1. Promoting high quality, cost effective drug therapy throughout the Military Health System PDTS and Its Impact on MTF Pharmacy Operations Gracie C. Ard, BS(MIS), CPhT, Program Integrity Analyst Hector Morales, BS, CHDM, POC Manager Roger F. Williams, MS, RPh, Senior Pharmacy Consultant 8 January 2007

2. DoD Pharmacoeconomic Center www.pec.ha.osd.mil Program Outline New Process for Monitoring Drug Seeking Beneficiaries PDTS Data Integrity Reports, Process and Issues Transitioning over to a National Provider Identifier

3. DoD Pharmacoeconomic Center www.pec.ha.osd.mil Monitoring Drug Seeking Beneficiaries Agenda - Discuss the different types of blocks able to be placed on a beneficiary Discuss the authorization and information needed for each type of block or exclusion Identify the steps required to register a patient in the program Explain the limitations of CHCS and PDTS on blocking used at other MTFs

4. DoD Pharmacoeconomic Center www.pec.ha.osd.mil The DSB Monitoring Process Locking beneficiary into an MTF pharmacy Locking beneficiary into one provider Locking beneficiary into one or more medications or excluding controlled medications Using the request form to lock beneficiary The POC’s response when beneficiary attempts to access other MTF pharmacies

5. DoD Pharmacoeconomic Center www.pec.ha.osd.mil DSB Lock Request Form (Complete)

6. DoD Pharmacoeconomic Center www.pec.ha.osd.mil DSB Lock Request Form (top) Printed Name Signature Email Phone Number Title Site / Company Effective Date Fax this form to the DoD Pharmacy Operations Center (POC) at (210) 221-8131 ATTN: Hector Morales Individual Requesting Lock DSB Lock Request Form Drug Seeking Beneficiary’s Information NameLast: First: MI: Birth Date Sponsor’s SSN - -

7. DoD Pharmacoeconomic Center www.pec.ha.osd.mil DSB Lock Request Form (middle) Note: The lock will prevent the member from using their TRICARE benefits at the mail order pharmacy or a retail pharmacy. If this member pays cash for the prescription we will not have control over that dispensing nor be able to see that prescription in PDTS. Restrict beneficiary to pay 100% for all medications at retail. Forces beneficiary to submit a paper claim to DoD pharmacy contractor. Restrict beneficiary to pay 100% for specific medication. Forces beneficiary to submit a paper claim to DoD pharmacy contractor. Restrict a beneficiary to a specific pharmacy or list of pharmacies (please list below). Restrict a beneficiary to a specific doctor or list of doctors (please list below). Exclude controlled substances from a beneficiary. Type of Lock Additional Information Reason for Request Restricted Medications MTF Pharmacy to Lock-In Printed name(s) of doctor(s) authorized to write prescriptions for beneficiary Doctor’s DEA number

8. DoD Pharmacoeconomic Center www.pec.ha.osd.mil DSB Lock Request Form (bottom) For Active Duty Members Only Printed Name of individual’s Commander (when duty is affected) Signature Printed Name of Hospital Commander Signature NOTICE: The requester acknowledges that criminal penalties under the Privacy Act (5 U.S.C. § 552a(i) (3)) or Health Insurance Portability and Accountability Act of 1996 may apply if it is determined that the requester, or any individual employed or affiliated therewith, knowingly and willfully obtained the file(s) under false pretenses. Further, the requester acknowledges that criminal penalties may be imposed under 18 U.S.C. § 641, which provides that if it is determined that the requester, or any individual employed or affiliated therewith, has taken or converted to his own use data file(s), or received the file(s) knowing that they were stolen or converted, they shall be fined under Title 18, imprisoned not more than 10 years, or both. In addition, the requester and any individual employed or affiliated therewith may be subject to civil suit under the Privacy Act for damages which occur as a result of willful or intentional actions which violate an individual’s rights under the Privacy Act or Health Insurance Portability and Accountability Act of 1996. http://www.pec.ha.osd.mil/PDTS/pdts_mtfs.htm

