title: Managing the Rising Costs and High Drug Expenditures in Critical Care Pharmacy Practice.
abstract: Pharmaceutical costs for patients in the intensive care unit (ICU) constitute a large portion of hospital drug budgets. Unfortunately, prices for medications commonly used in the ICU are on the rise for a variety of reasons. In particular, the U.S. Food and Drug Administration's Unapproved Drugs Initiative, generic manufacturers cornering the marketplace, drug shortages, and regulatory device changes are major drivers of pharmaceutical price escalation affecting costs in the ICU. Furthermore, traditional high acquisition cost items still pose challenges to controlling costs. To offer strategies to mitigate the rising costs of pharmaceuticals in the ICU setting, we searched the PubMed/Medline and International Pharmaceutical Abstracts databases and other related sources to identify published cost-saving protocols concerning specific medications that are affected by rising prices or have traditional high acquisition costs. In the absence of specific protocols, we offer possible cost-saving initiatives based on published literature regarding specific agents or based on our own diverse set of experiences. Finally, we review suggested clinical and operational activities at an institutional level to address these rising drug costs in the ICU setting.
authors.affiliation: Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky.|Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky.
authors.forename: Alexander H
authors.initials: AH
authors.lastname: Flannery
authors.affiliation: Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky.|Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky.
authors.forename: Komal
authors.initials: K
authors.lastname: Pandya
authors.affiliation: Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky.
authors.forename: Melanie E
authors.initials: ME
authors.lastname: Laine
authors.affiliation: Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Almeter
authors.affiliation: Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky.|Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Flynn
mesh_terms: D017046:Cost Savings; D003422:Critical Care; D020927:Dexmedetomidine / Q000191:economics; D016527:Drug Costs; D015942:Factor VIIa / Q000191:economics; D005102:Health Expenditures; D006801:Humans; D007362:Intensive Care Units; D010607:Pharmacy Service, Hospital; D014665:Vasodilator Agents / Q000191:economics
chemical_list: D014665:Vasodilator Agents; D020927:Dexmedetomidine; D015942:Factor VIIa
keywords: cost; cost savings; critical care; medication