Presentation Transcript

1. Pharmoeconomics: Are your drug file prices accurate?Utilizing pharmacy databases to identify cost opportunities

   Andrew Henriksen PBM/CMOP Pharmacoeconomic Data Manager
2. Workshop Objectives Learn tips to optimize local drug file setup Introduction to methods used to validate data using available reports and tools Learn how to access the Pharmacoeconomic SharePoint site and other available resources including future CDW reports and tools
3. Drug File Optimization
4. How cost data gets entered into VISTA Prime Vendor Invoices uploaded via the Drug Accountability application Data must be verified before being accepted Quantity issues (dispense unit vs. order unit, bottle size) Different dispense unit (gram vs. inhaler) Different NDC ordered Items not purchased through prime vendor (omeprazole via repackaging provider) must be updated manually
5. How costs gets into VISTA (and to PBM) File 50: DRUG File Synonyms: Can have multiple NDC’s each with their own price, quantity, dispense unit per order unit entered Only one price at a time, assigns the most recent invoice price or last price change to all fills going forward (not tied to NDC) Does not use CMOP prices for fills dispensed by CMOP, price assigned is current price in local drug file
6. Example -Tiotropium 30 (Prime Vendor) Prime Vendor uses capsule for unit price, the VA National Drug File (NDF) uses purchase price for dispense unit price TIOTROPIUM 18MCG INHL CAP 30 ORDER UNIT: BX// PRICE PER ORDER UNIT: 54.14// DISPENSE UNIT: PKG// DISPENSE UNITS PER ORDER UNIT: 30 PRICE PER DISPENSE UNIT: 1.8047
7. NDF data base-Tiotropium
8. Strategies to optimize file 50 setup TIOTROPIUM 18MCG INHL CAP 30 MESSAGE: DISPENSE PER BOX (NOT CAPSULES)  to ALERT pharmacy staff ORDER UNIT: PK// PRICE PER ORDER UNIT: 54.14// DISPENSE UNIT: EA// DISPENSE UNITS PER ORDER UNIT: 30// 1 PRICE PER DISPENSE UNIT: 1.804754.14 ******************************************************************************* This entry is marked for the following PHARMACY packages: D - Drug Accountability Select SYNONYM: // 30597007541 INTENDED USE: DRUG ACCOUNTABILITY// NDC CODE: 00597-0075-41// ORDER UNIT: PK// PRICE PER ORDER UNIT: // <leave blank> DISPENSE UNITS PER ORDER UNIT: //1 PRICE PER DISPENSE UNIT: // <leave blank>
9. Example - Ziprasidone Some products are essentially “flat priced” all strengths cost about the same
10. Ziprasidone fills ZIPRASIDONE 20MG CAP Strength from National Drug File match => 20 MG Strength currently in the Drug File => 20 MG Strength => 20 Unit => MG POSSIBLE DOSAGES: DISPENSE UNITS PER DOSE: 1 DOSE: 20MG PACKAGE: IO DISPENSE UNITS PER DOSE: 2 DOSE: 40MG PACKAGE: IO
11. Flat Priced Products Dexlansoprazole: once daily dosing, low volume Ziprasidone: BID dosing, big volume Aripiprazole: once daily dosing, big volume Pregabalin: up to QID dosing, growing volume Duloxetine: up to BID dosing, growing volume Desvenlafaxine: once daily dosing, low volume Others?
12. Summary: drug file setup optimization Use Drug Accountability package to lock in appropriate quantity dispense units per order unit Utilize the drug message screen to guide pharmacy staff on how to complete orders Consider provider Quick Orders to aid prescribing Limit possible doses to 1 dose per strength on flat priced items (utilize tablet splitting where appropriate)
