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MTF Prescription Restriction Program

MTF Prescription Restriction Program. MTF Prescription Restriction program. MTF Prescription Restriction Process. MTF providers identify beneficiary who may have “drug seeking behavior” or high risk of harming self or others Use Pharmacy Data Transaction Service (PDTS) to set restriction

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MTF Prescription Restriction Program

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  1. MTF Prescription Restriction Program MTF Prescription Restriction program

  2. MTF Prescription Restriction Process • MTF providers identify beneficiary who may have “drug seeking behavior” or high risk of harming self or others • Use Pharmacy Data Transaction Service (PDTS) to set restriction • The provider has the option to: • Restrict all meds to a specific pharmacy(s) and/or provider(s) • Restrict controlled meds to a specific provider or list of providers • Exclude controlled substances or specific non-controlled substance(s) at mail order or retail pharmacy • The restriction form is available on the PEC website: • http://pec.ha.osd.mil/Pharmacy_restriction.php

  3. Medication Restriction Program • MTFcommunicates to the POC which restriction type to manage pharmacy benefit • Requires signature and coordination of the “Triad Team” comprised of the Provider, Nurse Case Manager, and the MTF Pharmacist • Coordination between Triad Team and POC when SM is on leave or transfers for care • Community-Based Pharmacy Restriction Program • AD Members assigned to CBWTU • Community-based Pharmacy Restriction Form • Specific retail network pharmacy • Specific network provider • For Restriction Removal or temporary lift: • Contact the POC at 1-866-275-4732 option 8 or send e-mail to: pdts.ameddcs@amedd.army.mil

  4. Retail Medication Restriction Program (1-1-1) • Express Scripts, Inc. (ESI) identifies members quarterly • ESI sends data to Managed Care Support Contractor (MCSC) to examines medical & pharmacy claims to include / exclude in program • ESI generates letters to members to select pharmacy, provider & medical facility • Letters not returned in 60 days or undeliverable are set at 100% Prepayment on all control meds • Member returns letter with selections • ESI sends information to POC to enter selections in PDTS

  5. PDTS: Lock-In Edit

  6. How Will the Lock-in Edit Work? What is the Lock-in edit? • The MTF Lock-in edit is an overridable PDTS warning that is triggered by patient restrictions established through the Prescription Restriction Programs • For patients with restrictions established through Prescription Restriction Programs: – MTF: •PDTS will return a warning message to AHLTA and CHCS if an unauthorized provider and/or pharmacy attempts to prescribe/dispense a medication •Lock-in warnings at MTFs can be overridden by the provider and pharmacy – Retail and Mail Order pharmacies: •PDTS will continue to return rejections to the pharmacy and the prescription will not process •Lock-in rejections at retail and mail order pharmacies can not be overridden by the pharmacy

  7. MTF Lock-in Edit: Scenario and messaging • Patient RESTRICTED to Prescriber A for controlled medications • Conflict: LOCKED-INOrdered Drug: Percocet (oxycodone/acetaminophen) Comments:Additional Information:PRESCRIBER/DRUG NOT AUTHORIZED FOR THIS BENEFICIARY. PHARMACY ONLY, FOR QUESTIONS CALL 1-866-275-4732 OR DSN (312) 471-8274 OPTION 8.[PRESS RETURN TO CONTINUE] • The TMA POC toll free and DSN numbers are listed in the warning if detailed information on the restriction is required (e.g. the approved provider, pharmacy, etc). • AHLTA: Providers are presented with clinical reasons for not overriding the warning and

  8. Variations in the Warning Message

  9. Reports: Availability and Descriptions • Violation Reports – restricted members from your site that are in violation of their restriction • Site Reports – members with active restrictions • **70 and M2 Rejections Reports – restricted members from your site that attempted to violate their restriction at mail order and/or retail pharmacies. • **DUR Warning Reports – RXs that are the result of your MTF overriding the MTF Lock-in PDTS warning. Note: All reports are generated by individual site only. **70 and M2 Rejections reports and DUR Warning Reports are future initiatives.

  10. Example Violation report (Type I): (Restricted to a specific pharmacy or list of pharmacies and/or provider or list of providers for all medications)

  11. Example Site report (Type I): (Restricted to a specific pharmacy or list of pharmacies and/or provider or list of providers for all medications)

  12. How do I learn more about the MTF Lock-in or MTF Prescription Restriction Program? • Additional information on both topics is available at http://pec.ha.osd.mil/Pharmacy_restriction.php OR • Contact the TMA POC at: • 1-866-275-4732 or • DSN (312) 471-8274 OPTION 8 or • email pdts.ameddcs@amedd.army.mil

  13. Questions

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