Managing high cost and biotech drugs: two institutions' perspectives.

A proactive and multidisciplinary approach is used at The University of Texas MD Anderson Cancer Center to forecast the effect of new biotechnology and other high-cost agents prior to their commercial availability. Protocols, practice guidelines, and drug-use policies are developed to promote cost-effective use of these agents. To promote optimal utilization, two pharmacoeconomic strategies are used: cost reduction and drug performance. An economic impact analysis is performed on pending drug protocols, which includes hospital cost, patient billing, and estimates of insurance reimbursement denial risk. The management of biotechnology drug usage at the University of Pittsburgh Medical Center is through the drug advisory program (DAP). DAP is an organized, multidisciplinary program comprising numerous drug usage review functions including drug information, therapeutic evaluation and modification, drug morbidity and surveillance, and an investigational drug service. The objective of DAP is therapeutic efficiency, which has as its key elements efficacy, low toxicity, and low cost. The actual work of DAP takes place via multiple subcommittees and task forces whose recommendations are forwarded to the P & T Committee. These multidisciplinary groups ensure the involvement of the appropriate specialists in therapeutic decisions and, therefore, successful implementation of the recommendations.