9 th Annual Pharmacy Informatics Conference CHAMPVA Meds

9 th Annual Pharmacy Informatics Conference CHAMPVA Meds by Mail: Serving the Veterans’ Family Courtney Albritton, CPh. T Meds by Mail (Mb. M) – Dublin March 2018

Agenda Ø CHAMPVA/Meds by Mail (Mb. M) Program Overview Ø Mb. M Operations Ø Key Accomplishments FY 2014 -2017 – – – Digital imaging E-Rx Retail Recapture Specialty Pharmacy Team Virtual Pharmacy Services Ø Looking Ahead/Future Initiatives Ø Summary/Questions VETERANS HEALTH ADMINISTRATION 1

CHAMPVA Overview Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) Ø Comprehensive health care program (https: //www. va. gov/COMMUNITYCARE/docs/pubfiles/ programguides/champva_guide. pdf) Ø Eligible Beneficiaries Ø Benefits Ø Pharmacy Ø PBM Meds by Mail (Mb. M) Ø Retail Pharmacy Network VETERANS HEALTH ADMINISTRATION 2

PBM-Meds by Mail Program Overview Ø Mail-order pharmacy: non-urgent, maintenance medications (and some medical supplies) to CHAMPVA eligible beneficiaries. Ø No cost share; no annual deductible (vs. 25% copay in retail) Ø Pilot in 1995 between HAC (now OCC), the Leavenworth CMOP and Kansas City VAMC Ø First, limited to CHAMPVA beneficiaries living in Oklahoma; later expanded to seven Midwestern states in the late 1990’s Ø 1999 became a national program Ø 2004 added Dublin, GA servicing center Ø October 2008 VHA Pharmacy Benefits Management Services (PBM) assumes responsibility for Mb. M Program VETERANS HEALTH ADMINISTRATION 3

PBM-Meds by Mail partnerships within the VA system Ø CHAMPVA Civilian Health And Medical Program of the Department of Veterans Affairs § Health benefits program in which the VA shares the cost of certain health care services and supplies with eligible beneficiaries Ø Office of Community Care § Administers the CHAMPVA program and determines CHAMPVA eligibility status (which includes eligibility for Mb. M) Ø CMOP Consolidated Mail Outpatient Pharmacy § Seven CMOPs national wide, Mb. M primary CMOP is in Leavenworth, KS § Prescriptions processed by MBM are electronically submitted to CMOP for filling and shipping to the patient VETERANS HEALTH ADMINISTRATION 4

PBM-Meds by Mail Process - Overview VETERANS HEALTH ADMINISTRATION 5

Pharmacy Technician Rx Order Entry TEST, PATIENT <A> Ht(cm): _______ PID: XXX-XX-XXXX (______) DOB: XX X, XXXX (XX) Wt(kg): _______ (______) SEX: MALE Non-VA Meds on File Last entry on 05/12/17 Cr. CL: <Not Found> BSA (m 2): _______ ISSUE LAST REF DAY # RX # DRUG QTY ST DATE FILL REM SUP -------------------ACTIVE------------------1 7078025 AMOXICILLIN 250 MG CAP 30 S> 1115 02 -15 0 10 2 7065649 ARMODAFINIL 150 MG TAB 60 E> 1011 10 -11 0 30 -----------------NON-VERIFIED----------------19 7078031 ACETAZOLAMIDE 250 MG TAB 90 N> 02 -14 03 -16 1 30 ------------------PENDING------------------50 METHYLPREDNISOLONE 16 MG TAB QTY: 1 VETERANS HEALTH ADMINISTRATION 6 ISDT: 04 -30> REF: 0

