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PEC Update Drug Utilization and Cost Trends in the Military Health System

2. Topics. Pharmaceutical usageUsersPrescriptionsCostsPer beneficiary per year cost trendPrevalence of useIntensity of usePrice inflationTherapeutic mix / new drugsCost containment initiativesChanges at the PEC. 3. DoD Pharmacy Program Objective. Uniformly, consistently, and equitably provide appropriate drug therapy to meet patients' clinical needs in an effective, efficient, and fiscally responsible manner.

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PEC Update Drug Utilization and Cost Trends in the Military Health System

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    1. PEC Update Drug Utilization and Cost Trends in the Military Health System CDR Mark A. Richerson Director, DoD Pharmacoeconomic Center

    2. 2 Topics Pharmaceutical usage Users Prescriptions Costs Per beneficiary per year cost trend Prevalence of use Intensity of use Price inflation Therapeutic mix / new drugs Cost containment initiatives Changes at the PEC

    3. 3 DoD Pharmacy Program Objective Uniformly, consistently, and equitably provide appropriate drug therapy to meet patients clinical needs in an effective, efficient, and fiscally responsible manner

    4. 4 PEC Mission

    5. 5 TRICARE Pharmacy Benefit Outpatient Pharmacy Points of Service 536 Military Treatment Facility (MTF) pharmacies TRICARE Mail Order Pharmacy (TMOP) 54,000+ retail network pharmacies Non-network retail pharmacies

    6. 6 TRICARE Pharmacy Benefit Design Point of Service Comparison

    7. 7 Uniform Formulary Rx Co-Pays A simple chart. You have seen it before. It is a simple message. Our beneficiaries have a choice and may actively participate in managing the most comprehensive and robust pharmacy benefit in the nation. It isnt free, but then, how many things do you truly value, that cost you nothing?A simple chart. You have seen it before. It is a simple message. Our beneficiaries have a choice and may actively participate in managing the most comprehensive and robust pharmacy benefit in the nation. It isnt free, but then, how many things do you truly value, that cost you nothing?

    8. 8 Data Sources Pharmacy Data Transaction Service (PDTS) Rx usage and cost data for MTF, retail network pharmacies and TMOP) Uniformed Services Prescription Database (USPD) Rx usage data for MTF pharmacies Pharmaceutical prime vendor data Quantities and costs of drugs purchased by MTFs M2 data warehouse

    9. 9 TRICARE Eligible Beneficiaries By Month, FY03 FY04 (millions)

    10. 10 TRICARE Eligible Beneficiaries Monthly Average, FY04

    11. 11 Components of Utilization

    12. 12 Prevalence of Pharmacy Benefit Use FY02 FY04

    13. 13 MHS Pharmacy Benefit Users By POS, Jul 01 Sep 04

    14. 14 MTF Pharmacy Users by Age Jul 01 Sep 04

    15. 15 Mail Order Pharmacy Users by Age Jul 01 Sep 04

    16. 16 Retail Pharmacy Users by Age Jul 01 Sep 04

    17. 17 Unique Users by Point of Service All Ages, FY04

    18. 18 Unique Users by Point of Service By Age, FY04

    19. 19 Unique Users = 65 4Q FY01 4Q FY04

    20. 20 Unique Users < 65 4Q FY01 4Q FY04

    21. 21 Intensity of Prescription Use FY02 FY04

    22. 22 30-day Equivalent Rxs By POS, Oct 00 Dec 04

    23. 23 MHS 30-day Equivalent Rxs By Age, Apr 01 Dec 04

    24. 24 FY 2004 Drug Price Inflation

    25. 25 MHS Outpatient Drug Spend Definitions & Sources Retail network pharmacies (excludes non-network) Ingredient cost + dispensing fee + tax co-pay Source: Pharmacy Data Transaction Service (PDTS) TMOP Ingredient cost + admin fee co-pay Source: PDTS MTF pharmacies Ingredient cost only Sources: Prime Vendor (FY02) and PDTS (FY03 on)

    26. 26 MHS Outpatient Drug Spend ($Millions)

    27. 27 Cost per Beneficiary by Age FY02 FY04

    28. 28 Cost per Beneficiary by POS FY04

    29. 29 Pharmacy Cost Trend Components FY02 FY04

    30. 30 Pharmacy Cost Trend Components by Age FY03 FY04

    31. 31 Top 6 Therapeutic Classes based on MTF Prime Vendor Purchases

    32. 32 Cost Containment Initiatives PEC Update Feb 2004 Review results for: Second-generation antihistamines SSRIs Triptans Fluoroquinolones

    33. 33 2nd Generation Antihistamines (SGAs)

    34. 34 MTF SGA Days of Therapy Jul 01 Sep 04

    35. 35 MTF SGA Market Share By Days of Therapy, Jul 01 Sept 04

    36. 36 MTF SGA Mean Cost per Day of Therapy Jul 01 Aug 04

    37. 37 SSRIs

    38. 38 MTF SSRI Rx Fills Tabs/caps only, Jul 01 Sep 04

    39. 39 MTF Fluoxetine Rx Fills Jul 01 Sep 04

    40. 40 SSRI Mean Cost per Unit Tabs/caps only, Oct 99 Aug 04

    41. 41 Triptans

    42. 42 MTF Oral Triptan Utilization Tablets only, Jul 01 Sep 04

    43. 43 MTF Oral Triptan Market Share Tablets only, Jul 01 Sep 04

    44. 44 MTF Triptan Mean Cost Per Tablet Jul 01 Aug 04

    45. 45 MTF Mean Cost per Triptan Tablet Jan 03 Aug 04

    46. 46 Oral Fluoroquinolones for CAP & Sinusitis Gatifloxacin, Levofloxacin, Moxifloxacin

    47. 47 MTF Rx Fills for Gatifloxacin, Levofloxacin, & Moxifloxacin Apr 03 Sep 04

    48. 48 MTF Mean Cost per Tablet for Gatifloxacin, Levofloxacin, & Moxifloxacin Apr 03 Aug 04

    49. 49 MTF Mean Cost per Tablet for Gatifloxacin, Levofloxacin, & Moxifloxacin Tabs only, Apr 03 Aug 04

    50. 50 Changes at the PEC New Data Management Division Director is MAJ(P) Brett Kelly

    51. 51 Our New Home

    52. 52 THANK YOU!

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