Pharmacy Variation Utilization and variation for maintenance and scheduled drugs Nevin Aragam, CNA Analysis and Solutions

Outline We investigate Navy pharmacy utilization and variation for FY 2011 to identify and understand patterns among our population of maintenance and scheduled pharmaceutical users  Methods  All drugs  Maintenance drugs  Scheduled drugs FOR OFFICIAL USE ONLY 2

Methods FY 2011 PDTS via MDR Used catchment area of record to identify the eligible populations surrounding navy catchment regions Identified all eligible beneficiaries in FY 2011 using DEERS and the demographic information from the most recent FM the beneficiary appeared Maintenance drugs are identified with the MDR PDTS field Maintenance Drug = ‘Y’ Scheduled drugs and identified using the MDR PDTS field DEA Class = 1, 2, 3, 4, or 5* FOR OFFICIAL USE ONLY 3 * note, there were no drugs identified as having DEA class 1 in PDTS

All pharmacy age distribution FOR OFFICIAL USE ONLY 4 Age distribution for all pharmacy users

FOR OFFICIAL USE ONLY 5 All pharmacy utilization 30 day supplies per 1,000 Navy region beneficiaries by age 60, days supplies implies the average 80 year old takes about 5 medications daily

FOR OFFICIAL USE ONLY 6 Popular fill source AD beneficiaries fill almost exclusively at MTF pharmacies Active duty family members and retirees fill mostly at MTFs and a sizable proportion at retail pharmacies Retirees and their dependents fill fairly evenly across MTFs and retail pharmacies Source System ADADFMRET RETDEP/ OtherTotal Direct93.6%61.3%48.4%40.1%53.8% Retail5.3%37.4%40.6%50.9%39.2% Mail order0.3%0.7%6.4%5.3%4.1% Other0.8%0.6%4.5%3.6%3.0% Total100.0% Source: MHS Data Repository (MDR PDTS table FY2011).

Types of maintenance drugs Top 5 Maintenance drugs (15% of all maintenance drugs prescribed) 1. IBUPROFEN 2. SIMVASTATIN 3. LISINOPRIL 4. NEXIUM 5. LIPITOR FOR OFFICIAL USE ONLY 7

8 Maintenance drug age distribution Age distribution for maintenance pharmaceutical users

FOR OFFICIAL USE ONLY 9 Maintenance drug utilization 30 day supplies of maintenance drugs per 1,000 Navy region beneficiaries by age 50, days supplies implies the average 80 year old takes about 4 maintenance medications daily

FOR OFFICIAL USE ONLY 10 Maintenance drug regional variation High: NH Pensacola (13, day supplies) Low: NCA MSMA (9, day supplies) High/Low: 1.41 (Beneficiaries in NH Pensacola use 1.4 times as many maintenance drugs as those in the NCA MSMA) Regional variation for maintenance drug prescriptions per 1,000 beneficiaries

Scheduled drugs FOR OFFICIAL USE ONLY 11 ScheduleAbuse potential Accepted medical use Likelihood of psychological or physical Dependence Examples IHighNoNo accepted safety for use Heroin, LSD, marijuana IIHighYesHighAmphetamine (Adderall ® ), methamphetamine (Desoxyn ® ), cocaine IIIModerateYesModerateVicodin ®, Tylenol with codeine ®, ketamine IVLowYesLimitedAlprazolam (Xanax ® ), diazepam (Valium ® ) VLowYesLimited Robitussin AC ®,Phenergan with Codeine ®

Types of scheduled drugs Top 5 Scheduled drugs (55% of all schedules drugs prescribed) 1. HYDROCODONE-ACETAMINOPHEN 2. ZOLPIDEM TARTRATE 3. OXYCODONE-ACETAMINOPHEN 4. ALPRAZOLAM 5. DIAZEPAM Scheduled drugs can also be maintenance drugs: 1. CLONAZEPAM 2. CONCERTA 3. LYRICA 4. ADDERALL XR 5. VYVANSE FOR OFFICIAL USE ONLY 12

FOR OFFICIAL USE ONLY 13 Scheduled drug age distribution Age distribution for scheduled pharmaceutical users

FOR OFFICIAL USE ONLY 14 Scheduled drug utilization 30 day supplies of scheduled drugs per 1,000 Navy region beneficiaries by age 1, days supplies implies the average 80 year old takes about 1.5 scheduled drug medications daily

FOR OFFICIAL USE ONLY 15 Scheduled drug regional variation High: NH Pensacola (1, day supplies) Low: NCA MSMA ( day supplies) High/Low: 1.89 (Beneficiaries in NH Pensacola use nearly twice as many scheduled drugs as those in the NCA MSMA) Regional variation for scheduled drug prescriptions per 1,000 beneficiaries

FOR OFFICIAL USE ONLY 16 Questions? Nevin Aragam

Appendix Navy region definitions by catchment area DMIS ID: NCA MSMA – Tide Water MSMA San Diego MSMA Puget Sound MSMA NH Beaufort NH Camp Lejeune NH Jacksonville NH Lemoore NH Pensacola NH Twentynine Palms FOR OFFICIAL USE ONLY 17