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Drug Costs Are Target of Long Beach Hospital Pharmacist

Melinda Klein scours studies and patrols the halls in an effort to ensure smart spending.

January 03, 2006|Denise Gellene | Times Staff Writer

When Sepracor Inc. wanted Long Beach Memorial Medical Center to use more of its asthma medicine, the company went to see Melinda Klein.

Three published studies touted the benefits of Xopenex for asthma patients requiring emergency care. But Klein, a Memorial pharmacist, thought the medicine looked no better than an inexpensive generic drug.

Klein recommended keeping Xopenex off the hospital's list of preferred medicines, or formulary. A hospital committee of doctors, nurses and pharmacists voted to follow her advice, despite objections from some local allergists.

With drug costs threatening to consume more of their budgets, hospitals are turning to experts like Klein. At Memorial, she oversees a team of pharmacists who pore over clinical studies to penetrate drug-company hype. Although Klein does not have the final say on which medicines make it onto the hospital's list of preferred drugs, her opinion carries weight.

"The pharmacy has a lot of power," said Sara Owen, a Sepracor sales representative who had sought Klein's endorsement of Xopenex.

When Klein, a graduate of USC's School of Pharmacy, started at Memorial in 1982, her focus was getting prescriptions filled quickly and accurately. After she became director of inpatient pharmacy five years ago, Klein's attention was increasingly drawn to the bottom line.

What prompted the change was a tough healthcare environment that has seen hospitals slash services or shut down altogether. An increase in uninsured patients and uncertainty about reimbursement are forcing hospitals to look for efficiencies. Add to that a wave of costly new medicines that threaten to consume a greater portion of hospital budgets.

Memorial says Klein's efforts have saved the hospital money while giving patients access to appropriate drugs. But some doctors say the drive to control costs may prevent some patients from receiving drugs that may be better for them.

"My feeling is that a patient comes first," said Steven Meltzer, an asthma specialist in Long Beach and member of the hospital's education committee who wanted to see Xopenex added to Memorial's formulary. "At the hospital they may have some other criteria for making a judgment."

From a tiny office in the hospital's basement, Klein monitors an annual budget of more than $13 million. Charts tracking drug expenditures cover a bulletin board. Each day she receives spending reports on the 25 costliest drugs used at the hospital. Five expensive medicines can't be administered without her OK.

Seated at her desk, Klein produced Exhibit A in her war on waste: a cardboard box containing 110 asthma inhalers that had been abandoned by patients leaving the hospital. When new, the inhalers contained a two-week supply, or 28 doses, of Advair, more than needed by patients during a typical hospital stay. Klein grabbed three of the used inhalers. "Look at this one, 20 doses left! And this one, 18 doses. Here's another, 28 doses. It was never touched."

Two years ago, Long Beach Memorial spent $28,000 on Advair, but in fiscal 2004 the amount exploded to $138,000 -- reflecting nearly a fivefold increase in prescriptions. Klein blamed a barrage of TV ads and sales pitches to doctors.

In March, Klein persuaded the hospital to substitute drugs that use a different kind of inhaler, one that could be loaded with the exact number of doses each patient needed. She contended that Advair wasn't suited to hospital use and had some risky side effects. Her decision looked smart in November when the Food and Drug Administration warned that Advair could increase patients' risk of severe asthma attacks and death.

"I like to think we're ahead of the curve," Klein said.

Advair marketer GlaxoSmithKline said the FDA action was unwarranted and could put patients who might have used the drug at risk of uncontrolled asthma. Regarding Memorial's policy, spokeswoman Lisa Behrens said that hospital stays vary and it would be "concerning" if patients who needed Advair weren't able to get it.

Klein is careful to keep herself from coming under the influence of drug companies. She won't accept pens, notepads or other gifts. Klein strives to limit the industry's sway with the medical staff. Not long ago, she annoyed nurses when she confiscated bottles of hand lotion that had drug company logos on them.

In May, Memorial barred sales reps from providing free meals to doctors and nurses on hospital grounds. Klein pressed for the ban, modeled on prohibitions at Veterans Administration hospitals. The policy also prevents sales reps from promoting products to physicians that aren't on Memorial's formulary. The prohibition doesn't apply off campus.

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