Effect of a pharmacy-based cost-containment program on cimetidine costs and use.

A program developed by the University of California at San Diego Medical Center to curb over-prescribing of cimetidine is described. Guidelines for cimetidine use were approved in September 1985. Pharmacists undertook physician education and enforced the guidelines by monitoring patients through a specially designed documentation form. When use of cimetidine was not in compliance with the guidelines, the pharmacists contacted the physicians to recommend changes. Use of cimetidine hydrochloride injection declined 49% between September 30 and December 6, 1985. Extrapolated to an entire year, this reduction would result in cost savings of +12,000 to +16,000. However, after pharmacists stopped enforcing the guidelines in December 1985, use of cimetidine hydrochloride injection gradually increased to near control levels. In February 1986, the review of patients receiving cimetidine was reinstituted, resulting in another decline in use. Periodic review and reinforcement by pharmacists appear necessary to ensure that cimetidine continues to be prescribed appropriately.