VA Pharmacy Conference 2008 Consolidated Mail Outpatient Pharmacy Operations

1. VA Pharmacy Conference 2008 Consolidated Mail Outpatient Pharmacy Operations Kenneth Siehr Deputy Chief Consultant- Pharmacy Benefits Management Service Consolidated Mail Outpatient Pharmacy Operations Department of Veterans Affairs

2. Overview • A little about me • Life of a VA mail out prescription • Outpatient prescription fulfillment system • CMOP today • CMOP history • How we got to where we are • CMOP of Tomorrow • How does this affect you?

3. Who Is This Guy? • 30+ years in Federal Pharmacy • Pharmacy Intern VA Madison 1977 • Army Pharmacist 1978-81 • VA Staff Pharmacist 81-82 • VA Pharmacy Supervisor since 1982 • Chief of Pharmacy 1988 • Managed Multiple Services at Medical Center • VISN Formulary Leader (VISN 12) when positions were established • PBM Manager 2004 • Present Position 10/07

4. The Life of a VA Mail Out Prescription

5. Life of a VA Mail Out Prescription Provider Orders Medication Patient Receives 1 Hour to ?? 10 Hr 12 – 48 Hrs 48 Hrs to ?? Awaiting Verification CMOP Filling Delivery to Patient Awaiting Transmission to CMOP Goal: Delivery to Patient with 10 days of Patient/Provider request

6. VHA Outpatient Medication Fulfillment System Contracting and Procurement Medical Centers CMOP Delivery to Patient Goal: Delivery to Patient with 10 days of Patient/Provider request

7. Medical Center • Interface between • Patient and fulfillment system • Provider and fulfillment system • Ensures right • Medication for patient clinically • Dose, frequency • Cost efficiency • Dispenses Prescriptions (20%) • Window • Mail • Responsible for Performance • Chief of Pharmacy, Facility TMT, VFL

8. CMOP • Dispenses Prescriptions (80%) • Mail • Primary Interface • Patient delivery services • USPS, FedEx • Mail consolidators • Direct to patient vendors • NAC for outpatient medication contracts • Contractors for direct to patient delivery • Responsible for Performance • CMOP Director, National CMOP and PBM

9. Contracting and Procurement • National Pharmacy Benefits Management Services • Formulary Management • Identifies contacting opportunities • Monitors utilization • Contract compliance • National Acquisition Center (NAC) • National contracts, BPAs, FSS • Procurement and Contracting staff at each site and CMOP • Responsible for Performance • Chief of Pharmacy, CMOP Director • National PBM, NAC

10. Delivery to Patient • Window at Medical Centers • To Patient’s Home • Contracted or third party vendors • US Postal Service • Federal Express or similar vendor • Mail consolidators • Facilitate and speed process • Direct to patient contractors • Responsible for Performance • Contracting Officer for contracted services • USPS

11. VHA Outpatient Medication Fulfillment System Contracting and Procurement Medical Centers CMOP Delivery to Patient Goal: Delivery to Patient with 10 days of Patient/Provider request

13. CMOP Today • 7 separate locations • Each highly automated and highly efficient and successful but with different equipment and software • Different practices, processes and products • Murfreesboro – Media Mail • Hines – mail manifesting • Various prescription and mailing labels • Limited national CMOP information system • Beginnings of organizational support structure • Collection of 7 individuals, not an integrated system

14. CMOP: Grass Roots Effort • Grass roots effort • Concept proven at West LA and Leavenworth • RFP Process • Equipment centrally funded • Medical Centers selected were to provide support • Facilities Management, Contracting, Human Resources etc. • Medical Centers serviced provided inventory funding • CMOP Director reported to local Board • CMOP needed and fostered entrepreneurial culture • Highly successful results

15. Each CMOP a Contract • Each CMOP the result of a turn key contract with a vendor • Vendor provided all equipment and software • Different vendors = different equipment and software not designed to integrate with other CMOPs

16. Early CMOP Organization • Each CMOP essentially owned by the Medical Centers it serviced • Reporting to a Board made up of customers • Unique equipment and software • Organizational support provided by host site

17. CMOP Tomorrow • 7 integrated locations • Each highly automated and highly efficient with different equipment but the same software • Standardized practices, processes and products • Same product list • Centralized customer interface, QA etc. • Patient medications from any CMOP • Robust national CMOP information system accessible by users • Standardized reports • ProClarity cubes • Mature and effective organizational support structure

18. How Does This Affect You? • Ability to seamlessly shift workload between CMOPs • Equipment breakdown, disaster recovery • Specialty CMOPs • Patient centric, ship from closest CMOP • More tools • Track Rx and package • Report and trend problems • Track and validate costs

19. Murfreesboro Zip Code Distribution

20. How Does This Affect You? • Standardized product lists • Medical/Surgical supplies • Medications and pack sizes • Medication event prevention • Screen and identify inappropriate Rx directions • Rx quantity checks

21. Get Involved and Work With Your VISN Formulary Leader as We Transition