Oxazepam Cost-Savings Conversion

Abstract

After Mylan Pharmaceuticals dramatically increased the cost of generic lorazepam, the projected impact on the 1998 VA Northern California Health Care System (VANCHCS) pharmaceutical budget was significant. Requests for voluntary conversion from lorazepam to less-expensive alternative benzodiazepines had no significant impact on prescribing practices. The objective of this project was to determine mental health patients' clinical tolerance with conversion from lorazepam to an alternative benzodiazepine, primarily oxazepam. A structured conversion program was developed as a combined effort between Pharmacy and Mental Health Services. Seventy patients cared for by five outpatient psychiatrists were enrolled in the 4-month project. The active conversion took place over 1 month and involved one of two methods: clinical pharmacy specialist recommendation or direct intervention. At the conclusion of the project, 88.6% of patients were converted from lorazepam to an alternative benzodiazepine or were taken off benzodiazepines completely. Oxazepam was chosen in 45.7% of these cases, resulting in an annual cost savings of $15,800. Based on the results of this project, lorazepam prescribing is now restricted to the mental health service.