Formulary Management Case Study
Neil Medical Group interventions produce an average of $20,000 in annual cost savings.
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Long-term care facilities often care for medically-complex residents who require multiple drug therapies. These medications may improve residents’ quality of life, but the financial impact of the medication regimen can be significant for the long-term care facility. A recent study published in the Journal of the American Medical Association found that list prices for over 600 brand name drugs increased 159% while net prices increased 60% over the course of a decade.
A long-term care facility must ensure that its pharmacy’s drug prices are comparable to other providers. Unfortunately, drug prices are increasing more rapidly than either the rate of inflation or the rate of reimbursement to facilities. Simply choosing a pharmacy with competitive prices is not enough. Your pharmacy partner must have the clinical skills and operational systems necessary to customize a cost-containment plan for your community.
Hernandez I, San-Juan-Rodriguez A, Good CB, Gellad WF. Changes in List Prices, Net Prices, and Discounts for Branded Drugs in the US, 2007-2018. JAMA. 2020 Mar 3;323(9):854-862. doi: 10.1001/jama.2020.1012. PMID: 32125403; PMCID: PMC7054846.
Neil Medical Group utilizes best practices to reduce the long-term care facility’s financial burden including:
THERAPEUTIC INTERCHANGE PROGRAM
After a prescriber adopts the medication formulary Neil Medical Group will automatically substitute an equally effective, lower priced formulary drug when a non-formulary drug is prescribed.
THE NMG DIFFERENCE
Many long-term care pharmacies require an “all or nothing” approach to the pharmacy formulary. Neil Medical Group honors each prescriber’s preference to accept some or all of the pharmacy formulary. Recognizing that a one size fits all approach doesn’t work in LTC, Neil Medical Group further customizes the formulary to address cost centers based on prescribing patterns from referring hospitals.
A Neil Medical Group clinical pharmacist is available to review new orders for Medicare A/Managed Care residents. The clinical pharmacist recommends medication discontinuation, consolidation, or substitution of drugs not covered by the formulary agreement.
CLINICAL PHARMACIST REVIEW
THE NMG DIFFERENCE
Many long-term care pharmacies only intervene when the medication is identified in the pharmacy formulary. Neil Medical Group’s expert pharmacists also make recommendations for cost containment changes for less common medications that may not be addressed by the formulary. These recommendations are made promptly and can be communicated via encrypted e-mail, fax, or other methods allowing the facility to quickly implement recommendations to reduce cost.
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ANALYSIS & REPORTING OF COST-CONTAINMENT EFFORTS
During Quality Assurance and Performance Improvement (QAPI) team meetings the Neil Medical Group consultant pharmacist will review medication cost centers with the QAPI team.
THE NMG DIFFERENCE
Ongoing communication is the key to an effective medication cost-containment program. Many long-term care pharmacy providers simply claim to provide the lowest pricing or offer a standardized formulary agreement to all clients. Neil Medical Group pharmacists work closely with the community’s nursing and medical team members to identify facility-specific strategies to avoid high-cost medications.
Neil Medical Group and its partner facilities collaborate to contain medication costs while providing clinically appropriate drug therapy for residents. Our interventions produce an average of $20,000 in annual cost savings (in addition to the savings provided by a standard formulary approach) for a mid-sized high acuity skilled nursing facility.