1. VA Pharmacy Conference 2008 Consolidated Mail Outpatient Pharmacy Operations Kenneth Siehr Deputy Chief Consultant- Pharmacy Benefits Management Service Consolidated Mail Outpatient Pharmacy Operations Department of Veterans Affairs

2. Overview A little about me Life of a VA mail out prescription Outpatient prescription fulfillment system CMOP today CMOP history –How we got to where we are CMOP of Tomorrow How does this affect you?

3. Who Is This Guy? 30+ years in Federal Pharmacy –Pharmacy Intern VA Madison 1977 Army Pharmacist 1978-81 VA Staff Pharmacist 81-82 VA Pharmacy Supervisor since 1982 Chief of Pharmacy 1988 Managed Multiple Services at Medical Center VISN Formulary Leader (VISN 12) when positions were established PBM Manager 2004 Present Position 10/07

4. The Life of a VA Mail Out Prescription

5. Awaiting Verification 1 Hour to ??10 Hr12 – 48 Hrs 48 Hrs to ?? Awaiting Transmission to CMOP CMOP Filling Delivery to Patient Provider Orders Medication Patient Receives Goal: Delivery to Patient with 10 days of Patient/Provider request Life of a VA Mail Out Prescription

6. VHA Outpatient Medication Fulfillment System Medical Centers CMOP Contracting and Procurement Delivery to Patient Goal: Delivery to Patient with 10 days of Patient/Provider request

7. Medical Center Interface between –Patient and fulfillment system –Provider and fulfillment system Ensures right –Medication for patient clinically –Dose, frequency –Cost efficiency Dispenses Prescriptions (20%) –Window –Mail Responsible for Performance –Chief of Pharmacy, Facility TMT, VFL

8. CMOP Dispenses Prescriptions (80%) –Mail Primary Interface –Patient delivery services USPS, FedEx Mail consolidators Direct to patient vendors –NAC for outpatient medication contracts –Contractors for direct to patient delivery Responsible for Performance –CMOP Director, National CMOP and PBM

9. Contracting and Procurement National Pharmacy Benefits Management Services –Formulary Management –Identifies contacting opportunities –Monitors utilization –Contract compliance National Acquisition Center (NAC) – National contracts, BPAs, FSS Procurement and Contracting staff at each site and CMOP Responsible for Performance –Chief of Pharmacy, CMOP Director –National PBM, NAC

10. Delivery to Patient Window at Medical Centers To Patient’s Home –Contracted or third party vendors US Postal Service Federal Express or similar vendor –Mail consolidators Facilitate and speed process –Direct to patient contractors Responsible for Performance –Contracting Officer for contracted services –USPS

11. VHA Outpatient Medication Fulfillment System Medical Centers CMOP Contracting and Procurement Delivery to Patient Goal: Delivery to Patient with 10 days of Patient/Provider request

13. CMOP Today 7 separate locations Each highly automated and highly efficient and successful but with different equipment and software Different practices, processes and products –Murfreesboro – Media Mail –Hines – mail manifesting –Various prescription and mailing labels Limited national CMOP information system Beginnings of organizational support structure Collection of 7 individuals, not an integrated system

14. CMOP: Grass Roots Effort Grass roots effort –Concept proven at West LA and Leavenworth RFP Process –Equipment centrally funded –Medical Centers selected were to provide support Facilities Management, Contracting, Human Resources etc. –Medical Centers serviced provided inventory funding CMOP Director reported to local Board CMOP needed and fostered entrepreneurial culture –Highly successful results

15. Each CMOP a Contract Each CMOP the result of a turn key contract with a vendor –Vendor provided all equipment and software Different vendors = different equipment and software not designed to integrate with other CMOPs

16. Early CMOP Organization Each CMOP essentially owned by the Medical Centers it serviced Reporting to a Board made up of customers Unique equipment and software Organizational support provided by host site

17. CMOP Tomorrow 7 integrated locations Each highly automated and highly efficient with different equipment but the same software Standardized practices, processes and products –Same product list –Centralized customer interface, QA etc. –Patient medications from any CMOP Robust national CMOP information system accessible by users –Standardized reports –ProClarity cubes Mature and effective organizational support structure

18. How Does This Affect You? Ability to seamlessly shift workload between CMOPs –Equipment breakdown, disaster recovery –Specialty CMOPs –Patient centric, ship from closest CMOP More tools –Track Rx and package –Report and trend problems –Track and validate costs

19. Murfreesboro Zip Code Distribution

20. How Does This Affect You? Standardized product lists –Medical/Surgical supplies –Medications and pack sizes Medication event prevention –Screen and identify inappropriate Rx directions –Rx quantity checks

21. Get Involved and Work With Your VISN Formulary Leader as We Transition