The Cleveland Clinic was being clobbered by rapidly rising prices for two commonly used drugs, one used to control heart failure and the other in conjunction with cardiac testing. With few available generic options or substitutions, the Ohio-based healthcare provider systematically rethought how the drugs should be prescribed.
According to a case study in the New England Journal of Medicine, Cleveland Clinic physicians and pharmacists extensively reevaluated its use of nitroprusside and isoproterenol.
The wholesale price for nitroprusside rose 30-fold between 2012 and 2015, from $27.46 per 500 milligrams to $880.88. The price for a single milligram of isoproterenol rose even higher, from $26.20 to $1,790.11.
Such drug price increases have become common in recent years, drawing criticism for the pharmaceutical sector. However, the provider community has mostly been on its own to address the issue.
The Cleveland Clinic
The Cleveland Clinic stopped using nitroprusside as an automatic therapy for hypertension following heart surgery, and cut dosages significantly for its other uses, including an automatic high dosage in conjunction with electronic monitoring.
It also substituted nitroglycerin for post-surgical treatments and clevidipine to treat aortic dissection and dobutamine for patients undergoing myectomies. It also cut dosages for isoproterenol.
As a result, the Cleveland Clinic cut its costs for nitorprusside 56 percent between 2012 and 2015 and reaped savings of more than $8 million. It cut its isoproterenol costs by 55 percent and saved $581,986.
The case study concluded that such savings can be accomplished if an organization’s clinical membership is on board and are willing to develop drug usage metrics in order to achieve savings.
“We believe that our strategy can be implemented for other pharmaceuticals associated with large price increases,” the case study concluded. “Ultimately, this strategy can be used by other health care systems to help manage rising pharmaceutical costs.”