Student-run low-income family medicine clinic: controlling costs while providing comprehensive medication management

To evaluate the impact of implementing cost-control measures on drug use and financial performance of a student-run safety net clinic and to assess the effect of the measures on patient care.

Medication histories and patient information were obtained from the University of Nebraska Medical Center's student-run safety net clinics' (SHARING and GOODLIFE) computer databases and internal medication cost documents for all patients treated with medications at the clinics from April 1, 2006, through March 31, 2008. Main outcome measures were cost, use, and source of all medications and the resultant financial savings between the pre- and post-periods.

200 patients were treated with medications during the 2-year period (164 patients before April 1, 2007, and 137 after). A majority of clinic patients were treated for chronic conditions, including 62% for hypertension, 54% for diabetes, 46% for dyslipidemia, and 26% for depression. The average monthly cost to the clinics for medications decreased from $5,444.87 before April 1, 2007, to $3,714.05 (P = 0.002) after. With these changes, the cost per prescription from any delivery method decreased from $15.28 to $13.02 (P < 0.001) and the average cost per prescription decreased from $27.32 to $20.27 (P < 0.001) after formulary implementation. The number of prescriptions per patient per month was unchanged.

Medication management with a closed formulary in a diverse uninsured population reduced expenditures, with the largest savings coming from using prescriptions more efficiently while also providing a similar level of medical care.