Pharmacoeconomics

Report
1
PHARMOECONOMICS:
ARE YOUR DRUG FILE PRICES
ACCURATE?
UTILIZING PHARMACY DATABASES TO IDENTIFY
COST OPPORTUNITIES
Andrew Henriksen PBM/CMOP Pharmacoeconomic Data
Manager
Workshop Objectives
2



Learn tips to optimize local drug file setup
Introduction to methods used to validate data using
available reports and tools
Learn how to access the Pharmacoeconomic
SharePoint site and other available resources
including future CDW reports and tools
3
Drug File Optimization
How cost data gets entered into VISTA
4

Prime Vendor Invoices uploaded via the Drug
Accountability application
 Data
must be verified before being accepted
 Quantity issues (dispense unit vs. order unit, bottle size)
 Different dispense unit (gram vs. inhaler)
 Different NDC ordered

Items not purchased through prime vendor
(omeprazole via repackaging provider) must be
updated manually
How costs gets into VISTA (and to PBM)
5

File 50: DRUG File
 Synonyms:
Can have multiple NDC’s each with their own
price, quantity, dispense unit per order unit entered
 Only one price at a time, assigns the most recent invoice
price or last price change to all fills going forward (not
tied to NDC)
 Does not use CMOP prices for fills dispensed by CMOP,
price assigned is current price in local drug file
Example -Tiotropium 30 (Prime Vendor)
6
Mck
Description
Strength
Form
NDC
Item #
1771930
SPIRIVA HANDIHALER 30
18MCG
CAP W/DEV
005970075-41
Purchase
Unit
Price
Price
Manufacturer
Size
$54.14
$1.8047
30
Prime Vendor uses capsule for unit price, the VA National
Drug File (NDF) uses purchase price for dispense unit price
TIOTROPIUM 18MCG INHL CAP 30
ORDER UNIT: BX//
PRICE PER ORDER UNIT: 54.14//
DISPENSE UNIT: PKG//
DISPENSE UNITS PER ORDER UNIT: 30
PRICE PER DISPENSE UNIT: 1.8047
NDF data base-Tiotropium
7
Strategies to optimize file 50 setup
8
TIOTROPIUM 18MCG INHL CAP 30
MESSAGE: DISPENSE PER BOX (NOT CAPSULES)  to ALERT pharmacy staff
ORDER UNIT: PK//
PRICE PER ORDER UNIT: 54.14//
DISPENSE UNIT: EA//
DISPENSE UNITS PER ORDER UNIT: 30// 1
PRICE PER DISPENSE UNIT: 1.8047 54.14
*******************************************************************************
This entry is marked for the following PHARMACY packages: D - Drug Accountability
Select SYNONYM: // 30597007541
INTENDED USE: DRUG ACCOUNTABILITY//
NDC CODE: 00597-0075-41//
ORDER UNIT: PK//
PRICE PER ORDER UNIT: // <leave blank>
DISPENSE UNITS PER ORDER UNIT: // 1
PRICE PER DISPENSE UNIT: // <leave blank>
Example - Ziprasidone
9
Mck Item
#
Description
Strength
Form
NDC
Purchase
Price
Unit
Price
Manufacturer
Size
1413988
GEODON CAP 20MG 60
20 MG
CAPSULE
00049-3960-60
$397.54
$6.63
60
1380088
GEODON CAP 40MG 60
40 MG
CAPSULE
00049-3970-60
$397.54
$6.63
60
1391838
GEODON CAP 60MG 60
60 MG
CAPSULE
00049-3980-60
$482.45
$8.04
60
1394576
GEODON CAP 80MG 60
80 MG
CAPSULE
00049-3990-60
$482.45
$8.04
60
Some products are essentially “flat priced” all strengths cost about the same
Ziprasidone fills
10
va_product
Day
Qty/ Dose
supply Qty day ordered schedule
Cost (as
written)
Cost (if using higher
capsule strength)
ZIPRASIDONE HCL 40MG CAP
30
120
4
80
BID
$795
$398
ZIPRASIDONE HCL 40MG CAP
30
120
4
80
BID
$795
$398
ZIPRASIDONE HCL 20MG CAP
30
180
6
60
QAM & QHS
$1193
$482
ZIPRASIDONE HCL 20MG CAP
30
180
6
60
QAM & QHS
Total:
Savings:
$1193
$3976
$482
$1760
$2216
ZIPRASIDONE 20MG CAP
Strength from National Drug File match => 20 MG
Strength currently in the Drug File => 20 MG
Strength => 20 Unit => MG
POSSIBLE DOSAGES:
DISPENSE UNITS PER DOSE: 1
DISPENSE UNITS PER DOSE: 2
DOSE: 20MG
DOSE: 40MG
PACKAGE: IO
PACKAGE: IO
Flat Priced Products
11