PBM-Mb. M Operations Ø 2 service centers- Cheyenne, WY and Dublin, GA Ø 136 GS employees + augmented with 59 contract staff – – Call center staff [51] Pharmacy Technician staff [48] Pharmacists [66] Admin/Specialty [30] Operational Snapshot: FY 2013 – FY 2017 Annual Prescription Workload Annual Drug Cost (CMOP) Average Prescription Cost Annual Program Operating Costs Mb. M Users Call Center Volume VETERANS HEALTH ADMINISTRATION FY 13 2. 67 M $189 M $71. 00 $12. 5 M 114, 735 367, 571 FY 14 2. 72 M $180 M $72. 34 $13. 9 M 119, 512 454, 208 FY 15 2. 79 M $216 M $77. 57 $15. 5 M 124, 747 436, 629 FY 16 2. 89 M $229 M $79. 24 $16. 3 M 130, 359 513, 180 FY 17 3. 1 M $248 M $80. 07 $17. 3 M 138, 359 568, 266 7

Prescription Volume Increase Fiscal Year 2009 - 2017 3 500 000 3, 107, 490 55. 2% Increase 3 000 2 500 000 2, 002, 533 1 500 000 FY 09 FY 10 FY 11 VETERANS HEALTH ADMINISTRATION FY 12 FY 13 FY 14 FY 15 FY 16 FY 17 8

Call Volume Increase: FY 2008 -2017 700 000 600 000 Daily avg: 2, 500 calls Number of Calls 500 000 400 000 300 000 Call Center Volume 200 000 Audio. Care Call Volume 100 0 FY 08 FY 09 FY 10 VETERANS HEALTH ADMINISTRATION FY 11 FY 12 FY 13 FY 14 FY 15 FY 16 FY 17 9

FY 2014 -2017 Accomplishments VETERANS HEALTH ADMINISTRATION 10

PBM-Mb. M Program Changes: FY 2014 -2017 Ø Implemented Digital Imaging system from OPEX Ø E-Prescribing Ø Retail Recapture/Specialty Pharmacy Ø PBM Virtual Pharmacy Services (VPS) Program VETERANS HEALTH ADMINISTRATION 11

Digital Imaging System for Prescription Processing VETERANS HEALTH ADMINISTRATION 12

Virtual Prescription Processing Workflow VETERANS HEALTH ADMINISTRATION 13

Pharmacist Verification (DAPER screen shot) VETERANS HEALTH ADMINISTRATION 14

Pharmacist Verification (Vist. A screen shot) VETERANS HEALTH ADMINISTRATION 15

Monthly E-Rx Workload: FY 2014 -2017 90 000 81 122 80 000 70 000 60 000 80 293 79 221 78 502 74 727 71 728 69 359 85 309 62 585 FY 14 50 000 FY 15 40 000 FY 16 30 000 FY 17 20 000 10 000 0 Oct Nov Dec Jan VETERANS HEALTH ADMINISTRATION Feb Mar Apr May Jun Jul Aug Sep 16

Retail Recapture and Specialty Pharmacy Purpose/Objectives: Ø Grant Thornton Study – VA saves $135 M annually with PBM -Mb. M (cost avoidance) Ø Recapture high dollar and/or high volume Rxs lost to the retail setting § Hep C, Albuterol Inhalers Ø Medications requiring special handling/delivery (Tikosyn) Ø Medications requiring a short turn-around time (Ibrance) Ø Medication with high harm potential or lack of efficacy if noncompliant (e. g. , Hep C) VETERANS HEALTH ADMINISTRATION 17

PBM Virtual Pharmacy Services (VPS) Program Remote Prescription Verification: PBM Partnership with VA Medical Center Pharmacies to Reduce Prescription Fulfillment Time VETERANS HEALTH ADMINISTRATION 18

Background VHA Handbook 1108. 05 Outpatient Pharmacy Services New and refill Rx’s mail delivery must be processed for filing within two working days of receipt Issue… “many VAMC Pharmacies report significant backlog of pending file prescriptions” Impact to the Veteran Ø Delay in prescription fulfillment Ø Possible disruption in medication therapy Ø Dissatisfaction with service (longer time to receive prescriptions) Impact to the VA Medical Center Ø Ø Increase phone call volume to pharmacy /Dissatisfaction among pharmacy staff Resources diverted away from direct patient care Potential increase in medication errors Significant use of overtime pay, comp time, contracts VETERANS HEALTH ADMINISTRATION 19 10/15/2021

