title: From a to z: medication cost-management strategies for disproportionate share hospitals.
abstract: BACKGROUND
  Harris County Hospital District, Houston, TX, is a publicly funded hospital system that provides care to residents of Harris County with a need-based payment system. The Harris County Hospital District pharmacy department, with a drug budget of more than $75 million in fiscal year 2010, utilizes a closed formulary system that is managed by the Formulary Management and Pharmacoeconomics Service, along with the medical staff. This service is comprised of clinical pharmacists whose goal is to provide a comprehensive, safe, and cost-effective formulary.
  
  
  OBJECTIVE
  To describe the unique formulary management process at a county hospital system and what makes this process cost-effective, which may benefit pharmacy departments in institutions serving an indigent patient population.
  
  
  CONCLUSIONS
  The Harris County Hospital District drug formulary is overseen by the Pharmacy & Therapeutics committee, which is supported by 5 therapeutic subcommittees, including antimicrobials, cardiovascular, general formulary, central nervous system, and oncology. The Pharmacy & Therapeutics Committee consists of a medical staff committee that is supported by clinical pharmacists, who serve as the facilitators of these 5 subcommittees. Their responsibilities include the provision of drug information for formulary decisions, providing parameters to govern the use of certain medications, communicating changes to the formulary, conducting class reviews and medication utilization evaluations, coordinating annual pharmaceutical bids, reviewing and writing medication use policies and procedures, facilitating the use of cost-effective medications, and monitoring the use of medications in the hospital system.
  
  
  CONCLUSIONS
  The processes incorporated by Harris County Hospital District in its formulary management are cost-effective and may be beneficial to other pharmacy departments, especially those institutions that serve an indigent patient population and are interested in cost-effective management strategies.
authors.affiliation: Manager, Department of Pharmacy, Harris County Hospital District, Houston, TX.
authors.forename: Andrea
authors.initials: A
authors.lastname: Henry
authors.affiliation: Clinical Pharmacist III, Formulary Management & Pharmacoeconomics Service, Department of Pharmacy, Harris County Hospital District, Houston, TX.
authors.forename: Goldina Ikezuagu
authors.initials: GI
authors.lastname: Erowele
authors.affiliation: Assistant Professor, Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Texas Southern University, and Drug Information Specialist, Harris County Hospital District.
authors.forename: Uche Anadu
authors.initials: UA
authors.lastname: Ndefo
authors.affiliation: Formulary Command Center Clinical Pharmacist, Department of Pharmacy, Harris County Hospital District, Houston, TX.
authors.forename: Jackie
authors.initials: J
authors.lastname: Milton-Brown
authors.affiliation: Clinical Pharmacist III, Formulary Management & Pharmacoeconomics Service, Department of Pharmacy, Harris County Hospital District, Houston, TX.
authors.forename: Enock
authors.initials: E
authors.lastname: Anassi
authors.affiliation: Clinical Pharmacist III, Formulary Management & Pharmacoeconomics Service, Department of Pharmacy, Harris County Hospital District, Houston, TX.
authors.forename: Wendy
authors.initials: W
authors.lastname: Green
authors.affiliation: Clinical Pharmacist III, Formulary Management & Pharmacoeconomics Service, Department of Pharmacy, Harris County Hospital District, Houston, TX.
authors.forename: Adriana
authors.initials: A
authors.lastname: Alvidrez
authors.affiliation: Director, Department of Pharmacy, Harris County Hospital District, Houston, TX.
authors.forename: Alphonsus U
authors.initials: AU
authors.lastname: Okpara