13. Questions?
14. Validating Data: Available Reports and Tools
15. Reports and Tools High Cost RX report [PSO HI COST] CMOP Cost Reports http://vaww.national.cmop.va.gov/CostReports/default.aspx Prime Vendor Purchase reports
16. High Cost RX report [PSO HI COST] Run High Cost RX report [PSO HI COST] in VISTA Beginning Date: (APR 1, 2011) Ending Date: (APR 31, 2011) Dollar Limit : (0-9999): 30// 0  Capture all fills DEVICE: HOME// ;255;999999  Send to file, do not need to print out on paper
17. High Cost RX report via Data Warehouse Use CDWwork--(or, could use RDWwork or local data warehouse) select distinct LEFT(DateText,7) as month, d.visn, b.sta3n, Facility, b.RxNumber , b.LocalDrugNameWithDose, c.VAProductIdentifieras CMOPID , c.DrugNameWithDose, c.DrugNameWithoutDose, A.DaysSupply , UnitPrice, Qty, (UnitPrice*QtyNumeric)as Total_Cost , RxStatus from CDWwork.RxOut.RxOutpatFilla inner join CDWwork.RxOut.RxOutpatbon a.RxOutpatIEN=b.RxOutpatIEN and a.sta3n=b.Sta3n inner joinCDWwork.Dim.NationalDrug con a.NationalDrugIEN=c.NationalDrugIEN inner join CDWwork.Dim.VistaSitedon a.Sta3n = d.Sta3n inner join CDWwork.Dim.Datee on a.ReleaseDateTime=e.Date where a.ReleaseDateTime >= dateadd(MONTH, -2, GETDATE()) AND A.Sta3n>0 AND D.Sta3n<999 and((UnitPrice*QtyNumeric)>1000) and c.DrugNameWithoutDose not in ('imatinib‘, 'nilotinib', 'sorafenib', 'LENALIDOMIDE', 'SUNITINIB', 'ENTECAVIR', 'ERLOTINIB','PEGFILGRASTIM','DARUNAVIR‘) and(VISN =‘#') and a.Sta3n =‘###’ order by month desc, d.visn, b.sta3n, Facility, b.RxNumber, b.LocalDrugNameWithDose, c.DrugNameWithDose, c.DrugNameWithoutDose, Unitprice, Qty, (UnitPrice*QtyNumeric)
18. NDF data base
19. CMOP Cost Reports
20. Quantity: 14 or 56? Or 16 or 64?
21. Prime Vendor Reports Purchase reports Penny prices Contract compliance Custom reports
22. Purchase Reports SMO  Pharmacy Management / Programs Access Reports & Analysis  Create Report  Canned Report  Purchasing Detail Report  Invoice Level Detail (choose the dates to search, customers account numbers and items to include)
23. Purchase Reports SMO  Pharmacy Management / Programs Access Reports & Analysis  Create Report  Canned Report  Purchasing Detail Report  Invoice Level Detail (choose the dates to search, customers account numbers and items to include)
24. Cost Change Report (Penny drugs) SMO  Ordering / Inventory  Reports  Contract Change Report
25. Cost Change Report (Penny drugs)
26. Contract Compliance SMO  Pharmacy Management / Programs Access Reports & Analysis  Create Report  Canned Report  Savings Identification  Contract Compliance/ Lost Savings (choose both Contract and Non-contract, display results as CSV)
27. Contract Compliance **Report does not tell you if alternate item was in stock that day; gives stock level of item you ordered not the alternatives. Also, may list alternatives that are not on FSS
28. McKessonCustom Report:Template Using Reports & Analysis 6.6 McKesson Connect  Pharmacy Management/Programs  Select Access Reports & Analysis  Create report  Custom report Formatting: In the Field Selection, select the following parameters to invoice level: account name, account #, invoice extended price, invoice/credit #, invoice credit/date, invoiced price (dose) invoiced price (pkg.), invoiced quantity, item description, McKesson item #, NDC and package size Results Display select all Level 1 group by: Account number Level 2 group by: Item description Saving Report: In save to my reports box  name report and save
29. Third Party: Update Prior to March 18th,2011 maximum collection was $51/Rx After March 18th-third party will pay the actual cost of the Rx plus an administration fee of $11.40 The actual cost billed to third party comes directly from your drug file Important: pricing in the drug file MUST be accurate or you risk losing $$$$$