VETERANS HEALTH ADMINISTRATION 20

VPS Growth: # of VAMCs Using Service 21 19 18 15 13 7 2 VETERANS HEALTH ADMINISTRATION 2017. 2016 2015 2014 2013 2012 2011 21

Current List of VPS Sites 1. VA TVHS, Nashville, TN (Jan 2011) 2. VAMC Mt. Home, TN (Jun 2011) 3. VAMC Portland, OR (Nov 2011) 4. VAMC Cincinnati, OH (Dec 2011) 5. VAMC Long Beach, CA (Feb 2012) 6. VAMC Minneapolis, MN (Jun 2012) 7. VAMC Philadelphia, PA (Jul 2012) 8. VA Puget Sound HS, WA (Nov 2012) 9. VAMC Loma Linda, CA (Jan 2013) 10. VAMC Denver, CO (Feb 2013) VETERANS HEALTH ADMINISTRATION 11. VAMC Spokane, WA (May 2013) 12. VAMC White City, OR (Jun 2013) 13. VAMC Walla, WA (Mar 2014) 14. VAMC Anchorage, AK (April 2015) 15. VAMC Montana (April 2015) 16. VAMC Roseburg, OR (May 2015) 17. VAMC Phoenix, AZ (May 2015) 18. VAMC Baltimore, MD (Aug 2015) 19. VAMC Washington, DC (Oct 2016) 20. VAMC Greater LA, CA (May 2017) 21. VAMC Detroit, MI (Sep 2017) 22

VPS Workload: FY 2011 -2017 Rx’s Processed 3 500 000 3 059 576 3 000 3 225 897 2 500 000 1 776 900 2 000 2 075 554 1 500 000 1 000 657 919 1 304 602 500 0 76 855 2011 2012 VETERANS HEALTH ADMINISTRATION 2013 2014 2015 2016 2017 23

VPS Scorecard Snapshot VETERANS HEALTH ADMINISTRATION 24

VPS Scorecard Results 2015: Change in Comp Time and Overtime Pre and Post VPS Implementation* Comp Time Used (avg)† # Sites Prior # Sites Post Zero hours /pay period 3 10 Zero hours /pay period 4 13 1 -25 hrs/pay period 8 3 1 -25 hrs/pay period 6 0 26 -50 hrs/pay period 1 0 51 -75 hrs/pay period 1 1 Overtime Used (avg)‡ # Sites Prior Post 26 -50 hrs/pay period 1 1 51 -75 hrs/pay period 1 0 76 -100 hrs/pay period 0 0 76 -100 hrs/pay period 1 0 > 100 hrs/pay period 2 0 0 * 14 of 18 sites responded † Sites provided estimates of the avg # of Overtime hours > 100 hrs/pay period 0 * 14 of 18 sites responded † Sites provided estimates of the avg # of VETERANS HEALTH ADMINISTRATION Comp Time hours 25

Looking Ahead Ø Information Technology – Continued enhancements to electronic workflow (DAPER 2. 0) – Inbound Electronic prescribing – Call center enhancements/consolidation – My. Healthe. Vet for CHAMPVA beneficiaries Ø Other Goals – Continued marketing efforts to increase beneficiary use of Mb. M for high volume/high cost drugs filled in retail (Hep C, Naloxone, other specialty items) – Staffing plan to match the organizational needs – New building –Dublin VETERANS HEALTH ADMINISTRATION 26

Contacts Susan E. Brooks susan. brooks 4@va. gov Supervisory RPh MBM & VPS Coordinator John Santell John. santell@va. gov Associate Chief Consultant (Acting), MBM Ron Nosek Ron. Nosek@va. gov Deputy Chief Consultant (Acting), PBM VETERANS HEALTH ADMINISTRATION 27 10/15/2021

Questions? Courtney D. Albritton, CPh. T PBM-Meds By Mail courtney. albritton@va. gov VETERANS HEALTH ADMINISTRATION 28