9. DoD Pharmacoeconomic Center www.pec.ha.osd.mil Data Integrity Reports Agenda - Discuss the High Dose Alert, Stoplight and Over $2000 reports Outline current prescription data transfer functionality between CHCS and PDTS Discuss CHCS file and table builds for FRM and ADN files Identify preventative measures to reduce data integrity issues

10. DoD Pharmacoeconomic Center www.pec.ha.osd.mil Data Integrity Reports Over $2000 Report –FY07 Oct-Dec, 520 New RXs over priced by $28+M –FY07 Oct-Dec, 419 Refill RXs over priced by $3+M HDA Report –MTFs at 200% Tolerance –Retail and Mail Order at 100% Tolerance Stoplight Report –Overview of HDA sent to Service Consultants

11. DoD Pharmacoeconomic Center www.pec.ha.osd.mil Sample Stoplight Report

12. DoD Pharmacoeconomic Center www.pec.ha.osd.mil Prescription Data Entry Provider Order Entry RXs –Is active in PDTS once entered by provider –Is in suspense in CHCS until processed by pharmacy –Modifications and cancellations by providers not sent to PDTS Pharmacy Order Entry RXs –Remove Refill - Cancel RX –Non-compliant RX - Discontinued RX –Modify RX- Edit RX

13. DoD Pharmacoeconomic Center www.pec.ha.osd.mil New Prescription Screen

14. DoD Pharmacoeconomic Center www.pec.ha.osd.mil File and Table Builds ADN file building –Package size –Legal Status –NDC –Default Unit FRM file building –Days Supply Field –PDTS Cost Field –Local Cost Field

15. DoD Pharmacoeconomic Center www.pec.ha.osd.mil ADN and FRM Files

16. DoD Pharmacoeconomic Center www.pec.ha.osd.mil Preventative Measures Correct drug file and table build Run CHCS Adhoc reports to identify and correct DI problems Educate users

17. DoD Pharmacoeconomic Center www.pec.ha.osd.mil National Provider Identifier Conversion Project Agenda - Outline current system used to identify medical providers and pharmacies Discuss how future system will be established to identify medical providers and pharmacies Explain how conversions will occur within the DoD Direct Care system Discuss impact on providers and pharmacies

18. DoD Pharmacoeconomic Center www.pec.ha.osd.mil Current Identifier Process Physicians and other practitioners - –Retail and Mail Order must use a DEA # –MTFs use SSN for Inside providers and either a DEA # or License # for Outside providers Pharmacies - all points of service use an NCPDP # to identify the dispensing location MTF Pharmacies obtain NCPDP numbers through the POC

19. DoD Pharmacoeconomic Center www.pec.ha.osd.mil Future Identifier Process HIPAA act of 1996 mandates the use of a standard unique health identifier for all healthcare providers The National Provider Identifier (NPI), a unique identification number issued by the government, identifies a specific provider or dispensing location will be used in both the private sector and all DoD points of service. The NPI does not replace the need for individual DEA numbers or state license numbers

20. DoD Pharmacoeconomic Center www.pec.ha.osd.mil National Provider Identifier The NPI is a 10 digit numeric with a check digit in the last position Two Types of NPIs available - –Type 1 NPI for physicians and other practitioners –Type 2 NPI for hospitals, pharmacies and other service providers Transition to NPIs will begin in both the private sector and DoD in May 2007

21. DoD Pharmacoeconomic Center www.pec.ha.osd.mil Obtaining an NPI DoD facilities - Each MTF should already have obtained its organizational NPI MTF pharmacies - the POC is obtaining NPIs for all DoD pharmacies based on their unique NCPDP numbers Physicians and other practitioners, both DoD and private sector providers are required to apply for their own NPI

22. DoD Pharmacoeconomic Center www.pec.ha.osd.mil Impact of NPI Conversion MTF Pharmacies will have updated their NCPDP numbers before NPIs are loaded Loading NPIs, both Type 1 and Type 2 will be done automatically in CHCS Problems associated with transactions without a valid NPI

23. DoD Pharmacoeconomic Center www.pec.ha.osd.mil Questions 210-221-8274 1-866-275-4732 pdts.ameddcs@amedd.army.mil