Dexlansoprazole: once daily dosing, low volume
Ziprasidone: BID dosing, big volume
Aripiprazole: once daily dosing, big volume
Pregabalin: up to QID dosing, growing volume
Duloxetine: up to BID dosing, growing volume
Desvenlafaxine: once daily dosing, low volume
Others?
Summary: drug file setup optimization
12




Use Drug Accountability package to lock in
appropriate quantity dispense units per order unit
Utilize the drug message screen to guide pharmacy
staff on how to complete orders
Consider provider Quick Orders to aid prescribing
Limit possible doses to 1 dose per strength on flat
priced items (utilize tablet splitting where
appropriate)
13
Questions?
14
Validating Data:
Available Reports and Tools
Reports and Tools
15


High Cost RX report [PSO HI COST]
CMOP Cost Reports
http://vaww.national.cmop.va.gov/CostReports/default.aspx

Prime Vendor Purchase reports
High Cost RX report [PSO HI COST]
16

Run High Cost RX report [PSO HI COST] in VISTA
 Beginning
Date: (APR 1, 2011)
 Ending Date: (APR 31, 2011)
 Dollar Limit : (0-9999): 30// 0  Capture all fills
 DEVICE: HOME// ;255;999999  Send to file, do not
need to print out on paper
High Cost RX report via Data
Warehouse
17
Use CDWwork --(or, could use RDWwork or local data warehouse)
select distinct LEFT(DateText,7) as month, d.visn, b.sta3n, Facility, b.RxNumber
, b.LocalDrugNameWithDose, c.VAProductIdentifier as CMOPID
, c.DrugNameWithDose, c.DrugNameWithoutDose, A.DaysSupply
, UnitPrice, Qty, (UnitPrice*QtyNumeric)as Total_Cost
, RxStatus
from CDWwork.RxOut.RxOutpatFill a
inner join CDWwork.RxOut.RxOutpat b on a.RxOutpatIEN=b.RxOutpatIEN and
a.sta3n=b.Sta3n
inner join CDWwork.Dim.NationalDrug c on a.NationalDrugIEN=c.NationalDrugIEN
inner join CDWwork.Dim.VistaSite d on a.Sta3n = d.Sta3n
inner join CDWwork.Dim.Date e on a.ReleaseDateTime=e.Date
where a.ReleaseDateTime >= dateadd(MONTH, -2, GETDATE()) AND A.Sta3n>0 AND
D.Sta3n<999 and ((UnitPrice*QtyNumeric)>1000) and c.DrugNameWithoutDose not
in ('imatinib‘, 'nilotinib', 'sorafenib', 'LENALIDOMIDE', 'SUNITINIB',
'ENTECAVIR', 'ERLOTINIB','PEGFILGRASTIM','DARUNAVIR‘) and (VISN =‘#') and
a.Sta3n =‘###’
order by month desc, d.visn, b.sta3n, Facility, b.RxNumber,
b.LocalDrugNameWithDose, c.DrugNameWithDose, c.DrugNameWithoutDose,
Unitprice, Qty, (UnitPrice*QtyNumeric)
18
NDF data base
19
CMOP Cost Reports
20
CMOP-761 RX Cost Report (2/23/2011 12:00:00 AM Through
3/24/2011 11:59:59 PM)
New York (630)
CMOPID
NDC
VAPrintName
…
…
XU838
AVK19641
XU845
AVK19840
XU845
AVK19840
XU846
AVK19758
….
DEPEND BELTED
W/BUTTONS XTRA
ABSORB
DEPEND UNDERWEAR
SUPER PLUS MEN
SM/MED
DEPEND UNDERWEAR
SUPER PLUS MEN
SM/MED
DEPEND UNDERWEAR
SUPER PLUS WMN
SM/MED
XU847
UnitCost
NumberRX
QTY
TotalCost
…
…
…
…
$32.0200
16
34
$1,088.6800
$50.0600
19
22
$1,101.3200
$53.2800
11
16
$852.4800
$50.0600
3
5
$250.3000
DEPEND UNDERWEAR
AVK19779 SUPER PLUS WMN XLG
$53.2800
2
3
$159.8400
XU874
ATTENDS REGULAR
PRKBRB40 BRIEF X-LARGE
$28.7600
6
10
$287.6000
…
…
…
…
…
…
…
Total Number Rx
Total Drug Cost
Avg. Drug Cost per Rx
20,292
$540,400.3546
$26.6312
Quantity: 14 or 56? Or 16 or 64?
21
Mck
Item #
Description
Strength Form Purchase Unit Cust
Cust
Manufacturer Mfr
Price
Price Cntrct # Cntrct Type Size
Name
KIMBERLY CLARK
3238912 DEPEND U/W WMN X/AB XLG 16 CS4
$44.43 $2.78
16
CORP
DEPEND U/W WMN X/AB XLG 14 CS4
KIMBERLY CLARK
?
?
?
14
CORP
Package Size
Multiplier
1.00
1.00
Prime Vendor Reports
22




