DoD Pharmacoeconomic Center The Impact of Sole Provider Program (SPP) / Warrior in Transition (WT) CHCS Drug Entries 1

DoD Pharmacoeconomic Center Global Guidance We do not recommend using Sole Provider Program, Warrior in Transition, or any other “dummy” drug entries in CHCS –Rationale: Prescriptions for these “drugs” generate valid, legal prescriptions on PDTS patient profiles We recommend utilizing the MTF Prescription Restriction Program which triggers MTF Lock-in warnings in CHCS/AHLTA when using SPP and/or WT entries 2

DoD Pharmacoeconomic Center Global Guidance If you continue to “dummy” drug entries for prescriptions, we recommend setting up the drugs in a way that minimizes the impact of the associated valid prescription. –You can control the NDCs and costs that are reported for “dummy” drug entries and prescriptions. 3

Minimizing the Impact of “Dummy” Drug Entries and Prescriptions Objective: maintain the effectiveness of the drug entry and minimize the impact on PDTS patient, provider, and site profiles. Solution: Multi-ingredient compound entry –Performs DUR checks and produces applicable drug class warnings for each component NDC; must ENABLE Drug Checks –Limitation: does not generate the DEA Overlap warning –Presents on PDTS/M2 with a Pseudo NDC; components (e.g. morphine) are not included in reports 4

DoD Pharmacoeconomic Center SPP/WTU Drug Entry: Why are they used? Mechanism to warn providers and pharmacy staff at the point of order entry and dispensing that this patient is on a sole provider program and/or a WT Mechanism to communicate the details of the situation, such as the PCM, secondary provider, contact number, risk status, and quantity limits

DoD Pharmacoeconomic Center Pharmacy Data Transaction Service (PDTS)/ MHS Mart (M2) PDTS: –Contains prescription data from MTF’s, Mail Order Pharmacy, and retail network pharmacies M2: –Contains medical and prescription information from MTFs and purchased care sector –Prescription information originates from PDTS 6

DoD Pharmacoeconomic Center What are PDTS and M2 used for? Reporting: Utilization and cost reports generated from PDTS or M2 are used by local, service, and DoD level leadership –Monitoring prescribing and utilization trends –Projecting the impact of proposed changes Patient Safety: Safety edits that automatically review the patient’s profile for appropriate therapy Identification of issues related to use of controlled substances

DoD Pharmacoeconomic Center What is the Impact on PDTS/M2? ALL of these entries show up as valid prescriptions NDCs, Drug Quantity, and Costs have the most meaningful impact on PDTS/M2

DoD Pharmacoeconomic Center Impact on decision-making: Real life examples NDC: –Increased number of Rx’s for controlled substances, including cocaine and morphine, for active duty members –Example: identified during the preparation in response to a Congressional inquiry and media question Cost/Quantity: –Rx costs are used in determining drug expenditures and data integrity issues –Example: $284,353.80/Rx for a SPP drug entry was identified by data integrity reports and review of expenditures for controlled substances Provider/Pharmacy IDs: –Used to identify fraud, abuse, and prescribing trends –Example: X% of controlled substance prescriptions were written by Provider Y

Example: Single ingredient drug entry

DoD Pharmacoeconomic Center Example: Single ingredient drug entry 11

Example: Multi-ingredient drug entry 12 Quantities equal to zero trigger the first NDC to be reported.

DoD Pharmacoeconomic Center Example: Multi-ingredient drug entry PDTS and M2 PDTS Rx #NDCBrand NameGeneric NameStrengthDosage Form LORAZEPAM 4 MG/MLDISP SYRIN LORAZEPAM 4 MG/MLDISP SYRIN LORAZEPAM 4 MG/MLDISP SYRIN CHCS PDTS RX#MEDICATION WTU PATIENT(NOTE RISK LEVEL & QTY L WTU PATIENT(NOTE RISK LEVEL & QTY L WTU PATIENT(NOTE RISK LEVEL & QTY L 13

DoD Pharmacoeconomic Center How do I trigger the pseudo NDC in CHCS? Legal status: 0 –manufactured in pharmacy; compound NDC and quantities –Must add 2-8 NDCs Component quantities –Each NDC added must have a quantity greater than 0 –0.001 (CHCS will not accept the leading 0) is the smallest quantity accepted 14

Triggering the pseudo NDC: Add New Drug to Formulary 15

DoD Pharmacoeconomic Center How do I minimize the cost of the prescription? Component quantities (ADN menu) –0.001 (CHCS will not accept the leading 0) is the smallest quantity accepted Local Cost = 0 Cost Flag –Set to Local Prescription Quantity –0.01 (CHCS will not accept the leading 0) is the smallest quantity accepted 16

Minimizing prescription costs: Formulary Maintenance

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DoD Pharmacoeconomic Center Drug File Template Summary Legal status: set up as a compound (0) NDCs: must be more 2-8 NDCs Quantities for each component: must be 1 or more (.001 recommended) Local cost = $0 Cost flag = Local Prescription quantity =.01

DoD Pharmacoeconomic Center Additional Considerations: Formulary Management Fields Formulary Status = FORMULARY Inactive Date = populated or blank –Some SPP processes rely on the drug entry being visible and available to providers and others rely on it being available only to pharmacy staff Comment = Reminder to determine RISK STATUS and QUANTITY LIMITS Max quantity =.01 or 1 (something low) Max days supply =

DoD Pharmacoeconomic Center Additional Considerations: Formulary Management Fields Dispense complete container = YES, if you are using a default quantity of 1 or NO, if you are using.01 Default Days Supply = 365 Default Quantity =.01 or 1 (something low) Default Sig = Reminder to perform a profile review Continuable = YES, in case the patient is admitted and is transferred 21

Additional Considerations: Formulary Management Fields

Additional Considerations: Prescription Information Sig = Sole provider and alternate name/contact info, in addition to risk status and quantity limits Provider = Sole provider, pharmacist involved in the SPP process, default provider –Default providers: MTF, OTHER (BM ): intended to be used for transfers of non-controlled substance prescriptions from one MTF to another MTF OTC, SELF CARE (BO ): intended to be used for OTC preparations –Pros for using default provider: does not assign a valid prescription to a person; known default to exclude when tracking prescribing –Cons for using default provider: not intended use, does not meet the needs of processes relying on the provider field to indicate the sole provider 23

Additional Considerations: Prescription Information

DoD Pharmacoeconomic Center Additional Considerations: Prescription Information Non-compliance: –Some processes include marking the prescription as “non-compliant” –Keeps the prescription on the active CHCS/AHLTA profile –Reverses the prescription from PDTS 25

DoD Pharmacoeconomic Center Summary Using a multi-ingredient compound set-up in CHCS will: Generate DUR warnings identifying Sole Provider patients Minimize the impact on reporting systems To trigger the multi-ingredient logic, you must: Legal status: set up as a compound (0) NDCs: must be more 2-8 NDCs Quantities for each component: must be 1 or more (.001 recommended) To minimize the costs reported for these entries, you can: Local cost = $0 Cost flag = Local Prescription quantity =.01

DoD Pharmacoeconomic Center Contact Info TMA POC DSN (312) Option 8 Libby Hearin