1. UF Implementation: Best Practices from MTFs ● Brian White Tripler Army Medical Center/Hawaii Multi-Service Market

2. Implementing the Uniform Formulary: Methods for a DoD Medical Center and Multi-Service Market Brian White, Pharm.D. Tripler Army Medical Center

3. 44 miles 30 miles Hawaii Multi-Service Market Army MTF Navy MTF Air Force MTF USCG MTF 

4. Monthly Outpatient Workload Tripler Army Medical Center Hawaii Multi- Service Market New Rxs32,10074,500 Refills11,10023,500 Total43,20098,000

5. The MTFs’ UF Challenge DoD Uniform Formulary BCF / ECF / UFNon-formulary Formulary Non-formulary MTF Formulary  #*%!

6. The Mission Efficient market share shift Preserve integrity of medical necessity criteria Minimize risk to the patient Optimize therapeutic outcomes BCF / ECF / UFDoD Non-formulary Drug BDrug A

7. Desired Market Shift? Unique Patients Decreased utilization of NF drug Adhere to medical necessity criteria Drug A (NF)Drug B

8. Desired Market Shift t Unique Patients t Suggestive of a coordinated, clinically-sound conversion strategy Drug A (NF)Drug B Total A+B

9. Regional MTF coordination Aggressively prevent initiation of NF drug therapy not meeting MN criteria Promote use of UF alternative Provide convenient access to NF drugs when indicated Apply proactive, clinically-sound patient conversion strategy Implementing UF Decisions

10. Regional Coordination DoD P&T Committee Oahu Regional P&T Committee Single CHCS formulary Army Air Force Navy USCG Consistent UF implementation strategy across MTFs Shared administrative resources Regional P&T coordinator / formulary manager

11. Prevent Unauthorized NF Drug Use Provider communication –“Shotgun approach” –Newsletter –Broadcast e-mails –P&T representatives –Clinical pharmacist inservices CHCS configuration

12.  Prevents provider Rx order entry/renewal  Allows pharmacy staff order entry  Allows refill patient-initiated refill processing

14. Provider Interface (AHLTA)

15. Facilitate Authorized NF Drug Use Grandfather pre-existing patients meeting medical necessity criteria Non-formulary drug request process –Convenient –Quick –Effective –Educational –Perceived clinical value

20. Promote Use of UF Alternative Medication Management Portal Newsletter Broadcast e-mails Clinical pharmacist presentations/detailing Targeted pharmaceutical rep detailing

24. Active Patient Conversion Strategy Magnitude of target patient population Demographics of target population Goal timeline Clinical risk –Adverse effects (toxicity) –Loss of therapeutic control/efficacy –Patient education requirements

25. anitdepressants Clinical Pharmacists BPH α-blockers PPIs ACE inhibitors.PCMs Converting MTF Rxs/Patients Specialists No conversion (Grandfathered) Clinical risk associated with conversionTime required for conversion Outpatient Pharmacy

26. Converting Non-MTF Rxs/Patients Mailers –Personalized –Avoid blind-siding the patient at the patient –MTF formulary alternatives –Tricare phamacy benefit options –Give patient an opportunity to be proactive Handout for patient/physician –Explanation –Formulary alternatives –On-line formulary URL

27. Pharmacy Informatics Support Identify affected patients –Conversion targets  Patient list for PCMs and clinic pharmacists  t-cons, appointments –Pts meeting MN  document local non-formulary approval –Patients with non-MTF prescriptions  mailers CHCS ad hocs and database analysis –Active Rxs for target drug –Filled within last 4-6 months –Retrieve assigned PCM and associated clinic –Retrieve mailing address and phone numbers –Retrieve relevant lab values or prescription history Service for whole MTF market

28. Conclusion Goal: Move market share –Extensive –Efficiently –Clinically sound process –Customer satisfaction Tools –Regional coordination/standardization –Diverse communication venues –Managing CHCS –Effective non-formulary drug request process –Proactive formulary conversions –Hands-on pharmacy involvement –Local CHCS data