Closed formulary keeps student-run clinic afloat

When a clinic run by pharmacy students implemented medication management with a closed formulary, it resulted in an average decrease in cost per prescription from $27 to $20. That was good news to the Sharing clinic, which serves the uninsured population of Omaha, Neb. Across the United States, approximately 59 student-run health clinics provide more than 36,000 student-provider clinic visits annually.

“The clinic was in jeopardy of closing, and a large part of its expenses was centered in its pharmacy budget,” says Kristen M. Cook, PharmD, an assistant professor of pharmacy at the University of Nebraska Medical Center.

There were three ways to deliver medications. First line delivery consisted of generic medications dispensed at the clinic and a bulk medication assistance program in which the clinic pharmacy contracted with a pharmaceutical company to provide in bulk the medications that were to be dispensed at the clinic.

The second delivery method was a medication assistance program that involved the dispensing of brand-name medications not available in generic form and of samples of branded drugs donated by pharmaceutical companies. The third line of delivery was reserved for contract pharmacy prescriptions, which were available at a designated contracted pharmacy.

During the two-year study, Cook says, 200 patients were treated, a majority for chronic conditions, including 62 percent for hypertension, 54 percent for diabetes, 46 percent for dyslipidemia, and 26 percent for depression. The average monthly cost to the clinic for medications decreased from $5,445 to $3,714. The study says that little or no cost for medications was shifted to patients.

Cook says the closed formulary was successful because of the physician buy-in up front. “They were involved in revising the formulary with us, looking at their own prescribing habits, and they had a lot of input as far as designing the formulary,” she says. What was most convincing? “We showed clinicians how much we were spending before implementing the formulary and afterward, and we showed them how much we could save per patient.”

Medication use, costs before and after formulary installed
April 1, 2006 to March 31, 2007 April 1, 2007 to March 31, 2008
Total number of visits 941 696
Total number of prescriptions 4,284 3,423
Medication cost, mean ± SD $5,445±1,469 $3,714±847
Number of prescriptions, mean ± SD 356±44 285±40
Cost per patient, mean ± SD $33±52 $27±30
Cost per prescription, mean ± SD $27±42 $20±24
Estimated saving per prescription ($)
Bulk MAP 102 111
MAP 396 364
Bulk medication dispensed from clinic stock 8 10
Bulk MAP: bulk medication assistance program; MAP: medication assistance program