Presentation is loading. Please wait.

Presentation is loading. Please wait.

Promoting high quality, cost effective drug therapy throughout the Military Health System Breaking Down Silos in Search of Value CAPT Mark A. Richerson,

Published byTrevor Lambert Modified over 9 years ago

Similar presentations

Presentation on theme: "Promoting high quality, cost effective drug therapy throughout the Military Health System Breaking Down Silos in Search of Value CAPT Mark A. Richerson,"— Presentation transcript:

1 Promoting high quality, cost effective drug therapy throughout the Military Health System Breaking Down Silos in Search of Value CAPT Mark A. Richerson, MSC, USN Director, Department of Defense Pharmacoeconomic Center

2 DoD Pharmacoeconomic Center www.pec.ha.osd.mil 2 Objectives Define “Value” and impact of Military Treatment Facilities Discuss silos affecting delivery of DoD Prescription Benefit Discuss the role of conference attendees "Breaking Down Silos to Enhance the Value of the Pharmacy Benefit Across the MHS"

3 DoD Pharmacoeconomic Center www.pec.ha.osd.mil 3 Evidence Based Medicine Approach to health care practice in which the clinician is aware of the evidence in support of his/her clinical practice, and the strengths of that evidence - McMaster University The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients - BMJ 312:71-2

4 DoD Pharmacoeconomic Center www.pec.ha.osd.mil 4 The Search for Value Less Costly, More Effective More Costly, More Effective More Costly, Less Effective Less Costly, Less Effective The Cost Effectiveness Plane Effectiveness Cost Vytorin & Pravachol The Cost Effectiveness Judgment Nirvana! Non Formulary! Simvastatin (Zocor) Effectiveness Cost

5 DoD Pharmacoeconomic Center www.pec.ha.osd.mil 5 TRICARE Eligible Beneficiaries Monthly Average, FY06 Retirees & Family Members < 65 Other >1% Retirees & Family Members ≥ 65 Active Duty Family Members Active Duty 1.8M 2.3M 3.2M 25% 36% 19% 9.2 Million FY05 FY06 9.1 Million FY04 8.9 MillionFY03 8.6 MillionFY02 Source: M2

6 DoD Pharmacoeconomic Center www.pec.ha.osd.mil 6 Unique Users - Point of Service All Ages, FY05 to FY06 Source: PDTS Unique Users FY05 = 6.6M FY06 = 6.7M Retail 46% 19% 28% Mail Order 4% 1% MTF 2% 1% 42% FY0630% FY06 5%

7 DoD Pharmacoeconomic Center www.pec.ha.osd.mil 7 30-day Equivalent Rxs By POS, Oct 00 – Sep 06 Source: USPD, PDTS

8 DoD Pharmacoeconomic Center www.pec.ha.osd.mil 8 $ in millions Sources: PDTS and Prime Vendor MHS Outpatient Drug Spend FY02FY03FY04FY05FY06 MTF$1,388 $1,565 ( 12.7%) $1,704 (  8.9%) $1,615 ( ↓ 5.2%) $1,536 ( ↓ 4.9%) Retail$1,278 $1,847 ( 44.6%) $2,430 (  31.6%) $3,162 (  30.1%) $3,912 (  23.8%) Mail Order $347 $429 (  23.4%) $546 (  27.3%) $629 (  15.2) $718 (  14.2) Total$3,013 $3,841 (  27.5%) $4,680 (  21.8%) $5,406 (  15.5%) $6,166 (  14.1%) Cost per Beneficiary $347 $430 (  23.9%) $511 (  18.9%) $587 (  14.8%) $672 (  14.5%)

9 DoD Pharmacoeconomic Center www.pec.ha.osd.mil 9 Class Review & Implementation Tracking Oct-04 Nov-04 Dec-04 Jan-05 Feb-05 Mar-05 Apr-05 May-05 Jun-05 Jul-05 Aug-05 Sep-05 Oct-05 Nov-05 Dec-05 Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 PPIs ARBs PDE-5s AF-DERMs MS-DMDs CCBs ACEs BPH-ABs M/Ks NCSs ALZs AD1s GABAs OABs MiscHTNs EMETs BCs LIP1s TZDs Nov-06 Dec-06Jan-07Feb-07 H2s ADHDs SED2s

10 DoD Pharmacoeconomic Center www.pec.ha.osd.mil 10 NF/3 rd Tier 30dRxs MTFs, All Implemented UF Classes

11 DoD Pharmacoeconomic Center www.pec.ha.osd.mil 11 "Breaking Down Silos to Enhance the Value of the Pharmacy Benefit Across the MHS" What Silos?

