pharmacy 483 institutional pharmacy practice

Download Pharmacy 483  Institutional Pharmacy Practice

Post on 06-Jan-2016

68 views

Category:

Documents

4 download

Embed Size (px)

DESCRIPTION

Pharmacy 483 Institutional Pharmacy Practice. Purchasing, Product, and Inventory Management Donald L. Bomgaars, M.S., M.B.A. bomgaars@u.washington.edu February 26, 2004. Pharmacy Practice Overview. Product Supply Chain Management Patient Care Issues & Management - PowerPoint PPT Presentation

TRANSCRIPT

  • Pharmacy 483 Institutional Pharmacy PracticePurchasing, Product, and Inventory Management

    Donald L. Bomgaars, M.S., M.B.A.bomgaars@u.washington.edu

    February 26, 2004

  • Pharmacy Practice OverviewProduct Supply Chain Management

    Patient Care Issues & Management

    Institutional Level Therapy Management

    Population Level Management

  • Lecture Overview

    PRODUCT & VENDOR SELECTION PROCESSGROUP PURCHASINGPURCHASING & DISTRIBUTION CHANNELS INVENTORY CONTROL SYSTEMSPRICING & REGULATORY ISSUESRELATIONSHIPS WITH THE PHARMACEUTICAL INDUSTRY

  • SELECTION PROCESS

    ASSESSMENT OF NEEDSP&T decisionsPatient populationsStaff preferencesManaged care environment

  • SELECTION PROCESS

    SUPPLIER APPROVALQuality assurance

  • BIG PHARMA, INC.

    Product Line Oral solids, controlled substances, SVP, LVP, topicals, peptides, and chemicals

    Supplier Type - ( )Primary/( )Secondary/( )Marketer

    Back Order History What & when?

    QA/QC Director & Production Director Appropriate educational backgrounds and experience?

    Recall History Is there a pattern?SUPPLIER CERTIFICATION REVIEW

  • BIG PHARMA, INC. (cont.)

    FDA Documents & Company Responses What was noted or observed? How did the company respond? Was there a Warning Letter issued by the FDA? Is there a pattern of observations from visit to visit?

    Overall Comments Company SOPs review, financial news reports, company web site info, recent FDA approvals?

    Recommendation - Approve, qualified approval, disapprove?SUPPLIER CERTIFICATION REVIEW

  • SELECTION PROCESS

    SUPPLIER APPROVALQuality assuranceSupplier performance historyTerms and conditions

  • SELECTION PROCESSPRODUCT SPECIFICATIONSBioequivalence issues http://www.fda.gov/cderPackaging issues

    CONTRACT BID & AWARDSConventional RFQ processOnline reverse auction

  • SELECTION PROCESS

    PRODUCT SPECIFICATIONS

    CONTRACT BID AND AWARDS

    POST-AWARD MONITORING

  • GROUP PURCHASING ORGANIZATIONSADVANTAGESPooled volumesShared resourcesPeer networkingDISADVANTAGESLoss of controlVariety of constituenciesMember compliance issues

  • PURCHASING & DISTRIBUTION CHANNELS

    Supply Chain Management

    coordination of processes from the supplier of raw materials to the end user.

  • PURCHASING & DISTRIBUTION CHANNELS

    Wholesaler versus Direct Purchases Selection of a Distribution VendorBig Three vs. regional playersSpecialty distributors and grey-market sources

  • PURCHASING & DISTRIBUTION CHANNELSPrime Vendor Wholesaler Features We ValueAccess to online inventory status and QOHAccurate representation of TOS and MOSBar code receivingElectronic access to invoices and statementsClean and standardized product detail infoData warehouse of purchase history infoMarkers in wholesaler database to direct purchases to desired productsPick & ship accuracyCustomer service follow-up

  • PURCHASING & DISTRIBUTION CHANNELSValue ManagementOther directions for improvement: reverse distribution processindigent care program managementinformation companies (HBOC, MediQual, CIC) pharmacy distribution systems (Pyxis, API, Owens) and pharmacy department management (Swedish)manufacturing component (Cardinal Assist, National PharmPak, RP Scherer)

  • PURCHASING & DISTRIBUTION CHANNELSE-CommerceExpanding efficiencies to other members of supply chain Decreased transaction expenses, increased info flow

    Impact on wholesalers

    Pharma to patients direct Dispensing with the intermediaries?

