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PharmacoeconomicsAndrew Henriksen PBM-CMOP
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
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
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
Tools
Current Month - locally available prior to PBM extraction
High Cost RX report – VISTA CMOP monthly cost reports McKesson purchasesHistorical ProClarity-data from PBM extraction McKesson reports
SharePoint Site
SharePoint Site
Link: http://vaww.national.cmop.va.gov/pre/PharmacoEconomic/default.aspx
You can request access from the page or send an email to me at [email protected]
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
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 tablet @ $68.45)
Drug File Maintenance Tab
Reports Monthly Cost Review Top 25 drugs by total cost Unmatched items Individual drug analysis reports
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
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
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
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
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
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
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
Capture your High Cost RX report
Save into notepad
Review with Excel
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
Drug file items over/under by +/-$1,000 compared to CMOP avg unit costDrug Name Qty Local Fill Drug File Avg CMOP Avg CMOP Over Under
Cost Unit Cost Unit Cost Qty
TIOTROPIUM 18MCG INHL CAP 30 344 $17,458.00 $50.75 $66.87 511($8,237.32)
ALBUTEROL 90/IPRATROP 18MCG 200D PO INHL 722 $19,746.70 $27.35 $43.53450 ($7,281.00)
ASPIRIN 25MG/DIPYRIDAMOLE 200MG SA CAP 14,220 $14,876.75 $1.05 $1.3015,930 ($3,984.33)
IPRATROPIUM BROMIDE 17MCG 200D ORAL INHL 145 $4,049.85 $27.93 $47.94199 ($3,981.99)
RABEPRAZOLE NA 20MG EC TAB 1,200 $766.33 $0.64 $2.72 1,080($2,252.95)
METOPROLOL SUCCINATE 100MG SA TAB 4,470 $905.59 $0.20 $0.65 3,735($1,666.10)
CLONIDINE 0.3MG/24HR PATCH 492 $8,153.67 $16.57 $27.29 152($1,629.06) INSULIN SYRINGE 0.5ML 30G 0.5IN 50,180 $2,012.22 $0.04 $4.34 366 ($1,573.76)
ZIPRASIDONE HCL 80MG CAP 720 $2,090.53 $2.90 $4.02 1,290($1,444.40)
METOPROLOL SUCCINATE 50MG SA TAB 3,990 $602.92 $0.15 $0.48 3,910($1,274.06)
MONTELUKAST NA 10MG TAB 13,170 $26,444.22 $2.01 $2.18 7,141($1,257.21)
RISPERIDONE 2MG TAB 915 $3,786.40 $4.14 $0.69 915 $3,158.83LEVETIRACETAM 500MG TAB 9,306 $12,874.88 $1.38 $0.15 2,640
$3,246.72CITALOPRAM HYDROBROMIDE 20MG TAB 3,315 $1,615.06 $0.49 $0.04
7,785 $3,504.44ALENDRONATE 70MG TAB 2,048 $10,060.44 $4.91 $0.47 820 $3,639.24MOMETASONE FUROATE 220MCG ORAL INHL 120 9 $525.78 $58.42 $27.39
212 $6,578.36RISPERIDONE 4MG TAB 1,995 $12,938.65 $6.49 $1.51 1,950 $9,693.02
Review with Access
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]
How do I request a fix of submitted data?
Send an email 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
Questions?