Purchase reports
Penny prices
Contract compliance
Custom reports
Purchase Reports
23
SMO  Pharmacy Management / Programs Access Reports &
Analysis  Create Report  Canned Report 
Purchasing Detail Report  Invoice Level Detail
(choose the dates to search, customers account numbers and
items to include)
Selected Date Range:
04/01/2010 to 04/15/2011
Customer
Unit
Ext.
Cust#
Name
EMost# NDC/UPC
Item Description
Invc/Cred # Invc/Cr Da Ordr Fill Net UOM Price Price
VA MED CTRNORTHPORT
DEPEND U/W WMN
727477 MED
3238979 03600-0197-58 S/AB S/M 18 CS4
7467106567 3/2/2011
1
1
1 CS
$44.43 $44.43
VA MED CTRNORTHPORT
DEPEND UWEAR
727477 MED
3238953 03600-0195-58 WMN S/M 20 CS4 7463190472 2/1/2011
1
1
1 CS
$44.43 $44.43
Purchase Reports
24
SMO  Pharmacy Management / Programs Access Reports &
Analysis  Create Report  Canned Report 
Purchasing Detail Report  Invoice Level Detail
(choose the dates to search, customers account numbers and
items to include)
Cust# EMost# NDC/UPC
Item Description
Invc/
Cred #
Invc/
Credit
Date
C
Unit
Ordr Fill Ret Net UOM Price
Ext. Price
679786 1383165 00078-0438-15 GLEEVEC TAB 400MG (SCORED) 30
7465244831 2/16/11 Y
1
1
0
1 EA
$2,321
$2,321
679786 1383165 00078-0438-15 GLEEVEC TAB 400MG (SCORED) 30
7467164465 3/2/11 Y
2
2
0
2 EA
$2,321
$4,642
679786 1383165 00078-0438-15 GLEEVEC TAB 400MG (SCORED) 30
7471758424 4/5/11 N
2
2
0
2 EA
$4,570
$9,139
Cost Change Report (Penny drugs)
25

