Leveraging Health-System Pharmacy Operations and Drug Cost Savings to Sustain a Remote Clinic

PURPOSE: Vannie Cook Children’s Clinic, located in McAllen, Texas, is the region’s first pediatric hematology/oncology clinic. The mission of the clinic is to offer treatment to children along the Mexico border in South Texas who suffer from cancer and blood disorders. Currently, the clinic accrues over $5 million annually in drug procurement costs with little to no reimbursement and is challenged to continue operations. With no on-site pharmacy, Vannie Cook obtains medications and infusions necessary for patient care within the clinic from a for-profit pharmacy. The purpose of this project is to leverage Texas Children’s Hospital pharmacy operations in providing medication to the Vannie Cook Clinic at a lower cost to ensure sustained operations. METHODS: This was a retrospective, single-arm descriptive study that reviewed outpatient drug order invoices from March to May 2017 to assess the average monthly cost of medications, and, specifically, to determine which medications would yield the most cost savings. After identifying the first medication(s) to be piloted given their expense and stability, a process was developed, operationalized, and implemented for the preparation and dispensing of the medication for delivery and administration to the patients of the remote clinic. After implementation of the first pilot, order invoices from December 2017 to March 2018 were analyzed and a comparison study was conducted against the data from March to May 2017, to evaluate cost savings after implementation. RESULTS: The data analysis consisted of descriptive statistics. Comparisons of data from March to May 2017 and December 2017 to March 2018 for all primary and secondary objectives was performed. A total of 11 doses were prepared and dispensed to the clinic between December 2017 and March 2018 for a cost savings total of approximately $27,500. Each dose of pegaspargase arrived as scheduled and was successfully administered to each patient. The rate of savings per month with leveraging health-system pharmacy operations and drug cost savings was $9,200. The local, for-profit pharmacy was not called to prepare or dispense a dose since the implementation of the pilot process. CONCLUSION: The remote children’s infusion clinic was able to save a significant amount of money that allowed them to continue to provide quality healthcare at a lower price. The cost savings demonstrated by implementing a new process for the preparation, dispensing, and shipping of chemotherapy doses for administration to patients in a remote clinic supports the value of leveraging health-system pharmacy resources to help sustain rural clinics.