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Breaking Down Silos in Search of Value

Breaking Down Silos in Search of Value. CAPT Mark A. Richerson, MSC, USN Director, Department of Defense Pharmacoeconomic Center. Objectives. "Breaking Down Silos to Enhance the Value of the Pharmacy Benefit Across the MHS". Define “Value” and impact of Military Treatment Facilities

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Breaking Down Silos in Search of Value

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  1. Breaking Down Silos in Search of Value CAPT Mark A. Richerson, MSC, USN Director, Department of Defense Pharmacoeconomic Center

  2. Objectives "Breaking Down Silos to Enhance the Value of the Pharmacy Benefit Across the MHS" • Define “Value” and impact of Military Treatment Facilities • Discuss silos affecting delivery of DoD Prescription Benefit • Discuss the role of conference attendees

  3. Evidence Based Medicine Approach to health care practice in which the clinician is aware of the evidence in support of his/her clinical practice, and the strengths of that evidence - McMaster University The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients - BMJ 312:71-2

  4. The Search for Value Vytorin & Pravachol Non Formulary! Cost • Effectiveness Nirvana! Simvastatin (Zocor) The Cost Effectiveness Judgment More Costly, More Effective More Costly, Less Effective Cost • Effectiveness Less Costly, Less Effective Less Costly, More Effective The Cost Effectiveness Plane

  5. Retirees & Family Members ≥ 65 Active Duty FY02 8.6 Million FY03 8.9 Million 1.8M 1.8M 19% 19% FY04 9.1 Million FY05 FY06 9.2 Million 9.2 Million 2.3M 3.2M 25% 36% Active Duty Family Members TRICARE Eligible Beneficiaries Monthly Average, FY06 Other >1% Retirees & Family Members < 65 Source: M2

  6. Unique Users - Point of Service All Ages, FY05 to FY06 Unique Users FY05 = 6.6M FY06 = 6.7M Mail Order MTF 1% 1% 4% 5% 2% 46% Retail 28% 19% 42% FY06 30% FY06 Source: PDTS

  7. 22 MTF 20 Sep 2006 MTF 49%Retail 37% Mail Order 14% 18 16 14 Retail Apr 2001 MTF 76%Retail 14% Mail Order 10% 12 30d EQ Rxs (Millions) 10 8 TSRx Apr 01 6 Mail Order 4 2 FY01 FY02 FY03 FY04 FY05 FY06 0 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 30-day Equivalent Rxs By POS, Oct 00 – Sep 06 Source: USPD, PDTS

  8. MHS Outpatient Drug Spend $ in millions Sources: PDTS and Prime Vendor

  9. CCBs ACEs H2s PPIs OABs BPH-ABs TZDs ARBs GABAs M/Ks LIP1s MiscHTNs AF-DERMs NCSs SED2s EMETs MS-DMDs ALZs ADHDs BCs AD1s PDE-5s Jul-05 Jul-06 Dec-06 Jan-07 Feb-07 Nov-06 Oct-05 Apr-06 Oct-06 Apr-05 Oct-04 Jan-06 Jan-05 Jun-06 Jun-05 Feb-06 Mar-05 Mar-06 Feb-05 Dec-05 Sep-05 Sep-06 Dec-04 Nov-05 Nov-04 May-06 Aug-05 Aug-06 May-05 Class Review & Implementation Tracking

  10. NF/3rd Tier 30dRxsMTFs, All Implemented UF Classes

  11. "Breaking Down Silos to Enhance the Value of the Pharmacy Benefit Across the MHS" What Silos?

  12. Pharmacy World

  13. Stakeholders in the MHS Pharmacy Benefit • Patients/Beneficiaries • Clinicians • Policy makers • Congress • Resource Managers • Industry

  14. Resource Manager Aerial View of Rx Benefit Silos Congress Industry Policy Maker Patient Clinician

  15. Pharmacy Cost Trend Components Sources: M2, PDTS, and Prime Vendor data

  16. Take Away Message: • Take advantage of this opportunity to better understand various stakeholder perspectives. • Ask questions and share what you learn with others. • Know the significant role you play in sustaining this premier, clinically sound, and cost effective benefit.

  17. www.pec.ha.osd.mil

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