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Pharmacy Data

Pharmacy Data. Mark W. Smith, PhD July 13, 2005 Health Economics Teleconference Seminar 1-800-767-1750 access code 45043. Topics. Overview of Data Sources Access & File Names Highlights of Contents Guidance for Use Non-VA Pharmacy Data. Abbreviations. AAC: Austin Automation Center

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Pharmacy Data

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  1. Pharmacy Data Mark W. Smith, PhDJuly 13, 2005Health Economics Teleconference Seminar 1-800-767-1750 access code 45043

  2. Topics • Overview of Data Sources • Access & File Names • Highlights of Contents • Guidance for Use • Non-VA Pharmacy Data

  3. Abbreviations • AAC: Austin Automation Center • BPA: Blanket Purchase Agreement • CMOP: Centralized Mail-Order Pharmacy • DSS: Decision Support System • MCRR: Medical Care Cost Recovery program • NDE: National Data Extract • PBM: Pharmacy Benefits Management • VAMC: Veterans Affairs Medical Center • VISTA: Veterans Health Information Systems and Technical Architecture

  4. Overview - 1 • VISTA • Repository of primary data: clinicians enter data directly • Many files comprise pharmacy data “package” • Separate VISTA system at each VAMC • PBM v3.0 Database • Data from local VISTA systems + new elements • National coverage: all VA pharmacies • Only outpatient prescriptions available currently • DSS National Pharmacy Extract • Data from local DSS systems + new elements • National coverage: all VA (local) DSS systems • Inpatient and outpatient prescriptions available

  5. Overview - 2 • DSS National Data Extracts • Contains all types of care (inpatient, outpatient, pharmacy) • Separate from DSS Pharmacy Extract • Data from local DSS systems + new elements • National coverage

  6. Additional Pharmacy Data Sources • Fee Basis files • Data from non-VA pharmacies paid by VA • National coverage • DSS Production Data • Contains finer detail than national DSS extracts • Pertains to local DSS system only

  7. A Record Represents • VISTA, PBM database, DSS national pharmacy extract, Fee Basis: • a single prescription or supply for an individual • DSS NDE for inpatient/outpatient care: • all prescriptions and supplies for a person on a particular day

  8. A Record Represents • DSS production data: • All prescriptions and supplies for a person handled by a particular production unit on a particular day • examples of production units: on-site pharmacy, CMOP

  9. Data Format • VISTA: ASCII • PBM: You may request SAS, MS Access, or Visual FoxPro • DSS NDEs at AAC: SAS • KLF Menu (DSS): Spreadsheet

  10. Access -- Summary • PBM: Extracts made by PBM staff (www.vapbm.org) • DSS Rx NDEs: detailed files stored at AAC and accessed through timeshare accounts; some summary data available for free via KLFMenu • VISTA: Difficult to obtain direct access; easier to request data from local IRMS. N.B.: IRMS staff cannot accept Research funds. They do you a favor by making an extract.

  11. Access -- Reference • See Table 1 of: MW Smith, G Joseph. Pharmacy Data in the VA Health Care System. Medical Care Research and Review 2003;60(3 Suppl): 92S-123S. www.herc.research.med.va.gov/Pubs_medcare2.htm

  12. Cost of Obtaining Data • PBM • Managerial & oversight projects: no charge • Unfunded pilot studies: usually no charge • Funded studies: charges for programmer time + optional consulting on study design • Ask PBM/SHG staff ahead of time • Other sources • No charge to user; AAC charges billed to VAMC • KLF Menu: free unless you need to put in your ID # and password

  13. Contents For PBM and DSS Pharmacy Extract: VIReC research user guide: VHA pharmacy prescription data. Hines, IL: Veterans Affairs Information Resource Center (VIReC). 2005. URL:www.virec.research.med.va.gov For all sources (but somewhat dated): Table 2 in Smith and Joseph Med Care Res Rev article.

