ASHP, ePocrates to launch new formulary service

FRAMINGHAM (11/20/2003) - By coupling hospitals' formularies with in-depth drug information and then making the integrated data readily accessible via Internet-connected PCs, a new service from ePocrates Inc. promises to help hospitals keep a lid on rising drug and related processing costs. The Web hosting and medical reference service, dubbed ePocrates Rx Online + AHFS DI, is slated to be formally introduced next week. It is the result of a partnership between ePocrates Inc., a San Mateo, Calif.-based developer of clinical reference guides for hand-held and desktop computers, and the American Society of Health-System Pharmacists (ASHP), a 30,000-member professional association based in Bethesda, Md.

"We now have (our hospital formulary) in the handhelds and desktops of physicians. They can't say they don't know what the formulary is," said Douglas E. Miller, Pharm. D., assistant vice president for Atlanta-based Grady Health System, which recently deployed the new product. Previously, Grady's formulary -- a list of commonly stocked drugs that physicians are expected to use when prescribing -- was bound in paper books and updated only once a year, Miller noted.

Giving prescribers "access to on-the-spot drug information" and making it easy for administrators to update the list of approved drugs should encourage doctors to consult the formulary when making prescriptions and avoid selecting more expensive off-formulary drugs, Miller said.

Hospitals developed formularies to promote appropriate and cost-effective use of drugs, said Andrew Burns, vice president of clinical products for ePocrates. But, doctors don't always find it convenient to consult the often cumbersome paper lists. As a result, Burns said, they may fail to select less costly, approved generic or therapeutic alternatives. Or hospital pharmacists may have to intervene or engage in time-consuming "callbacks" to inform the physician the prescribed drug isn't on the formulary.

Two to five percent of the time a physician uses the service the doctor would more be more likely to select a generic or therapeutic alternative to a name brand drug than the prescriber would have without the easily accessible database, Burns predicted. That's according to findings of ePocrates' own studies. If proved true, the savings could add up over time. The average price difference between major name brand drugs and their top 25 generic equivalents was 38.7 percent, according to a 2001 study by the Canadian Generic Pharmaceutical Association.

Hospitals don't need to add IT resources to exploit the new service because ePocrates hosts the information on its own Web servers, Burns said. ePocrates handles most the of up-front integration effort, training hospital administrators to load and update formulary information and clinical notes via a template.

Doctors at a hospital running the service may go to any Internet-connected PC on the hospital's network and tap into the database simply by clicking an icon. The formulary is integrated with the American Hospital Formulary Service Drug Information (AHFS DI), a widely used database published by the ASHP; and ePocrates Rx Online. The ePocrates Rx Online application includes peer-reviewed information on more than 2,800 drugs and allows professionals to check drug interactions among up to 50 medications at one time.

The service also allows healthcare professionals to check selected medications against the formularies ePocrates hosts for more than 70 health plans, Medicaid agencies, and pharmacy benefit management companies. That way, company officials say, physicians can determine whether the drugs will be covered by a patient's insurance plan.

Palm and Pocket PCs users also can download the formularies and a version of ePocrates Rx via hot sync.

Pricing for a three-year site license starts at US$11,000 per year for a 100-bed hospital.

ePocrates is far from alone in the formulary management market. Electronic formulary solutions are available from several companies including Thomson MICROMEDEX of Greenwood Village, Colo., and MedKeeper of Denver, Colo. Nonetheless, ePocrates hopes to leverage its user base of 325,000 healthcare professionals, including 20 percent of practicing U.S. physicians it says uses ePocrates services, to propel it into the hospital market.

Hospitals "will jump at the chance to make their drug formularies more readily available to clinicians, said Eric Brown, principal analyst at Forrester Research in Cambridge, Mass. However, he added, "The risk is that this is a short-term solution." Longer term, he said hospitals would want to integrate the formulary databases into enterprise-wide applications.

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