12 DoD Pharmacoeconomic Center www.pec.ha.osd.mil 12

13 DoD Pharmacoeconomic Center www.pec.ha.osd.mil 13 Stakeholders in the MHS Pharmacy Benefit Patients/Beneficiaries Clinicians Policy makers Congress Resource Managers Industry

14 DoD Pharmacoeconomic Center www.pec.ha.osd.mil 14 Patient Policy Maker Congress Clinician Industry Resource Manager Aerial View of Rx Benefit Silos

15 DoD Pharmacoeconomic Center www.pec.ha.osd.mil 15 Pharmacy Cost Trend Components FY02- FY03 FY03- FY04 FY04- FY05 FY05- FY06 Change in Prevalence % Beneficiaries Using the Pharmacy Benefit 5.2%0.7%2.9%1.5% Change in Intensity 30 day Equivalent Rxs per User 6.3% 6.8%5.6% Price inflation Weighted % Change in price of Drugs 5.5%6.7%5.9%4.2% Mix/New Drugs Change in drug mix and new drug usage 5.1%4.0%-1.4%2.6% % Change in Average Cost per Beneficiary per Year 23.8%18.9%14.8%14.5% Sources: M2, PDTS, and Prime Vendor data

16 DoD Pharmacoeconomic Center www.pec.ha.osd.mil 16

17 DoD Pharmacoeconomic Center www.pec.ha.osd.mil 17

18 DoD Pharmacoeconomic Center www.pec.ha.osd.mil 18  Take advantage of this opportunity to better understand various stakeholder perspectives.  Ask questions and share what you learn with others.  Know the significant role you play in sustaining this premier, clinically sound, and cost effective benefit. Take Away Message:

19 Promoting high quality, cost effective drug therapy throughout the Military Health System www.pec.ha.osd.mil

Download ppt "Promoting high quality, cost effective drug therapy throughout the Military Health System Breaking Down Silos in Search of Value CAPT Mark A. Richerson,"

Similar presentations

Military Health System Overview LCDR Christian Wallis Director, Remote Site Healthcare TRICARE Area Office Europe.

Military Health System Overview LCDR Christian Wallis Director, Remote Site Healthcare TRICARE Area Office Europe.
Promoting high quality, cost effective drug therapy throughout the Military Health System TRICARE Mail Order Pharmacy LTC Don De Groff

Promoting high quality, cost effective drug therapy throughout the Military Health System TRICARE Mail Order Pharmacy LTC Don De Groff
Line Efficiency     Percentage Month Today’s Date

Line Efficiency     Percentage Month Today’s Date
LCDR Marisol Martinez, PharmD Fort Sam Houston, TX

LCDR Marisol Martinez, PharmD Fort Sam Houston, TX
Leading the Way Upstream: The Military Health System for 2012 and Beyond June 21, 2011 RADM C.S. Hunter, MC, USN Deputy Director TRICARE Management Activity.

Leading the Way Upstream: The Military Health System for 2012 and Beyond June 21, 2011 RADM C.S. Hunter, MC, USN Deputy Director TRICARE Management Activity.
Promoting high quality, cost effective drug therapy throughout the Military Health System MTF Prescription Restriction Program MTF Prescription Restriction.

Promoting high quality, cost effective drug therapy throughout the Military Health System MTF Prescription Restriction Program MTF Prescription Restriction.
Evaluation of the TRICARE Program FY 2011 WHAT IS TRICARE? TRICARE is a family of health plans for MHS. TRICARE responds to the challenge of maintaining.

Evaluation of the TRICARE Program FY 2011 WHAT IS TRICARE? TRICARE is a family of health plans for MHS. TRICARE responds to the challenge of maintaining.
Module 10: Pharmacy. Module Objectives After this module, you should be able to: Describe the TRICARE pharmacy benefit Explain features of the various.

