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:
You can request access from the page or send an to me at

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 $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 Name Qty Local Fill Drug File Avg CMOP Avg CMOP Over Under
Cost Unit Cost Unit Cost Qty
TIOTROPIUM 18MCG INHL CAP $17, $50.75 $ ($8,237.32)
ALBUTEROL 90/IPRATROP 18MCG 200D PO INHL 722 $19, $27.35 $ ($7,281.00)
ASPIRIN 25MG/DIPYRIDAMOLE 200MG SA CAP 14,220 $14, $1.05 $ ,930 ($3,984.33)
IPRATROPIUM BROMIDE 17MCG 200D ORAL INHL 145 $4, $27.93 $ ($3,981.99)
RABEPRAZOLE NA 20MG EC TAB 1,200 $ $0.64 $2.72 1,080 ($2,252.95)
METOPROLOL SUCCINATE 100MG SA TAB 4,470 $ $0.20 $0.65 3,735 ($1,666.10)
CLONIDINE 0.3MG/24HR PATCH 492 $8, $16.57 $ ($1,629.06)
INSULIN SYRINGE 0.5ML 30G 0.5IN 50,180 $2, $0.04 $ ($1,573.76)
ZIPRASIDONE HCL 80MG CAP 720 $2, $2.90 $4.02 1,290 ($1,444.40)
METOPROLOL SUCCINATE 50MG SA TAB 3,990 $ $0.15 $0.48 3,910 ($1,274.06)
MONTELUKAST NA 10MG TAB 13,170 $26, $2.01 $2.18 7,141 ($1,257.21)
RISPERIDONE 2MG TAB 915 $3, $4.14 $ $3,158.83
LEVETIRACETAM 500MG TAB 9,306 $12, $1.38 $0.15 2,640 $3,246.72
CITALOPRAM HYDROBROMIDE 20MG TAB 3,315 $1, $0.49 $0.04 7,785 $3,504.44
ALENDRONATE 70MG TAB 2,048 $10, $4.91 $ $3,639.24
MOMETASONE FUROATE 220MCG ORAL INHL $ $58.42 $ $6,578.36
RISPERIDONE 4MG TAB 1,995 $12, $6.49 $1.51 1,950 $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 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

24. Questions?