1. Implementing and Monitoring Pharmacotherapy Benefit Rebecca Ruiz-McGill, Bob Leischow, Dale Gehring and Corbie Ball Arizona Smokers’ Helpline a service funded by the AZ Department of Health Services, a part of the AZ College of Public Health.

2. Arizona Cessation History  Arizona Smokers’ Helpline began operations in 1995 and became a service funded by Arizona Department of Health Services (ADHS) in 1996.  Group-based cessation classes funded by the state in 1997.  Medications for tobacco cessation introduced by each group-based project as cessation programs grew.

3. AZ Cessation History  Each project provided different discount benefit for cessation clients.  State standardized and centralized pharmacotherapy benefit FY 03-04.  December 2003, AZ Smokers’ Helpline allowed to provide benefit to telephone-based clients.

4. The Benefit 50% discount on:  Zyban (with prescription),  Patch: 14-day supply 7,14, or 21mg dose;  Gum: 48 or 50 pieces of 2m or 4mg dose;  Lozenge: 72 pieces of 2mg or 4mg dose.

5. The Benefit  Six vouchers redeemable within seven days from date of issue  Valid for up to 6 months  Client allowed to access benefit once every 6 months

6. Managing the Benefit  ADHS contracted with US Script to manage the pharmacy benefit.  US Script contracts with any pharmacy within state to accept discount on medications as offered through various health plans.  Enrollment tracked as client enrolls for Helpline or community-based cessation programs.

7. Managing the Benefit Need to screen for contraindications Need to monitor use Need to minimize abuse Need to track product distribution Need to verify IDs

8. Managing the Benefit  US Script tracks enrollee’s name, contact info, birth date, vouchers redeemed, and product distributed.  Helpline needed to develop ID verification process, contraindication screening and internal process to minimize abuse.

9. Process development  Developed medication screener to ensure contraindications were addressed.  Doctor’s written approval needed for the following: pregnant women, those under 18 and those with contraindications as listed by product.

10. Process Development  Developed an ID verification process using community-based program’s offices and our office as verification sites.  Minimized abuse by training staff to verify client has not been enrolled in the program during last 6 months within US Script database

11. Promoting the Benefit  Mass mail out using database which captures data that tracks healthcare providers who refer clients or request materials.  Benefit also promoted through on- going trainings for healthcare providers.

12. Results US Script Utilization Report Period Clients Enrolled IDs ReceivedID % # Clients who redeemed vouchers % Clients who redeemed vouchers Vouchers Redeemed (claims) Vouchers redeemed per client 12/1/03-1/31/04 813239.5%2125.9%321.5 1/1/04-3/31/04 17910458.1%8044.7%2373.0 4/1/04-6/30/04 22814664.0%13860.5%3272.4 7/1/04-9/30/04 21812758.3%12055.0%3663.1 10/1/04-10/30/04 684058.8%3652.9%902.5 11/1/04-11/30/04 1555434.8%6843.9%1552.3

13. Results Products Redeemed (# of weeks) Patches% PatchGum% GumLozenge% LozengeZyban% Zyban 12/1/03-1/31/04 2371.9%412.5%4 13.1% 1/1/04-3/31/04 18678.5%229.3%218.9%83.4% 4/1/04-6/30/04 21967.0%4814.7%309.2%309.2% 7/1/04-9/30/04 29380.1%205.5%287.7%256.8% 10/1/04-10/30/04 7987.8%11.1%00.0%1011.1% 11/0/04-11/30/04 11876.1%95.8%2113.5%74.5%

14. What have we learned  Directly linking US Script data with client intake data at the start of the program to assess impact on quit status.  Product compliance an issue.  Identification process a barrier.

15. Contact Information  Rebecca Ruiz-McGill  rrmcgill@u.arizona.edu rrmcgill@u.arizona.edu  www.tepp.org www.tepp.org  www.ashline.org www.ashline.org