Module 10: Pharmacy. Module Objectives After this module, you should be able to: Describe the TRICARE pharmacy benefit Explain features of the various.
Promoting high quality, cost effective drug therapy throughout the Military Health System Tools to Manage Purchased Care: An MTF Perspective CDR Jill Pettit,

Promoting high quality, cost effective drug therapy throughout the Military Health System Tools to Manage Purchased Care: An MTF Perspective CDR Jill Pettit,
As of 9/3/2015 1 1 DoD Pharmacoeconomics & Pharmacy Benefit Conference January 9 th, 2006 Major Travis Watson, MS, USA Deputy Director, DoD Pharmacy Programs.

As of 9/3/ DoD Pharmacoeconomics & Pharmacy Benefit Conference January 9 th, 2006 Major Travis Watson, MS, USA Deputy Director, DoD Pharmacy Programs.
Promoting high quality, cost effective drug therapy throughout the Military Health System PDTS and Its Impact on MTF Pharmacy Operations Gracie C. Ard,

Promoting high quality, cost effective drug therapy throughout the Military Health System PDTS and Its Impact on MTF Pharmacy Operations Gracie C. Ard,
Module 10: Pharmacy. Module Objectives After this module, you should be able to: Describe the TRICARE pharmacy benefit Explain features of the various.

Module 10: Pharmacy. Module Objectives After this module, you should be able to: Describe the TRICARE pharmacy benefit Explain features of the various.
CBHI Service Utilization FY 2014 July 1, 2013 through June 30, 2014 Prepared by Office of Behavioral Health staff 10/10/2014.

CBHI Service Utilization FY 2014 July 1, 2013 through June 30, 2014 Prepared by Office of Behavioral Health staff 10/10/2014.
1 TRICARE MANAGEMENT ACTIVITY Uniform Formulary, An Overview DoD Pharmacoeconomics & Pharmacy Benefit Conference 10 January 2005 Colonel James H. Young.

1 TRICARE MANAGEMENT ACTIVITY Uniform Formulary, An Overview DoD Pharmacoeconomics & Pharmacy Benefit Conference 10 January 2005 Colonel James H. Young.
Module 10: Pharmacy. 2 Module Objectives After this module, you should be able to: Describe the TRICARE pharmacy benefit List who is eligible for TRICARE.

Module 10: Pharmacy. 2 Module Objectives After this module, you should be able to: Describe the TRICARE pharmacy benefit List who is eligible for TRICARE.
Module 10: Pharmacy. 2 Module Objectives After this module, you should be able to: Describe the TRICARE pharmacy benefit List who is eligible for TRICARE.

Module 10: Pharmacy. 2 Module Objectives After this module, you should be able to: Describe the TRICARE pharmacy benefit List who is eligible for TRICARE.
Pharmacoeconomic Center Conference January 8, 2007 RADM Tom McGinnis, U.S.P.H.S. Chief, DoD Pharmaceutical Operations Directorate V5.

Pharmacoeconomic Center Conference January 8, 2007 RADM Tom McGinnis, U.S.P.H.S. Chief, DoD Pharmaceutical Operations Directorate V5.
Promoting high quality, cost effective drug therapy throughout the Military Health System Industry Teleforum August 2010 P&T By Dr. Jeremy Briggs PharmD,

Promoting high quality, cost effective drug therapy throughout the Military Health System Industry Teleforum August 2010 P&T By Dr. Jeremy Briggs PharmD,
 Enhance the capacity of the Department of Family Medicine to train Residents to design, implement, and evaluate an EB/QI plan  Focus on:  Rural practice.

 Enhance the capacity of the Department of Family Medicine to train Residents to design, implement, and evaluate an EB/QI plan  Focus on:  Rural practice.
Acute Myocardial Infarction (Heart Attack) Committee Membership: B. Majcher, APRN, C. Mulhall, APRN, K. McLean, MD, M. Jarotkiewicz RRT, MS, Administrative.

Acute Myocardial Infarction (Heart Attack) Committee Membership: B. Majcher, APRN, C. Mulhall, APRN, K. McLean, MD, M. Jarotkiewicz RRT, MS, Administrative.

Similar presentations

Ads by Google