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Experience with a two-tiered therapeutic interchange policy.

¹Department of Pharmacy, University Hospital, Boston University Medical Center, MA 02118.

American Journal of Hospital Pharmacy

|September 1, 1989

Summary

This study shows a two-tiered therapeutic interchange policy can cut drug costs. Pharmacists can switch some drugs automatically, while others require prescriber approval, improving cost-effectiveness and physician acceptance.

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Area of Science:

Health Economics
Pharmacology
Hospital Pharmacy Management

Background:

University hospitals implement formulary policies for therapeutic interchange to manage drug costs.
A two-tiered approach allows routine interchanges for some drugs and requires prescriber contact for others.
Class representatives are designated for non-formulary drugs, with pharmacy able to change them based on price.

Purpose of the Study:

To evaluate the impact of a two-tiered therapeutic interchange policy on drug costs and prescribing patterns for histamine H2-receptor antagonists.
To assess the feasibility and acceptance of therapeutic interchange by physicians and pharmacists.

Main Methods:

Selection of a class representative for injectable histamine H2-receptor antagonists, considering past experiences with therapeutic equivalence.
Implementation steps included cost analysis, literature review, expert consultation, committee presentation, bidding, and staff education.
Analysis of prescribing data for both injectable and oral H2 antagonists before and after policy implementation.

Main Results:

Prescribing shifted from ranitidine to cimetidine as the designated class representative for injectable H2 antagonists (84% to 90%).
Similar shifts were observed for oral H2 antagonists.
Total hospital costs for H2 antagonists decreased by 8.4% within one year.

Conclusions:

A two-tiered therapeutic interchange policy effectively reduces drug costs.
This approach expands the range of drugs considered therapeutic equivalents acceptably to physicians and pharmacists.
The policy demonstrates a successful strategy for optimizing formulary management and cost savings.

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