1. How to Increase Compliance with DoD PEC Formulary Major Robin J. Johnson Diagnostics & Therapeutics Flt/CC P&T Chairperson Ellsworth AFB, South Dakota

2. Introduction Strategy Provider “Buy-In” Non-Formulary Request Process Physician Champion Stand firm

3. Strategy Educate MTF Providers New PCM Pharmacy Orientation letter IAW AFI 44-102, section 10.6.2, “PCMs…use formulary drugs wherever possible…DoD formulary 1 st line agents at all MTFs” Costs/comments on CHCS “choose Aciphex or Prilosec 1 st line, costs less”

4. Strategy Educate MTF Providers (Cont) Invite PCMs to P&T meetings as guests Explain all aspects of meeting; why we do what we do at these meetings New Item Requests welcome Educate on cost of meds (also in CHCS) Explain ramifications of adding med to formulary Impact of Civilian Rxs

5. Strategy Educate Civilian Providers & Patients MTF Website available (update issues) Paper formularies hand carried by patients Paper formularies faxed by request Absolutely do NOT allow a medication to stay on or go onto the MTF formulary that is not consistent with DoD BCF

6. Strategy Good relationship with Providers Invite them to P&T as guests; explain process Encourage them to use New Drug Request for consideration of MTF formulary addition Communicate, communicate, communicate Explain decisions made; give options and alternatives

7. Strategy Good relationship with Providers (cont) Make every effort to be available for the PCMs and try to work with their needs It’s not just a business, it’s caring about the patient

8. Provider Buy-In Understanding the P&T Processes/Budget More willing to follow the formulary Encourage patients to try formulary items, not newest, most advertised med (Woman’s Day, Reader’s Digest, TV, etc.) Communication again…make yourself available for patients and providers Teamwork is key…we’re all one team If they think you’re on their side…they’ll play ball

9. Non-Formulary Requests Process in place MDG form 28, Patient Specific Special Purchase Request MUST be submitted IAW MDG Policy meds may be ordered for patients: Enrolled to the MTF - CHCS Patient Enrollment History (PENR) status Must show medical necessity NO OTC meds

10. Non-Formulary Requests Review Process by Pharmacist Ensure criteria are met 1-week turn around time Signed lastly by SGH after patient has received the medication Denials to requests are explained to the PCM with suggested options of formulary items If PCM disagrees with denial, SGH is final say

11. Physician Champion SGH is the Physician Champion Make sure he’s on-board with Pharmacy Co-chairs P&T with Pharmacist and fully understands our processes and budget concerns Pharmacist is NOT just the recorder He has my back on decisions I respect his authority if he overrides a denial decision Good working relationship

12. Stand Firm It’s your budget; you have to answer to spending too much DoD PEC mandated changes: Voting is NOT an option at P&T Remove the drug – tell them at P&T Add the drug – tell them at P&T Vote ONLY on items that you may carry

13. Summary Strategy Provider “buy-in” Nonformulary Request Process Physician champion Stand firm

14. Maj. Robin J. Johnson D&T Flight/CC Ellsworth AFB, South Dakota Robin.johnson@ellsworth.af.mil DSN: 675-3252 Comm: 605-385-3252