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Why pharmacy, med/surg issues often look alike.facilitate a win-win contracting experience for supply chain management and the vendor.

Physician preference, standardization and monitoring of sales-rep activities are not the exclusive domain of med/surg contracting professionals. Their counterparts in pharmacy are dealing with similar issues. And, just like their med/surg counterparts, pharmacy directors are being challenged to balance their budgets in the face of new, expensive therapies and concerns about patient safety.

A case in point is Deborah Wible, Pharm. D., chief pharmacy officer of Continuum Health Partners, a large IDN in New York City comprising Beth Israel Medical Center, St. Luke’s-Roosevelt Hospital Center, Long Island College Hospital, the New York Eye and Ear Infirmary, and a number of non-acute-care facilities and associated physician-practice sites.

Wible became a pharmacist partly because of a postage stamp. “I was looking for a career in healthcare, and a commemorative pharmacy stamp came out,” she recalls. “A friend said, ‘How about pharmacy?’ That’s how I decided to become a pharmacist.” She received her doctorate in pharmacy from the University of California San Francisco, and completed a residency at the University of California Irvine. Then she moved across the country to Lenox Hill Hospital on Manhattan’s Upper East Side, where she served as clinical pharmacist and assistant director of clinical pharmacy services. In 1990, she joined Beth Israel as director of pharmacy. Over the course of the next 10 years, Continuum took shape, and Wible became corporate director of pharmacy and, more recently, chief pharmacy officer.

Gaining consensus
As Wible looks into Continuum’s future, one of the things that she sees is dollar signs. New treatment protocols for chemotherapy have large price tags associated with them. In addition, drugs for cardiology – one of Continuum’s major product lines – continue to climb in price, as does erythropoietin, a growth factor regulating red blood cell production.

Like many IDNs, Continuum relies on its group purchasing organization – Broadlane – to provide it a portfolio of pharmaceutical contracts. The challenge is to get everyone in the facility to use those contracts.

Continuum has assembled physician thought leaders in several disciplines – e.g., hematology, oncology, anti-infectives, cardiology and critical care – to reach consensus on the pharmaceuticals they believe would be most efficacious in their disciplines. “We have this discussion early on, before we try to implement product standardization,” says Wible. Standardization not only leads to lower prices, but it is an important part of Continuum’s efforts to develop standardized order sets, or treatment guidelines, for different types of patients.

Although the IDN – with help from Broadlane – is always on the lookout for lower-cost drugs, it takes other factors into consideration when choosing which pharmaceuticals to buy. For example, Continuum’s nurses deliver insulin to their diabetic patients through insulin pens or prefilled insulin dosers, rather than vials. “It’s easier to provide accurate dosing for the patient,” she says. “That’s a big safety initiative of ours.”

To be sure, physician preference is an issue, just as it is with medical devices. “There will always be people who have differences of opinion [on efficacy],” says Wible. Doctors must be convinced that lower-cost drugs (for example, first-line antifungals) will be just as efficacious as the incumbent, she says.

At the same time, Wible wants to minimize outside influences on the decision-making process. “We’re trying to figure out how to [encourage] doctors to do full disclosure,” she says. “We don’t want to prohibit them from serving as consultants to – or speakers for – pharmaceutical companies, but we do want them to clearly identify their relationship with a manufacturer when they present information for us to consider.”

Along those lines, Continuum monitors the activities of pharmaceutical sales reps in its facilities, balancing the needs of its physicians with those of the IDN. “Some facilities are talking about excluding or limiting sales reps,” says Wible. But Continuum only asks that reps check in with security first and stay away from patient-care areas. “Reps meet with the doctors and with me,” says Wible. “It’s advantageous for me to know what they’re selling and how they’re promoting it.”

Outside help
Continuum’s philosophy is one of compliance with the GPO portfolio. “If products are on contract through the GPO, then those are the products we are going to buy,” says Wible. Pharmacy monitors purchasing and claims data to see how compliant its physicians are with the contracts. Failure to meet compliance goals could reflect a number of things, says Wible. Perhaps the message hasn’t gotten to the buyers or prescribers, she says. Sometimes supply-related or packaging-related issues impede compliance.

Another key player in helping control the IDN’s pharmaceutical costs is its wholesaler, McKesson Corp. Considerations in selecting a wholesaler include fill rates, ability to deliver in the midst of a disaster, measures taken to ensure that counterfeit drugs are kept out of the system, and electronic ordering system. “The question is, ‘How can they help us with supply chain management?’” says Wible.

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