A commentary on high-cost drugs

We are at the threshold of a time when new, ultra-expensive drugs will be brought to market. At present only a few agents have been successfully marketed. Their extraordinary acquisition costs will cause the budgets of pharmacy departments to expand as these new drugs are approved for use by pharmacy and therapeutics committees. These new agents should not be approved unless the department of pharmacy has ensured that their use and expense will be adequately controlled through inventory control procedures, protocol management, and drug-use evaluation, and that this control will be coupled with the education of prescribers and, perhaps more important, hospital administrators and financial managers. Further, there are costs associated with the new agents that are beyond the acquisition cost. These hidden costs include protocol management, drug-use evaluation, efforts made to secure reimbursement, and educational activities undertaken to ensure an understanding of the drug's therapeutic and financial implications. In addition to understanding the costs, similar efforts must be made to understand the cost offsets that go beyond savings in nursing or pharmacy time or supplies. These cost offsets may include early discharge of inpatients or analyses of lifetime medical costs per patient. To be sure, the ultra-expensive drugs will cause us to change the way we analyze costs and cost offsets.