Completing NDF Patch

1. Completing NDF Patch RPMS Outpatient Pharmacy V7

2. National Drug File (NDF) • Master database of drugs • Routine updates distributed in/by VA • Periodic releases to IHS sites via IHS OIT • IHS patch may contain multiple VA updates: • Often a delay between new drug release to market and appearance in NDF • Updates PMI sheets • Updates work only for Pharmacy V7 sites • Contains: • New Drugs • Changes to old drugs • Inactivation of old drugs/NDC

3. NDF: Why is it important? • VA Drug Class is the key information used in drug-drug and drug-allergy checks in RPMS/EHR. • NDF allows for allergy checking to drug ingredients (excipients, vehicles). • NDF can help with food allergies through the ingredients listing. • NDF assists in standardizing the local drug file • NDF will affect CMOP.

4. What’s in an NDF entry? VA Product Name: MOMETASONE FUROATE 220MCG/INHL INHL,ORAL,30 VA Generic Name: MOMETASONE Dose Form: INHL,ORAL Strength: 220 Units: MCG/INHL National Formulary Name: MOMETASONE INHL,ORAL VA Print Name: MOMETASONE FUROATE 220MCG ORAL INHL 30 VA Product Identifier: M0650 Transmit to CMOP: Yes VA Dispense Unit: EA PMIS: MOMETASONE INHALATION POWDER - ORAL Active Ingredients: MOMETASONE Strength: 220 Units: MCG/INHL

5. What’s in an NDF entry? Primary VA Drug Class: RE101 Secondary VA Drug Class: CS Federal Schedule: 0 Unscheduled National Formulary Indicator: Yes National Formulary Restriction: Override DF Exclude from Dosage Checks: No NDC: 000085134103 UPN: VA Product Name: MOMETASONE FUROATE 220MCG/INHL INHL,ORAL,30 Manufacturer: SCHERING CORP Trade Name: ASMANEX TWISTHALER Route: INHALATION Package Size: 1 Package Type: INHALER

6. National Drug File Patch Release:The Dreaded Email

7. Pharmacy’s Part in the Process: NDF Reports Print and hold onto NOCL and MANC reports • Select National Drug File Reports Menu Option: NOCL Local Drugs With No VA Drug Class Report • This report should be run after executing the menu option "Merge National Drug File Data Into Local File". It may be useful to print this report before and after executing the "Allow Unmatched Drugs To Be Classed" option. It gives you a hard copy of the drugs from your local drug file which are "active" and have no VA Drug Classification. • You may queue the report to print, if you wish. • Select Printer: Must be sent to a printer (80 columns)

8. MANC Report • Select National Drug File Reports Menu Option: MANC Manually Classed Drugs Report • This report will give you an alphabetic listing, by local generic name, of the drugs from your local drug file which are "active" and have been assigned a manual VA Drug Classification through the option "Allow Unmatched Drugs To Be Classed". This report will exclude your supply items that have been assigned an "XA" class. • You may queue the report to print, if you wish. • Select Printer: Must be sent to a printer (80 columns)

9. Mailman Messages • 'Drugs Unmatched from National Drug File' • Print the message. • For each unmatched drug you will need to rematch the  drug to the NDF using the Pharmacy Data Management  Drug Enter/Edit option and re-enter possible dosages other than 1 or 2, which will be added automatically,  and re-enter any local possible dosages. You may also need to rematch the drug to an Orderable Item. This can be done using the Drug Enter/Edit option on the Pharmacy Data Management menu. • If you are using EHR be sure to let your CAC know which drugs have been rematched to that the CAC can check the EHR Quick Orders to see if they need to be edited. • Message lists drugs that have been unmatched: Active, Investigational Drugs, Inactive Entries Sample message: NITROGLYCERIN 0.4MG SL TAB 1034 (CMOP N0385) NITROGLYCERIN (ETHEX) 0.4MG TAB,SUB3/2/2011INGUAL,BTL,25 STRENGTH: .4UNITS: MG POSSIBLE DOSES DISP UNITS/DOSE DOSE PACKAGE BCMA UNITS/DOSE 1 .4 IO *361. [65214] 04/16/11 DATA UPDATE FOR NDF 371 NDF MANAGER *362. [65215] 04/16/11 UPDATED INTERACTIONS 339 NDF MANAGER !363. [65216] 04/16/11 DRUGS UNMATCHED FROM NATION 82 NDF MANAGER *364. [65217] 04/16/11 INTERACTIONS and ALLERGIES U 8 NDF MANAGER *365. [65218] 04/16/11 Products with changed classe 4 NDF MANAGER

