The specific benefits delivered by drug information services—researching, evaluating, and communicating drug information in order to assist in patient care decisions and develop evidence-based recommendations—require the skills of specially trained clinical pharmacists.1 Investing in such staff to develop an effective program provides an opportunity to create a revenue-generating model for your drug information practice.
The Drug Information Group (DIG) is a fee-for-service business unit within the University of Illinois at Chicago (UIC) College of Pharmacy. Historically, the DIG provided traditional, internal drug information services such as a bimonthly newsletter, P&T support, and responses to requests from providers and patients in the community. However, that practice model changed in 1997 when the unit was required to become self-supporting and eventually revenue generating for the College of Pharmacy. Through professional networking, the DIG signed its first major client in 1998—a long-term drug information services contract with a company that managed approximately 450 hospital pharmacies with an extensive call volume. This contract allowed the DIG to expand from three to five full-time drug information specialists, and it also necessitated the provision of extended service hours (7AM to 8PM during weekdays and 10AM to 2PM on Saturdays) to meet the needs of hundreds of pharmacies nationwide.
Today, networking remains the DIG’s primary mechanism for expanding its client base. The DIG employs a director of business development whose primary role is to identify potential clients and opportunities through cold calling, engaging current clients, and attending national meetings. In addition, potential clients can learn about our services on the DIG website (www.uicdruginfo.com). The DIG also responds to requests for proposals of drug information projects and collaborates with faculty members outside of the DIG on revenue-generating projects, such as research grants and training programs.
Contractual relationships must meet the needs of both parties; thus, an initial meeting is necessary to outline the respective parties’ needs and capabilities in order to set the tone for the relationship. The ensuing proposal for services should clearly define the purpose of the agreement, scope of services, responsibilities of both the drug information provider and the client, length of agreement, and compensation. Depending on the scope and length, consider developing a multifaceted pricing structure. For drug information requests from hospitals and health systems, two options should meet most needs: an annual flat fee that allows for unlimited requests, or a per-request pricing structure where the institution is invoiced quarterly based on the time required to complete each request. For other projects, hourly rates or a flat project fee also can be offered. Some organizations prefer to contract for a set annual amount (ie, retainer) that is billed against throughout the year. It is also wise to gauge the level of flexibility you have to negotiate pricing for services. At DIG, most of our contractual agreements are for one year, with annual renewals as requested by the client. The contract itself may be the standard UIC agreement, or the client may provide an agreement that is routed through the university’s office of business and financial services for review, editing, and approval.
When positioning your services, consider what additional capabilities your organization can provide. For example, by contracting with our DIG, clients can access the expertise of our drug information specialists, as well as a network of other health care professionals and experts at the University of Illinois at Chicago and surrounding medical centers, as needed. In addition, our clients recognize the inherent value of partnering with a third party that is both evidence-based and fair-balanced when completing a project.
Varied Clients, Varied Services
Drug information services can be offered to an array of settings, including individual hospitals, large health systems, pharmacy benefit management companies, pharmaceutical manufacturers, major health care corporations, medical education companies, pharmacy schools, and state agencies. To address this wide range of possible clients, consider offering services such as:
Furthermore, look for non-traditional approaches to developing client service options. Recently, the DIG developed a unique relationship with the Illinois Department of Healthcare and Family Services. In 2005, we initiated formulary support for the department’s preferred drug list as well as P&T consultative services. Two more units have grown out of this relationship: prior authorization services in 2006 and a pilot medication use review unit in 2012. The addition of these units has allowed the DIG and the College of Pharmacy to continue to expand staff and services in a variety of directions.
Creating a proper balance of staff is key to the provision of quality services. Currently, the DIG consists of ten drug information specialists, two drug information residents, and three assistants, handling operational, finance, and information technology issues. The majority of these staff members are residency-trained and board-certified with a wide range of professional experience. In addition to the two academic-based drug information residency positions, this year we also are initiating a joint residency with a pharmaceutical manufacturer. This program divides the resident’s training between UIC and the manufacturer (six months at each site) and provides the resident with experience in both academic and industry drug information practices. The prior authorization unit continues to expand and currently consists of an assistant director, 14 pharmacist FTEs, and a medical director position. Approximately 20 pharmacists are currently employed in the pilot medication use review unit. Although these units fall under the director of the DIG, they are primarily dedicated to the contracts with the Illinois Department of Healthcare and Family Services.
Despite the growth of our external client base, we continue to provide services to the University of Illinois Hospital and Health Sciences system, the UIC College of Pharmacy, and the Chicago community. For the hospital, the DIG continues to create and edit a bimonthly pharmacy newsletter, authors and edits formulary reviews, and participates in monthly P&T committee meetings. Unlike in years past, the hospital currently pays the DIG an annual fee for these services. As part of the community outreach mission of UIC, the DIG continues to operate a free local drug information phone line for area patients and health care providers to receive verbal consultation regarding drug therapy questions. In addition, members of the DIG faculty teach a literature evaluation and biostatistics course that is required for second-year pharmacy students at UIC, precept fourth-year students on drug information rotations, and oversee PGY1 residents for whom drug information training is required.
Even with the successes of the program, expansion efforts are challenging. Gaining initial access to potential clients remains difficult, and economic changes, particularly in the pharmaceutical industry as a result of the recession, impact the consistency of work from those sources. Balancing unpaid yet time-consuming teaching and other faculty requirements for the College of Pharmacy against client responsibilities can be daunting. In addition, locating appropriately trained individuals is often a complex process, with many pharmacists lacking suitable educational or employment backgrounds to work effectively in this setting. To be effective, drug information specialists must have a strong clinical knowledge base, analytical and problem-solving abilities, and highly developed verbal and written communication skills. Furthermore, faculty must be able to demonstrate flexibility, work independently, and adapt to a fast-changing work environment while managing their time effectively.
To establish a revenue-generating drug information center, take into account the amount of time and effort required to identify potential clients and develop contractual relationships. It may be worth hiring staff members dedicated specifically to this task. Having staff that are comfortable networking and interacting with potential clients also is key. When launching such a program, parent institutions should be prepared to invest funds and other resources upfront for two to three years in order to provide sufficient time for the center to hire the necessary qualified individuals and develop relationships. Finally, be ready to think creatively and provide services that clients may not have considered. Much of the growth we have experienced has been the result of taking on opportunities that initially were not within our scope of services.
Ultimately, drug information services can become not just self-supporting, but can also generate revenue for the institution. In our organization, revenue earned through existing contractual agreements covers the salaries of all drug information specialists and support staff within the center. Additional income from these agreements is used to support the missions of both the department of pharmacy practice and the College of Pharmacy as a whole. The DIG plans to build upon past successes and further expand services and staff in coming years, both nationally and globally.
Michael Gabay, PharmD, JD, BCPS, is the director of the Drug Information Group and Prior Authorization Services at the University of Illinois at Chicago College of Pharmacy, where he also serves as a clinical associate professor. He can be contacted at firstname.lastname@example.org.
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