title: Economic Outcomes Associated with a Pharmacist-Adjudicated Formulary Consult Service in a Veterans Affairs Medical Center.
abstract: BACKGROUND
  Several cost analysis studies have been conducted looking at clinical and economic outcomes associated with clinical pharmacist services in a variety of health care settings. However, there is a paucity of data regarding the economic impact of clinical pharmacist involvement in formulary management at the hospital level.
  
  
  OBJECTIVE
  To evaluate economic outcomes of a pharmacist-adjudicated formulary management consult service in a Veterans Affairs (VA) medical center offering outpatient and inpatient services.
  
  
  METHODS
  This VA medical center uses a pharmacist-adjudicated formulary management system for review of restricted drug consults. A retrospective review of electronic medical records was conducted to identify restricted drug consults at this institution between January 1, 2014, and March 31, 2014. Only restricted drug consults that were not approved were included for evaluation in order to best characterize the effects of formulary interventions by pharmacists. Economic outcomes were determined as direct cost savings by comparing the cost of requested drug with the recommended drug and accounting for the cost of pharmacist review. Characteristics of consults that were not approved and pharmacist rationale were also evaluated.
  
  
  RESULTS
  Of 1,802 restricted drug consults adjudicated by a pharmacist during the study period, 198 consults in 190 individual patients met criteria for inclusion and were evaluated. The most commonly requested indications were dyslipidemia, pain, and diabetes, while the most commonly requested drugs were rosuvastatin, insulin pens, tamsulosin, varenicline, ezetimibe, and rivaroxaban. The majority of consults were requested for outpatient use. Total cost savings among 195 evaluable consults was $420,324.05, while mean cost savings per consult was $2,229.43 (range: -$3,009.27-$65,982.36). The highest cost savings were seen with outpatient use.
  
  
  CONCLUSIONS
  A pharmacist-adjudicated formulary consult service in a VA medical center was associated with a substantial cost savings after adjustment for cost of pharmacist review. Future research should assess clinical outcomes associated with a restrictive formulary management system.
  
  
  BACKGROUND
  No outside funding supported this study. None of the authors report any financial interests or potential conflict of interest with regard to this work. Study concept and design were created by all authors. Data were collected and interpreted by Britt, with input from all authors. The manuscript was written by Britt and revised by all authors.
authors: 1 Durham VA Medical Center, Durham, North Carolina.
authors: Rachel B
authors: RB
authors: Britt
authors: 1 Durham VA Medical Center, Durham, North Carolina.
authors: Mohamed G
authors: MG
authors: Hashem
authors: 1 Durham VA Medical Center, Durham, North Carolina.
authors: William E
authors: WE
authors: Bryan
authors: 1 Durham VA Medical Center, Durham, North Carolina.
authors: Radhika
authors: R
authors: Kothapalli
authors: 1 Durham VA Medical Center, Durham, North Carolina.
authors: Jamie N
authors: JN
authors: Brown
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017046:Cost Savings / Q000191:economics* / Q000379:methods / Q000639:trends; D016527:Drug Costs / Q000639:trends; D005260:Female; D005572:Formularies, Hospital as Topic; D006787:Hospitals, Veterans / Q000191:economics* / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D010595:Pharmacists / Q000639:trends; D012017:Referral and Consultation / Q000191:economics* / Q000639:trends; D012189:Retrospective Studies; D014728:Veterans