FINANCIAL EVALUATION OF UNLICENSED MEDICATION SUPPLIED ON FP10HP AT UHNS

1. FINANCIAL EVALUATION OF UNLICENSED MEDICATION SUPPLIED ON FP10HP AT UHNS Helen Haley Pharmacy department, University hospital of North Staffordshire

2. Background • Cost containment initiatives within NHS • Traditional focus on drug expenditure for child health looking at in house prescribing • Expansion into other areas of prescribing • Expenditure on FP10HP for child health high compared with other directorates • 5,606 items dispensed on FP10HP for child health for financial year 2009/2010

3. Initial cost containment ideas • Encourage doctors to refer prescribing to GP for non urgent items • Ensure generic prescribing unless a specific brand is clinically appropriate • Ensure compliance with formulary • Review high cost/frequency drugs

4. High cost drugs • Unlicensed medication costs significant on FP10HP • Melatonin and Biomelatonin accounted for 212 prescriptions costing £26,815 • Omeprazole suspension was prescribed 17 times costing £3,089

5. Objective • Establish extent of unlicensed medication prescription on FP10HP • Review potential mechanisms to reduce FP10HP expenditure on unlicensed medicines • Evaluate the financial impact of recommended changes to prescribing practice

6. Method • Evaluation of top 50 Nic for child health from ePACT data for financial year 09/10 • Detailed examination of high cost drug spend to establish quantities dispensed over year • Determination of relative cost if equivalent drug was dispensed at UHNS

7. Results

8. Comparison of cost on FP10HP vs. UHNS

9. Financial impact if dispensed from hospital compared with FP10HP

10. Conclusions • Significant variation in cost of unlicensed products dispensed on FP10HP • Financial benefits from dispensing these unlicensed medications at UHNS pharmacy compared with supply on FP10HP • Potential annual savings of approximately £26,000.

11. Advantages of supply from hospital • Provides a consistent product impacting on:- • Clinical governance • Medication safety • Patient safety • Cost

12. Clinical governance • Adherence to hospital policy on unlicensed medication use • Only used when no suitable licensed alternative available1 • Each unlicensed medication is risk assessed and signed off by consultant, pharmacist and medical director • Allows annual review of unlicensed medicine use. • 1. The healthcare commission(2007). The best medicine – The management of medicines in acute and specialist trusts

13. Medication Safety • Selection of the most suitable product2 • Manufacturer • Formulation and excipients • Availability • Licensed status in other countries • Packaging • Pils • 2. Standing committee on medicines of the Royal college of paediatrics and child health and NPPG group (2000) – The use of unlicensed medicines or licensed medication for unlicensed applications in paediatric practice

14. Patient safety • Reduced risk of therapeutic failure/ADR due to differences in bioavailability3 • Reduced risk of therapeutic duplication or administration error • Avoids delay in supply of medication • 3. MHRA (2009) Interim report on the review of unlicensed medication

15. Financial • Cost containment removing variation in cost between different pharmacies • Allows focused purchasing for cost effectiveness with regular review of alternatives on the market • Purchasing power for bulk • Allows funding streams to be evaluated

16. Disadvantages of hospital supply • Increased workload for hospital pharmacy • Inconvenience for patient • Impact reduced by medical team pre ordering treatment • Allows dispensing during quiet periods • Patient to collect at convenience without waiting for dispensing

17. Update on project

18. Questions??