Journal des soins pharmaceutiques et des systèmes de santé
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Evaluation of a Retrospective Drug Utilization Review Program for the Treatment of Plaque Psoriasis: A Pilot Study

Bobby L Clark, Janeen DuChane, Francis Staskon, Mike Einodshofer, Karen Fitzner and Ian Duncan

Background: Because of their increasing use and high unit costs, biologics pose challenges to payer costcontainment efforts. Creative approaches are needed to assure clinical appropriateness and eliminate unnecessary costs related to biological medications. The biologic etanercept has been approved for treatment of chronic moderate to severe plaque psoriasis in certain adults; however the costs can be over $2,000 per month. Objective: The objective of this study was to evaluate the outcomes of a specialty pharmacy’s retrospective drug utilization review (rDUR) pilot program designed to identify patients with plaque psoriasis who were prescribed a dose of etanercept inconsistent with the manufacturer recommended dosing for plaque psoriasis. Methods: This descriptive analysis evaluated a pharmacist-initiated, provider-oriented rDUR pilot program for plaque psoriasis patients using etanercept. We assessed the rDUR program’s impact on annual cost. A retrospective descriptive analysis was undertaken to assess the rDUR program’s impact on annual cost associated with changes in dosage in prescribed amounts of etanercept for patients with plaque psoriasis. We examined prescription “fills” and cost per patient pre- and post-program implementation using wholesale acquisition costs (WAC). Retrospective DUR review criteria were based on dosing information contained in the prescribing label. Results: The rDUR targeted 388 providers with 444 plaque psoriasis patients; prescriber response rate to faxed reminder letters was 65.5%. Annual costs for etanercept patients had an upper range of $37,638, and annual payer savings associated with reduced dosing regimens were projected to be an average of $22,062 per patient per year. Conclusion: Proactive therapy management approaches are necessary for specialty medications to help eliminate unnecessary health-care expenses related to unintended prescribing in excess of the manufacturer’s recommended dosing. Pharmacist-led programs to provide information regarding manufacturer dosing recommendations can effectively be incorporated into specialty pharmacy, and can significantly and positively influence prescribing and control costs.