title: Pharmacy-enforced outpatient drug treatment protocols: a case study of Medi-Cal restrictions for cefaclor.
abstract: OBJECTIVE
  To evaluate whether a pharmacy-enforced treatment protocol successfully limited the use of a high-cost medication to high-risk patients.
  
  
  METHODS
  A case study cost-effectiveness analysis was conducted to evaluate a treatment protocol for cefaclor. Episodes of care were defined, healthcare expenditures for all services were aggregated, and demographic data were retrieved from a five percent random sample of California Medicaid (Medi-Cal) recipients. Data were available for episodes occurring before cefaclor was made available under Medi-Cal.
  
  
  METHODS
  Medi-Cal added cefaclor to its formulary, limiting its use to patients over 50 years of age with lower respiratory tract infections (LRTIs). The unit of analysis was an episode of outpatient antibiotic treatment.
  
  
  METHODS
  Confirmed LRTI episodes and unconfirmed LRTI cefaclor episodes were analyzed, including multiple episodes of treatment for individual patients. A total of 7855 non-cefaclor LRTI episodes and 2556 cefaclor episodes were analyzed.
  
  
  METHODS
  The primary outcome measures were healthcare expenditures three months after the initiation of antibiotic therapy, differentiated by type of service.
  
  
  RESULTS
  Physicians directed cefaclor toward higher-risk patients over age 50 years, even in unconfirmed LRTI episodes. Cefaclor use was estimated to reduce posttreatment costs by $388 per patient (p < 0.001), primarily because of reduced hospital expenditures of $366 (p < 0.001).
  
  
  CONCLUSIONS
  Pharmacy-enforced outpatient drug treatment protocols may be a viable alternative to restrictive formularies and prior authorization. In the case of cefaclor, the Medi-Cal treatment protocol appeared to allow high-risk patients better access to a high-cost medication while reducing total posttreatment costs.
authors.affiliation: Department of Pharmaceutical Economics and Policy, School of Pharmacy, University of Southern California, Los Angeles 90033.
authors.forename: J S
authors.initials: JS
authors.lastname: McCombs
authors.forename: M B
authors.initials: MB
authors.lastname: Nichol
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D002140:California; D002433:Cefaclor / Q000191:economics* / Q000627:therapeutic use; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D004363:Drug Utilization; D005069:Evaluation Studies as Topic; D005569:Formularies as Topic; D006801:Humans; D008484:Medicaid / Q000592:standards*; D008875:Middle Aged; D010594:Pharmacies / Q000191:economics / Q000592:standards; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000191:economics; D014481:United States
chemical_list: D002433:Cefaclor