SMO  Ordering / Inventory  Reports 
Contract Change Report
Cost Change Report (Penny drugs)
26
Item
Number NDC
Dose
Generic Proper Strength
Dose
Contract Description
Form
Price
Name
Generic Name
Sell Description
CIPROFLOX O/S 0.3%
1265883 61314-0656-25 FAL 2.5ML@
DROPS
CIPROFLOX O/S 0.3%
1266089 61314-0656-05 FAL 5ML@
DROPS
FELODIP ER TAB
TAB SR
1430412 63304-0436-01 5MG RAN 100@ 24H
FELODIP ER TAB
TAB SR
1432285 63304-0437-01 10MG RAN 100@ 24H
CORTIFOAM
1630235 68220-0140-15 15GM
POT CHL ER TB
1723915 00085-1718-01 20MEQ SCHE 1000
RISPERID TB 0.5MG
1752245 50458-0591-60 PATR 60@
RISPERID TB 3MG
1763101 50458-0594-10 UD PATR 100@
DESMOPR VL
4MCG/ML FER
2139327 55566-5040-01 10ML
TWINJECT 0.3MG
2142701 59630-0802-01 AUTO INJECTOR
GLYBURIDE TAB D
2220515 00093-9433-01 2.5MG TEV 100
Size
Supplier Account Name Qty
FALCON
CIPROFLOXACIN HCL PHARMACEUTICALS @ 1
FALCON
CIPROFLOXACIN HCL PHARMACEUTICALS @ 1
RANBAXY
FELODIPINE
PHARMACEUTICALS @ 100
RANBAXY
FELODIPINE
PHARMACEUTICALS @ 100
MEDA
HYDROCORTISONE PHARMACEUTICALS
ACETATE
INC
1
POTASSIUM
SCHERING
CHLORIDE
CORPORATION
1000
PATRIOT
RISPERIDONE
PHARMACEUTICALS @ 60
PATRIOT
RISPERIDONE
PHARMACEUTICALS @ 100
$0.01
0.30%
$0.01
0.30%
$0.01
5 MG
$0.01
10 MG
$0.01
10%
$0.01
20 MEQ
TABLET
$0.01
0.5 MG
TABLET
$0.01
3 MG
VIAL
COMBO
. PKG
$0.01
DESMOPRESSIN
4MCG/ML ACETATE
$0.01
0.3MG/0.3 EPINEPHRINE
TABLET
$0.01
FOAM/
APPL
TAB ER
PRT
2.5 MG
GLYBURIDE
FERRING
PHARMACEUTICALS
SHIONOGI PHARMA
INC
TEVA
PHARMACEUTICALS
Unit
Code
Contract
End Date
EACH
9/30/2011
EACH
9/30/2011
TAB
1/14/2015
TAB
1/14/2015
EACH
1/14/2013
TAB
8/31/2011
TAB
7/14/2013
UNIT
7/14/2013
1
EACH
1/31/2012
1
EACH
5/31/2011
100 TAB
4/14/2013
Contract Compliance
27
SMO  Pharmacy Management / Programs Access
Reports & Analysis  Create Report  Canned
Report  Savings Identification 
Contract Compliance/ Lost Savings (choose both
Contract and Non-contract, display results as CSV)
Contract Compliance
28
Item
Item Description
CITALOPRAM HYDROBROMIDE
Pkg Size: 100 Mfg Size: 100
CELEXA TAB 40MG 100
Alt Item Description
BLU PHARMACEUTICALS
LLC
AUROBINDO PHARMA
USA @
TORRENT PHARMA INC
@
APOTEX CORPORATION
CARACO
PHARMACEUTICALS @
GREENSTONE LIMITED
@
MYLAN
PHARMACEUTICALS @
Purch
Inv. Date Qty Supplier Name
12/1/
2010 1 FOREST PHARM/LABS
Alt Supplier Name
Max Lost
Purch Price Savings
Available
Qty
$201.15
BLU PHARMACEUTICALS LLC
AUROBINDO PHARMA USA
@
$3.83
$197.32
14
$3.91
$197.24
14
TORRENT PHARMA INC @
$6.18
$194.97
14
APOTEX CORPORATION
CARACO PHARMACEUTICALS
@
$9.04
$192.11
14
$12.44
$188.71
14
$12.63
$188.52
14
$12.75
$188.40
14
GREENSTONE LIMITED @
MYLAN PHARMACEUTICALS
@
**Report does not tell you if alternate item was in stock that day; gives stock level of
item you ordered not the alternatives. Also, may list alternatives that are not on FSS
McKesson Custom Report:
Template Using Reports & Analysis 6.6
29
• McKesson Connect  Pharmacy Management/Programs  Select
Access Reports & Analysis  Create report  Custom report
• Formatting:
• In the Field Selection, select the following parameters to invoice
level: account name, account #, invoice extended price,
invoice/credit #, invoice credit/date, invoiced price (dose)
invoiced price (pkg.), invoiced quantity, item description,
McKesson item #, NDC and package size
• Results Display select all
Level 1 group by: Account number
Level 2 group by: Item description
• Saving Report:
• In save to my reports box  name report and save
Third Party: Update
30



Prior to March 18th,2011 maximum collection was
$51/Rx
After March 18th-third party will pay the actual cost
of the Rx plus an administration fee of $11.40
The actual cost billed to third party comes directly
from your drug file
 Important:
pricing in the drug file MUST be accurate or
you risk losing $$$$$
31
Questions?
32
Pharmacoeconomic SharePoint site
and CDW
Link:
http://vaww.national.cmop.va.gov/pre/Pharmac
oEconomic/default.aspx
You can request access from the page or send
an email to me at [email protected]
Pharmacoeconomic SharePoint Site
33


National Savings Opportunities
Reports
 Monthly
Cost Review
 Top 25 (100) drugs by Total Cost
 Unmatched Items
 Individual drug analysis reports
National Savings Opportunities
34