  • INVENTORY CONTROL SYSTEMS

    Balancing the costsOrdering costsProduct costInventory carrying costsOutage costs

  • INVENTORY CONTROL SYSTEMSAlphabet soup of acronymsJIT, POS, MRP, ERPABC, EOQ, ROP Consignment stocking programsPOU replenishmentDemand forecasting

  • EOQ EXAMPLESFilgrastim: $1,627/pkg 700 annually $2.00 $163 4

    Cost =Demand=Reorder cost=Inventory carrying cost=EOQ= Multivitamin: $6/pkg 700 annually $2.00 $0.6 68

  • INVENTORY CONTROL SYSTEMSDEMAND FORECASTINGMoves further out the supply chainUses software algorithms to predict usage based on seasonal and customer specific anticipated fill dates.Longs Drug California DC reduced inventory by 58%, cut replenishment costs by 65%, maintained 99.5% controllable service levels, released enough cash flow ($60M) to purchase 20 stores.

  • INVENTORY CONTROL SYSTEMS

    Decision Support & MonitoringLinear programming Allows optimization under constrained resourcesDecision treesSimplifies complex decisions using outcomes and probability distributions

  • Decision Trees

    $328,000$328,000 (p= 1.0)$235,000 (p= 0.2)$340,000 (p= 0.8)$319,000STATUS QUO MAKESWITCHSUCCESSFULFAILURE

  • INVENTORY CONTROL SYSTEMSDecision Support & MonitoringMulti-Attribute Utility Theory (MAUT)Method of quantifying assessments of worth of diverse attributesFinancial conceptsTime value of money (NPV, IRR)Risk value of moneyStandard cost monitoring

  • PRICING & REGULATORY ISSUESFor Profit vs. Not For Profit StatusClass of trade and own use provisionsGovernmental/Regulatory impactsCost based vs. DRG based reimbursement Budget Deficit factor - OBRA 90Veterans Health Care Act of 1992Medicare APC programMedicare Prescription Drug, Improvement, and Modernization Act of 2003

  • PHARMACEUTICAL INDUSTRY RELATIONSHIPS

    The Global Market and Price ControlsImpact on the US marketCross border internet sales

  • PHARMACEUTICAL INDUSTRY RELATIONSHIPS

    The Changing Face of IndustryRapid consolidation continuesDriven by failure of the R&D organizations to meet the earning per share expectationsIncreased R&D expenditures may not solve the problems

  • PHARMACEUTICAL INDUSTRY RELATIONSHIPSThe Changing Face of R&DThe Human Genome project could provide up to 25,000 new molecular targets

  • PHARMACEUTICAL COMPANY RELATIONS

    HUMAN GENOME PROJECT TO SPARK EXPONENTIAL GROWTH IN NUMBER OF TARGETS FOR DRUG INNOVATION Source: Drews, Jurgen, M.D., "Genomic Sciences and the Medicine of Tomorrow: Commentary on Drug Development," Nature Biotechnology, Vol. 14, November 1996

  • PHARMACEUTICAL INDUSTRY RELATIONSHIPSThe Changing Face of R&DThe Human Genome project could provide up to 25,000 new molecular targetsCombinatorial chemistry will allow increases of the number of compounds synthesized and screened by a million-fold

  • PHARMACEUTICAL INDUSTRY RELATIONSHIPSThe Changing Face of R&DThe Human Genome project could provide up to 25,000 new molecular targetsCombinatorial chemistry will allow increases of the number of compounds synthesized and screened by a million-foldIncreased ways of attacking medical problems could fragment market and allow easier competition

  • PHARMACEUTICAL COMPANY RELATIONS

    Sources: PhRMA, 1997; The Wilkerson Group, 1995.SHRINKING PERIOD OF MARKET EXCLUSIVITY BETWEEN INTRODUCTION OF BREAKTHROUGH MEDICINE AND COMPETING INNOVATORS

  • PHARMACEUTICAL INDUSTRY RELATIONSHIPS

    MarketingPartners versus antagonistsManaged care organizationsGovernment funding for prescription coverageDTC and Internet marketing

  • SUGGESTED READINGSTEXT: www.ashp.com/bestpractices ASHP Technical Assistance Bulletin on Assessing Cost-Containment Strategies for Pharmacies in Organized Health-Care SettingsASHP Technical Assistance Bulletin on Hospital Drug Distribution and ControlASHP Guidelines for Selecting Pharmaceutical Manufacturers and SuppliersASHP Guidelines on Managing Drug Product Shortages

    Additional reference regarding business methodologies as they are used in the clinical arena: Magid, David et al., Doxycycline Compared with Azithromycin for Treating Women with Genital Chlamydia trachomatis Infections: An incremental Cost-Effectiveness Analysis, Ann Intern Med. 1996;124:389-399.Pharmacogenomics reference:Evans WE, McLeod HL. Pharmacogenomics-drug disposition, drug targets, and side effects. NEJM 2003; 348:538-49.

Recommended

View more >