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Pharmacoeconomics

Andrew Henriksen PBM-CMOP. Pharmacoeconomics. What is Pharmacoeconomics?. Compares of the value of one drug or drug therapy to another Provides guidance to allocate resources Identifies efficiencies or opportunities for improvement in care delivery. What is a Pharmacoeconomic Data Manager?.

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Pharmacoeconomics

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  1. Andrew Henriksen PBM-CMOP Pharmacoeconomics

  2. What is Pharmacoeconomics? • Compares of the value of one drug or drug therapy to another • Provides guidance to allocate resources • Identifies efficiencies or opportunities for improvement in care delivery

  3. What is a Pharmacoeconomic Data Manager? • Review and validation • VISNs and facilities prescription dispensing via your PBM extraction data • CMOPs prescription dispensing data • Look for variation • product utilization • drug pricing - Average Unit Cost (AUC) • dispense units per order unit • quantity per prescription

  4. Tools ProClarity • Used to determine pharmacy workload • Identify numbers of patients on, or prescriptions for a given product • Forecast pharmacy expenditures • Identify opportunities for improvement • Data accuracy is essential to decision makers

  5. Tools Current Month - locally available prior to PBM extraction • High Cost RX report – VISTA • CMOP monthly cost reports • McKesson purchases Historical • ProClarity-data from PBM extraction • McKesson reports

  6. SharePoint Site

  7. SharePoint Site 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

  8. SharePoint Site Topics Nationwide Initiatives • National saving opportunities VISN Specific Initiatives • Network and local saving opportunities Purchases • Savings by switching brand or size Contracts • Contract compliance reports, FSS price changes

  9. Savings Opportunities Tab • Products that are essentially flat priced on a mg to mg basis or where certain strengths are much more expensive than others (examples: ziprasidone, haloperidol 10mg) • Opportunities to save money dispensing one strength vs. another (example: dispensing 4 x 100mg imatinab tablets for a 400mg dose costs $79.23 vs. 1 x 400mg tablet @ $68.45)

  10. Drug File Maintenance Tab Reports • Monthly Cost Review • Top 25 drugs by total cost • Unmatched items • Individual drug analysis reports

  11. Monthly Cost Review Data from ProClarity Outpatient cube • VISN & site cost per unique – last 4 Qtrs • VISN & site cost per 30 day RX – last 6 mo • Site cost and usage comparison last two months • Templates to enter site specific data for last two months and site vs. complexity grouping

  12. Monthly Cost Review Used to identify large changes to sites costs. Examples: • Facility did not release prescription from ScriptPro –filled 44,000 less Day 30 RXs one month • Wrong dispense unit per order unit – entered price per bottle of 1,000 as price per unit • Brand vs. generic NDC purchase – 1 bottle of brand purchased, price on all RX’s in drug file

  13. Top 25 drugs by VA total cost Site data from ProClarity Outpatient cube CMOP data from CMOP Fiscal database • Compares the “correct” cost per unit to the average cost per unit from each sites PBM extraction • The “correct” price is determined by either the price in McKesson (one NDC) or CMOPs average cost per unit (when multiple NDC’s) • Goal is identify items with variance

  14. Unmatched Items • Data from PBM monthly extraction • Products that are listed as *local, *more info, *supply, or *study in ProClarity • *local: compounded products • *study: study drugs • *more info: may be in the NDF but there in not enough information to match • *supply: may or may not have an NDC

  15. Unmatched Items • Over $10 million spent annually on unmatched items • Potential workload savings if some of these items could be matched and sent to CMOP • Potential unit cost or quantity issues contributing to unusually high site costs • Potential for better pricing if national contracts could be negotiated

  16. Individual Drug Analysis reports • Data from ProClarity and McKesson • Lists sites average cost per unit from their drug file, McKesson prices, and purchases made by facilities and CMOPs • Goal is to have the sites drug files present an accurate picture of what they purchased and to identify opportunities for savings

  17. So can I check my data? • Determine your PBM data extract date (should be no sooner than the 5th of the month) • Run High Cost RX report [PSO HI COST] • Beginning Date: (APR 1, 2010) • Ending Date: (APR 30, 2010) • Dollar Limit : (0-9999): 30// 0 • DEVICE: HOME// ;255;999999

  18. Capture your High Cost RX report Save into notepad

  19. Review with Excel

  20. Review with Access Drug File Maintenance tool – Access database • Queries High Cost Rx report from VISTA and CMOP cost report • Uses the difference between CMOP average unit cost and local drug file average unit cost multiplied by local quantity dispensed to find the items with the largest variance

  21. Review with Access Drug file items over/under by +/-$1,000 compared to CMOP avg unit cost Drug NameQtyLocal Fill Drug File AvgCMOP AvgCMOP Over Under CostUnit CostUnit CostQty TIOTROPIUM 18MCG INHL CAP 30344$17,458.00$50.75$66.87511($8,237.32) ALBUTEROL 90/IPRATROP 18MCG 200D PO INHL722$19,746.70$27.35$43.53450($7,281.00) ASPIRIN 25MG/DIPYRIDAMOLE 200MG SA CAP14,220$14,876.75$1.05$1.3015,930($3,984.33) IPRATROPIUM BROMIDE 17MCG 200D ORAL INHL145$4,049.85$27.93$47.94199($3,981.99) RABEPRAZOLE NA 20MG EC TAB1,200$766.33$0.64$2.721,080($2,252.95) METOPROLOL SUCCINATE 100MG SA TAB4,470$905.59$0.20$0.653,735($1,666.10) CLONIDINE 0.3MG/24HR PATCH492$8,153.67$16.57$27.29152($1,629.06) INSULIN SYRINGE 0.5ML 30G 0.5IN50,180$2,012.22$0.04$4.34366($1,573.76) ZIPRASIDONE HCL 80MG CAP720$2,090.53$2.90$4.021,290($1,444.40) METOPROLOL SUCCINATE 50MG SA TAB3,990$602.92$0.15$0.483,910($1,274.06) MONTELUKAST NA 10MG TAB13,170$26,444.22$2.01$2.187,141($1,257.21) RISPERIDONE 2MG TAB915$3,786.40$4.14$0.69915$3,158.83 LEVETIRACETAM 500MG TAB9,306$12,874.88$1.38$0.152,640$3,246.72 CITALOPRAM HYDROBROMIDE 20MG TAB3,315$1,615.06$0.49$0.047,785$3,504.44 ALENDRONATE 70MG TAB2,048$10,060.44$4.91$0.47820$3,639.24 MOMETASONE FUROATE 220MCG ORAL INHL 1209$525.78$58.42$27.39212$6,578.36 RISPERIDONE 4MG TAB1,995$12,938.65$6.49$1.511,950$9,693.02

  22. How do I fix 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]

  23. How do I request a fix of submitted data? • Send an email request to Mike Wrobel, Alan Celestino and me including the below information • productname • Time period to correct • Wrong price (from individual prescriptions) • Correct price

  24. Questions?

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