Defense Health Agency Pharmacy Operations Building the New

Defense Health Agency Pharmacy Operations: Building the New… David W. Bobb, RPH, JD Chief, Pharmacy Operations Division Defense Health Agency November 7, 2018 “Medically Ready Force…Ready Medical Force” 1

Program Cost - MHS Outpatient Drug Spend FY 04 -18 (Includes Breakout of Compounds in Retail) Offsets Do. D Net Cost Estimated

Pharmacy Operations Intent “The greatest danger in times of turbulence is not the turbulence – it is to act with yesterday’s logic. ” – Peter Drucker Utilize new DHA authority to standardize operations & drive efficiencies across the pharmacy enterprise Leverage both Direct and Purchased Care Pharmacy programs to optimize the pharmacy benefit “Medically Ready Force…Ready Medical Force”

I Received This in an E-Mail… Ø From Star Trek… “We are the Borg. Lower you shields and surrender your ships. We will add your biological and technical distinctiveness to our own. Your culture will adapt to service us. Resistance is futile…” Ø A Do. D Pharmacist version… “We are the DHA. Lower you shields and surrender your MTFs. We will add your historical and military distinctiveness to our own. Your culture will adapt to service us. Resistance is futile…” “Medically Ready Force…Ready Medical Force” 4

“Medically Ready Force…Ready Medical Force” 5

The Who, What, Why, etc. Ø The ultimate goal of this transition for the Department of Defense is a more integrated, efficient, and effective system of readiness AND health that best supports the lethality of the force. Ø The number one priority of the Military Health System is readiness to support the warfighting mission of the Department of Defense. Ø The mission of Pharmacy Operations remains to support the warfighter, and care for our warfighter families, retirees, and beneficiaries by innovatively managing and standardizing the Do. D pharmacy benefit in a fiscally responsible manner to optimize readiness, improve health, and lower costs through better care. “Medically Ready Force…Ready Medical Force” 6

Phased Approach to Transition, but… Ø DHA developed a Phased approach to transition all MTFs: Ø Phase I (October 2018) – NCR, JAX+, WAMC+, Keesler, Charleston, SJ, Pope Ø Phase II (October 2019) – Transition more than 50 percent of MTFs and clinics in the U. S. Ø Phase III (October 2020) – Transition remaining MTFs and clinics in the U. S. Ø Phase IV (September 30, 2021) - Transition overseas MTFs and clinics Ø However, Pharmacy was one of three functional communities chosen for accelerated transition. This means that the DHA became responsible for all MTF pharmacy healthcare operations on 1 October 2018. “Medically Ready Force…Ready Medical Force” 7

What This Means Ø DHA is responsible for healthcare operations at MTF pharmacies Ø Services remain responsible for readiness Ø We have the opportunity to leverage both the direct care and purchased care aspects of the pharmacy benefit to optimize pharmacy services for our beneficiaries Ø Standardize, consolidate, and centralize policies, procedures, and processes across the pharmacy enterprise Ø Across the enterprise, we can implement the best programs and processes that each Service is currently doing “Medically Ready Force…Ready Medical Force” 8

Pharmacy Benefit/POD Changes ØIntroduction of a “Tier 4” formulary exclusionary status for medications Ø Simply put, drugs that will not be covered as part of the pharmacy benefit – exclude drugs from the Uniform Formulary that provide very little or no clinical effectiveness Ø Specific criteria Ø Part of the Do. D P&T process/meeting Ø Measured approach Ø Awaiting publication of the IFR Ø Director can give preferential status to brand name drugs “Medically Ready Force…Ready Medical Force” 9

Pharmacy Benefit/POD Changes Ø More robust formulary management (inpatient, medical benefit) Ø Potential savings by focusing on overall enterprise medication use instead of primarily outpatient Ø Work closely with the Health Plan Ø Industry meetings prior to P&T drug class reviews Ø Those doing the work will decide if needed Ø Not a blanket prohibition on ever holding these “Medically Ready Force…Ready Medical Force” 10

Pharmacy Benefit/POD Changes ØIncreased emphasis on clinical pharmacy services Ø Various studies have shown an ROI on clinical pharmacy services to be 3: 1 to 12: 1 Ø Allow pharmacists to practice at the top of their licenses Ø Better reflects the direction the profession is heading and aligns with civilian pharmacy practices Ø Staffing model changes, changes in distributive function, etc. “Medically Ready Force…Ready Medical Force” 11

Pharmacy Benefit/POD Changes ØCentralization and standardization of pharmacy automation equipment Ø Expect to generate savings at both the acquisition and maintenance stages Ø Assist with standardized training Ø Outpatient dispensing equipment key area ØOperational Do. D PDMP Ø Completed – December 2018 Ø Start using/populating January 1, 2019 “Medically Ready Force…Ready Medical Force” 12

Pharmacy Benefit/POD Changes ØCommon themes moving forward ØCentralize ØStandardize ØConsolidate “Medically Ready Force…Ready Medical Force” 13

Think About It… The secret of Change is to focus all of your energy not on fighting for the old, but on building the New. - Socrates It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is the most adaptable to change. - Charles Darwin “Medically Ready Force…Ready Medical Force” 14

Defense Health Agency Pharmacy Operations Update Questions? ? ? “Medically Ready Force…Ready Medical Force” 15