Andrew Henriksen PBM-CMOP Pharmacoeconomics

What is Pharmacoeconomics? Compares of the value of one drug or drug therapy to another Provides guidance to allocate resources Identifies efficiencies or opportunities for improvement in care delivery

What is a Pharmacoeconomic Data Manager? Review and validation VISNs and facilities prescription dispensing via your PBM extraction data CMOPs prescription dispensing data Look for variation product utilization drug pricing - Average Unit Cost (AUC) dispense units per order unit quantity per prescription

Tools ProClarity Used to determine pharmacy workload Identify numbers of patients on, or prescriptions for a given product Forecast pharmacy expenditures Identify opportunities for improvement Data accuracy is essential to decision makers

Tools Current Month - locally available prior to PBM extraction High Cost RX report – VISTA CMOP monthly cost reports McKesson purchases Historical ProClarity-data from PBM extraction McKesson reports

SharePoint Site

SharePoint Site Link: http://vaww.national.cmop.va.gov/pre/PharmacoEconomic/default.aspx You can request access from the page or send an email to me at Andrew.Henriksen@va.gov

SharePoint Site Topics Nationwide Initiatives National saving opportunities VISN Specific Initiatives Network and local saving opportunities Purchases Savings by switching brand or size Contracts Contract compliance reports, FSS price changes

Savings Opportunities Tab Products that are essentially flat priced on a mg to mg basis or where certain strengths are much more expensive than others (examples: ziprasidone, haloperidol 10mg) Opportunities to save money dispensing one strength vs. another (example: dispensing 4 x 100mg imatinab tablets for a 400mg dose costs $79.23 vs. 1 x 400mg tablet @ $68.45)

Drug File Maintenance Tab Reports Monthly Cost Review Top 25 drugs by total cost Unmatched items Individual drug analysis reports

Monthly Cost Review Data from ProClarity Outpatient cube VISN & site cost per unique – last 4 Qtrs VISN & site cost per 30 day RX – last 6 mo Site cost and usage comparison last two months Templates to enter site specific data for last two months and site vs. complexity grouping

Monthly Cost Review Used to identify large changes to sites costs. Examples: Facility did not release prescription from ScriptPro –filled 44,000 less Day 30 RXs one month Wrong dispense unit per order unit – entered price per bottle of 1,000 as price per unit Brand vs. generic NDC purchase – 1 bottle of brand purchased, price on all RX’s in drug file

Top 25 drugs by VA total cost Site data from ProClarity Outpatient cube CMOP data from CMOP Fiscal database Compares the “correct” cost per unit to the average cost per unit from each sites PBM extraction The “correct” price is determined by either the price in McKesson (one NDC) or CMOPs average cost per unit (when multiple NDC’s) Goal is identify items with variance

Unmatched Items Data from PBM monthly extraction Products that are listed as *local, *more info, *supply, or *study in ProClarity *local: compounded products *study: study drugs *more info: may be in the NDF but there in not enough information to match *supply: may or may not have an NDC

Unmatched Items Over $10 million spent annually on unmatched items Potential workload savings if some of these items could be matched and sent to CMOP Potential unit cost or quantity issues contributing to unusually high site costs Potential for better pricing if national contracts could be negotiated

Individual Drug Analysis reports Data from ProClarity and McKesson Lists sites average cost per unit from their drug file, McKesson prices, and purchases made by facilities and CMOPs Goal is to have the sites drug files present an accurate picture of what they purchased and to identify opportunities for savings

So can I check my data? Determine your PBM data extract date (should be no sooner than the 5th of the month) Run High Cost RX report [PSO HI COST] Beginning Date: (APR 1, 2010) Ending Date: (APR 30, 2010) Dollar Limit : (0-9999): 30// 0 DEVICE: HOME// ;255;999999

Capture your High Cost RX report Save into notepad

Review with Excel

Review with Access Drug File Maintenance tool – Access database Queries High Cost Rx report from VISTA and CMOP cost report Uses the difference between CMOP average unit cost and local drug file average unit cost multiplied by local quantity dispensed to find the items with the largest variance

Review with Access Drug file items over/under by +/-$1,000 compared to CMOP avg unit cost Drug Name Qty Local Fill Drug File Avg CMOP Avg CMOP Over Under Cost Unit Cost Unit Cost Qty TIOTROPIUM 18MCG INHL CAP 30 344 $17,458.00 $50.75 $66.87 511 ($8,237.32) ALBUTEROL 90/IPRATROP 18MCG 200D PO INHL 722 $19,746.70 $27.35 $43.53 450 ($7,281.00) ASPIRIN 25MG/DIPYRIDAMOLE 200MG SA CAP 14,220 $14,876.75 $1.05 $1.30 15,930 ($3,984.33) IPRATROPIUM BROMIDE 17MCG 200D ORAL INHL 145 $4,049.85 $27.93 $47.94 199 ($3,981.99) RABEPRAZOLE NA 20MG EC TAB 1,200 $766.33 $0.64 $2.72 1,080 ($2,252.95) METOPROLOL SUCCINATE 100MG SA TAB 4,470 $905.59 $0.20 $0.65 3,735 ($1,666.10) CLONIDINE 0.3MG/24HR PATCH 492 $8,153.67 $16.57 $27.29 152 ($1,629.06) INSULIN SYRINGE 0.5ML 30G 0.5IN 50,180 $2,012.22 $0.04 $4.34 366 ($1,573.76) ZIPRASIDONE HCL 80MG CAP 720 $2,090.53 $2.90 $4.02 1,290 ($1,444.40) METOPROLOL SUCCINATE 50MG SA TAB 3,990 $602.92 $0.15 $0.48 3,910 ($1,274.06) MONTELUKAST NA 10MG TAB 13,170 $26,444.22 $2.01 $2.18 7,141 ($1,257.21) RISPERIDONE 2MG TAB 915 $3,786.40 $4.14 $0.69 915 $3,158.83 LEVETIRACETAM 500MG TAB 9,306 $12,874.88 $1.38 $0.15 2,640 $3,246.72 CITALOPRAM HYDROBROMIDE 20MG TAB 3,315 $1,615.06 $0.49 $0.04 7,785 $3,504.44 ALENDRONATE 70MG TAB 2,048 $10,060.44 $4.91 $0.47 820 $3,639.24 MOMETASONE FUROATE 220MCG ORAL INHL 120 9 $525.78 $58.42 $27.39 212 $6,578.36 RISPERIDONE 4MG TAB 1,995 $12,938.65 $6.49 $1.51 1,950 $9,693.02

How do I fix my data? Prescription Cost Update [PSO RXCOST UPDATE] back to the date of the price change for each drug entry you are changing a price Date Range Recompile Data [PSO MGMT RPT RANGE COMPILE] back > 1yr once all the prescription cost updates have been run Monthly Rx Cost Compilation [PSO COSTMONTH]

How do I request a fix of submitted data? Send an email request to Mike Wrobel, Alan Celestino and me including the below information product name Time period to correct Wrong price (from individual prescriptions) Correct price

Questions?