity Committee. The proposed formulary adjustment will be discussed and voted on and could see integration for the second quarter of the 2011 fiscal year. In the last three weeks I have accomplished something of significance that I could not have prior to my first year in pharmacy school. The funny thing is that this is one of 6 projects that I have taken on in the last 3 weeks with more to come. I plan to keep showing the other interns here why they call us the "Leaders and the Best"