10. Mailman Messages (Continued) • 'Data Update for NDF' • Compare the drugs on the MANC and NOCL reports to the list of drugs that have been added to the NDF. • Based on your review of the Data Update message you may need to match or rematch drug entries from the NOCL and MANC reports to the NDF using the Drug Enter/Edit option. • All manually classified drugs and all drugs with no VA class should be rematched or matched whenever possible. Drugs that cannot be matched to the National Drug File can be manually classified by using the CLAS option on the National Drug File menu. • 'Updated Interactions' • This message provides information regarding drug interactions that have been added, edited, or inactivated. No action is required. • 'Interactions and Allergies Updated' • This message is informational and doesn't require any action. • ‘Products with changed classes' • This message is informational and doesn't require any action.

11. Unmatched Drugs • Need to be rematched ASAP • Common reasons for unmatching: • New NDC • Drug inactivated in NDF • Investigational and Inactive: • Should also be matched for interaction & allergy checking • Can’t match inactive drugs: • Sometimes the NDF entry is inactivated • Important thing is VA Class

12. NDF Data Update Message • Lists new drugs and modifications to existing drugs. • Compare this list to the NDF reports generated earlier and match as many as possible. • There are several portions so review them all.

13. NDF Data Update (cont.) Subj: DATA UPDATE FOR NDF [#65214] 04/16/11@10:10 371 lines From: NDF MANAGER In 'IN' basket. Page 1 *New* ------------------------------------------------------------------------------- The following VA Products have been added to the National Drug File. You may wish to review, then match or unmatch local drug file entries based on this updated information. ALISKIREN 150MG/AMLODIPINE 5MG/HYDROCHLOROTHIAZIDE 12.5MG TAB (CMOP - A1582) (DISPENSE UNIT - TAB) 000078-0610-15 ALISKIREN 300MG/AMLODIPINE 10MG/HYDROCHLOROTHIAZIDE 12.5MG TAB (CMOP - A1579) (DISPENSE UNIT - TAB) 000078-0613-15

14. NDF Data Update (cont.) The National Formulary Indicator has changed for the following VA Products. The National Formulary Indicator will automatically be changed in your local DRUG file (#50). The Auto-Create Possible Dosages settings have been edited for the following VA Products. Please review your local dosages for products matched to these entries. Edits to your site's possible dosages or local possible dosages may be needed. FENTANYL 20MCG/ML/NACL 0.9% INJ,BAG,250ML (CMOP - F0494)Auto-Create Default Possible Dosage? NOPossible Dosages To Auto-Create: No Possible Dosages INACTIVATED PRODUCTS WITH REPLACEMENTS BAG,URINARY DRAINAGE BIODERM #23046 [XT797] USE EXTERNAL CONTINENCE DEVICE BIODERM #23046 [XT660] INACTIVATED, NO MANUFACTURER FOUND AMYLASE 20000UNT/LIPASE 4500UNT/PROTEASE 25000UNT CAP,EC [A1093] UNMARKED FROM CMOP DISPENSE UNIT CHANGE

15. Rematching • Done through DRUG ENTER/EDIT. • Use information in the mailman messages as a guide. • If only rematching to NDF, use ^ST <enter> to jump to bottom. • If the NDF entry is inactivated, note the VA Drug Class then re-select the drug and stuff the VA Drug Class in the VA Drug Class field. • Don’t match to the wrong drug or strength. • If it’s a CMOP drug it must be matched to correct package.

16. Finishing Up • If any changes are made that affect orderable items quick orders to stop working. • If you maintain the pharmacy quick orders check any for the drugs modified by this patch to make sure they still work. • If you do not maintain quick orders give the person who does a list so the quick orders can be check and fixed if necessary. • Rest while you can because another patch will arrive in one month.

17. Questions