  14. Sample of Data Fields • Medication: drug name, NDC, formulary indicators • Dispensing: fill date, quantity dispensed, days supplied • Cost: purchase price (PBM, VISTA) or VA cost including overhead (DSS NDEs, DSS Pharmacy Extract)

  15. Sample of Data Fields • Patient: SCRSSN; date of birth, gender, age • Provider: provider ID, provider treating specialty • Note: Clinical information on related visits/stays can be linked to Rx data using SCRSSN

  16. Co-payments • VA charges some copayments • Depends on income, disability percentage • Rules & eligibility levels change year to year • Rules available on VA internet • Data sources do not show copayments; they show VA’s expense • MCRR files could show reimbursement from private insurance, if collected

  17. Unit Costs - 1 • There may be a contract price • Federal Supply Schedule (FSS) • FSS Tier Schedule • Federal ceiling price (“Big 4”) schedule • VA Blanket Purchase Agreement (BPA) • Price files available on PBM web site (www.vapbm.org)

  18. Unit Costs - 2 • There will be discrepancies across sites • Correct pricing requires *daily* updating of a VISTA price file at each VAMC, which does not occur • BPAs are specific to individual VAMCs • National VA formulary may limit use of selected medications • - see PBM website for current formulary, changes to formulary since 1998, and current rules for particular medications

  19. Choosing a Source: VISTA • Advantages • Greatest detail on costs, use of care • Access to data not available in extracts • Disadvantages • Can access data from only the local VAMC • Most often, extracts must be made by IRMS staff using specialized programs • Requires caution in interpreting differences across sites

  20. Choosing a Source: PBM • Advantages • National coverage in one extract • Only source that provides purchase price (sometimes inaccurate!) • Optional fee-based consulting on pharmacy data needs & use

  21. Choosing a Source: PBM • Disadvantages • PBM staff must create the extract • Does not show pharmacy clinic costs beyond purchase price • Limited clinical and demographic information

  22. Choosing a Source: DSS National Pharmacy Extract • Advantages • National coverage • Detailed cost data • Disadvantages • Limited prescription characteristics • Cost data do not show purchase price

  23. Choosing a Source: DSS Inpatient/Outpatient NDEs • Advantages • National coverage • Convenient summary cost data by treating specialty or overall • Disadvantages • Limited prescription characteristics • Only summary data: no data on individual prescriptions or supplies

  24. Choosing a Source: DSS Data via KLFMenu • Advantages • National coverage • Convenient summary cost data • Ease of access and use • Disadvantages • Only summary data: no data on individual prescriptions or supplies • Cannot select cases by SCRSSN

  25. Validation Studies: PBM vs. DSS • Do PBM and DSS data sources contain the same prescription records? • Study #1: 1,600 patients with hernias in CSP 456. Result: PBM and DSS Pharmacy Extract have >95% concordance in drug names, # scripts, # units dispensed.

  26. Validation Studies: PBM vs. DSS Study #2: >300 patients with heart disease in CSP 424. Result: PBM and DSS NDE daily summary have very poor concordance in monthly or annual pharmacy costs.

  27. Grouping Prescriptions • DSS sometimes groups two prescriptions into one record if they are for the same NDC and the same person on the same day • PBM does not group prescriptions in this way

  28. Other Notes on Pharmacy Data • KLF Menu provides summary DSS data on pharmacy spending • Pharmacy spending is one element of many DSS reports • Level: station, VISN, or nation • No data on individuals • Cannot be used to select data on a cohort of individuals

  29. Other Notes on Pharmacy Data • VA utilization and spending patterns for individual medications is often confidential • E.g.: nationwide prescribing patterns for branded antipsychotics for patients newly diagnosed with schizophrenia • Drug manufacturers seek these data to aid in negotiations with VA • Consult PBM before allowing private firms to see VA pharmacy data

  30. Cautions • Validation is essential • Fields may have missing or inconsistent values. • Different sites may complete fields differently. • Not clear yet whether all prescriptions are recorded, and how this varies by data source.

  31. Cautions • Data elements change each year • Written guides become outdated quickly • Crosscheck data elements against printed information: do you know what each field means? • E.g.: fill date vs. release date

  32. Validity Checks • Check data for erroneous values • Missing values • If possible, fill in values based on consistency checks (e.g., for gender, age) • Imputing values adds statistical uncertainty: should account for it (or at least mention if used rarely) • Inconsistent units • One 50ml bottle could be “50 units” in one record but “1 unit” in another record

  33. Non-VA Pharmacy Data • In CSP trials, we typically do not ask patients about non-VA pharmacy • Many VA users get all prescriptions through VA • VA is likely to be used for most expensive meds • Over-the-counter and occasional non- VA prescription use is unlikely to affect total Rx spending much

  34. Non-VA Pharmacy Sources • Drug Topics “Red Book” • Published annually • Offers “Average Wholesale Price” (AWP), the starting point for Medicaid drug payments • Private-sector claims data • Proprietary: must pay for access

  35. Questions on Pharmacy Data?

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