Background and importance Certain high-cost, tendered hospital medicines, especially biologic drugs, special budget medicines of hepatitis C virus (HCV) and haemophilia are covered by item-based reimbursement in Hungary. Patients receive such therapies in clinical centres, and hospital pharmacists report use item-by-item. The National Health Insurance Fund reimburses the product after having checked the appropriateness of the use. Accordingly, appropriateness of the administration by hospital pharmacy staff is of critical importance. The ever-expanding amount of high-cost hospital medicines with item-based reimbursement imposes an additional burden on institutions involved in the dispensing process.

Aim and objectives The aim of our study was to determine the time and cost implications of providing a safe and efficient supply of these high-cost specialty medications, and to confirm the shortages in personnel, infrastructure and funding.

Material and methods We have defined the activities related to supply of high-cost item-based medications in our institution (ordering medicines and requesting quotas, receiving goods, storing, preparing for administration, dispensing, reporting). We have conducted a prospective workload and time analysis for each related subtask (who, when, what, for how long) in June 2021. Based on these data, we calculated the mean time (±standard deviation) spent on the process steps and the related direct and indirect costs based on a national controlling manual for the first quarter of 2021.

Results The hospital pharmacy dispensed 50 high-cost item-based medications, 10 employees (3 pharmacists, 5 specialist pharmacy assistants, 1 administrator, 1 technical staff) were involved in the related workflow. We analysed data on 3368 preparations purchased during 263 orders, and a total of 1657 dispensing events over 3 months. The workload analysis yielded an average of 66.8±7.0 hours per month equalling daily 3.23± 0.16 hours, which was an average of 5.68± 0.15 min per dispensing event. The average direct human cost was €775.31±€91.37/month, direct non-human cost was €1228.26±€396.75/month and indirect non-human cost was €1256.7±€55.06/month, which was equivalent to €5.84±€0.3 per dispensing task

Conclusion and relevance Our findings provide valuable evidence on the workload burden and financial shortcomings of hospital pharmacies related to the dispensing and documentation of high-priced item-based reimbursed medicines in Hungary.

Conflict of interest No conflict of interest