Selection
 Review of high cost and high volume areas with significant variability in
prescribing patterns
 Lack of evidence to support prescribing differences
 New contracts or Blanket Purchase Agreements (BPA) that create
incentives
 Areas of concern where community standard may not be evidenced
based
Measures (ProClarity)
 Outpatient pharmacy costs only
 Denominator is OP Pharmacy users only (Pharmacy Unique)
 Numerator is based on VistA dispensing data
 Drug costs based on local drug file *
National Cost per Pharmacy Unique
$1,000
$900
$800
$700
$600
$500
$400
$300
$200
$100
$0
avg
min
max
range
SD
FY1999
$599
$456
$656
$200
$54
FY2000
$632
$461
$701
$241
$56
FY2001
$655
$500
$722
$222
$55
FY2002
$664
$507
$731
$223
$52
FY2003
$704
$547
$747
$200
$46
FY2004
$774
$616
$827
$212
$47
FY2005
$794
$639
$864
$225
$48
FY2006
$784
$670
$835
$165
$39
FY2007
$751
$666
$779
$113
$34
FY2008
$693
$628
$716
$88
$28
FY2009
$697
$624
$723
$99
$31
FY2010
$705
$615
$745
$130
$36
Cost Avoidance Results



FY ’09
 12 National initiatives
 $192 million cost avoidance (6.1% of outpatient expenditures)
 Drug cost per patient 0.61% compared to FY 08
FY ’10
 26 National initiatives
 $120 million cost avoidance (3.6% of outpatient expenditures)
 Drug cost per patient 1.08% compared to FY 09
FY ’11
 36 National initiatives
 Target $128 million cost avoidance (~3-4% of projected outpatient
expenditures)
 Savings through Q1: $14.8 million
Formulas





Most measures are cost per 30 day fill
Cost per 30 day based on total costs for drugs in
market basket and number of 30 day fill
equivalents
Market basket to include all relevant drugs in
targeted area
Drugs costs used in calculations come from local drug
file*
Results calculated quarterly by PBM
Definitions


Target – based on average of top 5 VISNs for
majority of initiatives or national average where
indicated. If there was an outlier, the top 2-6
networks were used.
Goal – network specific goal based on 75% of the
difference between network baseline and the
target (top 5 networks average)
Performance Measure



Dollar amount based on the national initiatives
Finance Committee satisfactory goal (green) is 50%
of dollar amount based on the national initiatives
(no longer reported though…)
National initiatives are not mandatory
Monthly Cost Review
40





VISN Cost/Day30RX last 6 mo, 6mo average
VISN Cost/ Pharmacy Unique last 4 Qtrs, FY YTD
Site Cost/Day30RX last two months and change for
previous month
Site Cost/ Day30RX last 6mo, 6mo average
Site and Complexity Group templates
Top 25 (100) Drugs by Total Cost
41
Unmatched Items
42
Individual Drug Analysis Reports
43
CDW, RDW, & VISN data marts
44
Regional Data Warehousing
Visual Architecture
Source
Systems
Facility 1
VistA
Corporate
Data
Warehouse
Shadow/Journal Reader
Process
Regional
VistA
Shadow
Near
Real
Time
Facility 2
VistA
Facility 3
VistA
• SQL Server
• Business key
• Time stamp
• OpCode (I/U/D)
Daily
Regional
Daily
Feeder
Data
Warehouse
• SQL Server
• Business key
• Time stamp
• OpCode (I/U/D)
• Indexes:
- VistAEditDate
- Business Key
Regional
Data
Warehouse
• SQL Server
• Business key
• Time stamp
• OpCode (I/U/D)
Daily
Cartoon depicting Regional Data
Warehouse Visual Architecture
• Business key
• Time stamp
45
• Cache Classes define data of interest
• Cache Methods insert or update to ODS
• Data includes Fact and Dimension data
• SQL Server
VISN
• Business key
Data
• Time stamp
Warehouse(s) • OpCode (I/U/D)
• Incremental loads are based upon
VistAEditDate timestamp
Drug Cost Report
46

Depending on perspective, one can look at the
difference between the average, median, and
mode cost prices from the pharmacy site acquisition
price
Drug Cost Report Definitions
47

Unit Price – The price the pharmacy paid for the med

National/Region/VISN/Station/PharmacySite

Average/Median/Mode

Prescriptions – Prescriptions

Quantity – Quantity

Difference – Difference Between Prices

Cost Impact = Difference * Quantity
Average Vs Median Vs Mode
48




Average is sensitive to outliers (high and low)
Median – Pick the median price among the stations
(not bad)
Mode – Pick the most common price among the
stations (not bad)
Reports show all of them depending on the
pharmacoeconomists mood and trust of the internal
data within the VISN and/or her fellow neighbors
Region II Mode Report
Region II Median Report
51
Questions?
How do I fix errors in my data?
52

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 data I
already transmitted to PBM?
53

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
http://vaww.national.cmop.va.gov/pre/PharmacoEco
nomic/Document%20Library5/1/PBM%20Data%2
0Correction%20submission.xlsx
54
Questions?

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