30. Questions?
31. Pharmacoeconomic SharePoint site and CDW Link: http://vaww.national.cmop.va.gov/pre/PharmacoEconomic/default.aspx You can request access from the page or send an email to me at Andrew.Henriksen@va.gov
32. Pharmacoeconomic SharePoint Site National Savings Opportunities Reports Monthly Cost Review Top 25 (100) drugs by Total Cost Unmatched Items Individual drug analysis reports
33. National Savings Opportunities Selection Review of high cost and high volume areas with significant variability in prescribing patterns Lack of evidence to support prescribing differences New contracts or Blanket Purchase Agreements (BPA) that create incentives Areas of concern where community standard may not be evidenced based Measures (ProClarity) Outpatient pharmacy costs only Denominator is OP Pharmacy users only (Pharmacy Unique) Numerator is based on VistA dispensing data Drug costs based on local drug file *
34. Cost Avoidance Results FY ’09 12 National initiatives $192 million cost avoidance (6.1% of outpatient expenditures) Drug cost per patient ­ 0.61% compared to FY 08 FY ’10 26 National initiatives $120 million cost avoidance (3.6% of outpatient expenditures) Drug cost per patient ­ 1.08% compared to FY 09 FY ’11 36 National initiatives Target $128 million cost avoidance (~3-4% of projected outpatient expenditures) Savings through Q1: $14.8 million
35. Formulas Most measures are cost per 30 day fill Cost per 30 day based on total costs for drugs in market basket and number of 30 day fill equivalents Market basket to include all relevant drugs in targeted area Drugs costs used in calculations come from local drug file* Results calculated quarterly by PBM
36. Definitions Target – based on average of top 5 VISNs for majority of initiatives or national average where indicated. If there was an outlier, the top 2-6 networks were used. Goal – network specific goal based on 75% of the difference between network baseline and the target (top 5 networks average)
37. Performance Measure Dollar amount based on the national initiatives Finance Committee satisfactory goal (green) is 50% of dollar amount based on the national initiatives (no longer reported though…) National initiatives are not mandatory
38. Monthly Cost Review VISN Cost/Day30RX last 6 mo, 6mo average VISN Cost/ Pharmacy Unique last 4 Qtrs, FY YTD Site Cost/Day30RX last two months and change for previous month Site Cost/ Day30RX last 6mo, 6mo average Site and Complexity Group templates
39. Top 25 (100) Drugs by Total Cost
40. Unmatched Items
41. Individual Drug Analysis Reports
42. CDW, RDW, & VISN data marts
43. Cartoon depicting Regional Data Warehouse Visual Architecture Regional Data Warehousing Visual Architecture Corporate Data Warehouse SQL Server Business key Time stamp OpCode (I/U/D) Shadow/Journal Reader Process Source Systems Regional VistA Shadow Daily Facility 1 VistA Near Real Time Regional Feeder Data Warehouse Regional Data Warehouse SQL Server Business key Time stamp OpCode (I/U/D) Daily Facility 2 VistA Facility 3 VistA SQL Server Business key Time stamp OpCode (I/U/D) Indexes: - VistAEditDate - Business Key Daily VISN Data Warehouse(s) SQL Server Business key Time stamp OpCode (I/U/D) Business key Time stamp Incremental loads are based upon VistAEditDate timestamp Cache Classes define data of interest Cache Methods insert or update to ODS Data includes Fact and Dimension data
44. Drug Cost Report Depending on perspective, one can look at the difference between the average, median, and mode cost prices from the pharmacy site acquisition price
45. Drug Cost Report Definitions Unit Price – The price the pharmacy paid for the med National/Region/VISN/Station/PharmacySite Average/Median/Mode Prescriptions – Prescriptions Quantity – Quantity Difference – Difference Between Prices Cost Impact = Difference * Quantity
46. Average Vs Median Vs Mode Average is sensitive to outliers (high and low) Median – Pick the median price among the stations (not bad) Mode – Pick the most common price among the stations (not bad) Reports show all of them depending on the pharmacoeconomists mood and trust of the internal data within the VISN and/or her fellow neighbors
47. Region II Mode Report
48. Region II Median Report
49. Questions?
50. How do I fix errors in my data? Prescription Cost Update [PSO RXCOST UPDATE] back to the date of the price change for each drug entry you are changing a price Date Range Recompile Data [PSO MGMT RPT RANGE COMPILE] back > 1yr once all the prescription cost updates have been run Monthly Rx Cost Compilation [PSO COSTMONTH]
51. How do I request a fix of data I already transmitted to PBM? Send an email request to Mike Wrobel, Alan Celestino and me including the below information Product name Time period to correct Wrong price (from individual prescriptions) Correct price http://vaww.national.cmop.va.gov/pre/PharmacoEconomic/Document%20Library5/1/PBM%20Data%20Correction%20submission.xlsx
52. Questions?