Department of Veterans Affairs

PBM Drug Accountability Conference San Antonio, TX May 11 - 13, 2010

VA Consolidated Mail Outpatient Pharmacy

Stephen J. Lewis RPh

Associate Director Murfreesboro, TN Department of Veterans Affairs Consolidated Mail Outpatient Pharmacy

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Department of Veterans Affairs Consolidated Mail Outpatient Pharmacy

CMOP Mission

To serve veterans through the safe, cost-effective, timely and efficient fulfillment of prescriptions in support of the provision of care.

CMOP Vision

 Partner with VA Medical Center customers in the provision of integrated and seamless care  Continuously improve quality processes and service provided  Ensure the highest level of integrity and accountability  Contribute as members of VA Pharmacy community  Contribute as members of the Pharmacy Profession  Be a “visible” component yet a transparent presence in the patient-centric pharmacy process  Continuously plan and prepare for response to emergent need both locally and nationally  Innovate, Automate, and Transform the provision of Prescription Benefit to veterans 3

       Initial review of the order Medication profile review Patient consultation Verification of patient address Daily transmission of orders Reporting of errors and patient complaints Notification of changes in product utilization       Verification of order transmissions Accurate and timely processing of orders Investigation, trending, and feedback for all errors and patient complaints reported Cancellation of order with explanation to the Medical Center, when applicable Proper inventory control Provision of cost reports

Medical Center CMOP

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Life of a VA CMOP Mail Outpatient Prescription

Provider Orders Medication/Supplies Patient Receives Medication/Supplies

1+ Hrs 10 Hrs 12 to 48 Hrs 48+ Hrs Awaiting Order Verification by VAMC CMOP Filling Awaiting Transmission of Order to CMOP Delivery of Product to Patient Goal: delivery to patient within 10 days of provider or patient request 5

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Unit of Use Dispensers (70%)

Knapp and SI Dispen-SI-Matic Highest efficiency with fewest errors  

Tablet/Capsule Dispensers (16%)

Baker and Others Automatic tablet/capsule counting Improved tablet/capsule delivery to eliminate miscounts • •

Controlled Substances (6%)

ADU, AutoMed-Fast Fill, and Others Accurate automated counting Complete inventory every 24 hrs •

Bulk Dispensing (4%)

Special shipping needs •

Manual Dispensing (3%)

Low use products  

Outsource Contractors (1%)

Medline and McKesson Large, heavy, or bulky non-drug products Data security compliant with VA standards 6

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Snapshot

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Address hygiene. Incorrect addresses are a cost to all, from destruction of drug costs, to return to shipper costs for certain packages. $180M per year on shipping alone.

For example, at Mid-South CMOP over the last six months over 8,100 packages have been returned. This is just controls.       3,824 Unclaimed 1,779 Address issues 1600 Three attempts made 336 Refused 203 Deceased.

Etc… 11

 ◦ ◦ ◦ ◦ ◦

Knowing what’s on the CMOP formulary.

Low use cancel backs. Do you really want to un mark them?

Running Pro-Clarity routine to determine products that could reach CMOP MOU threshold.

Contacts at your local CMOP for product addition.

 //vaww.apps.cmop.va.gov/CMOPProductLine/ Know your local transmit to CMOP time.

Know your station number.

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Quarter 1 Quarter 2

Cancel Report by Percent of Total FY10

Cancel Reason 001 TEMP OUT OF STOCK-OTHER 002 CMOP STOCKS ALTERNATE PACK SIZE: 003 NOT STOCKED IN CMOP-LOW USAGE 004 QTY EXCEEDS DAYS SUPPLY 005 NDF CHANGE-REMATCH 006 PRODUCT DISCONTINUED 007 MANUFACTURER'S BACKORDER 008 MAILING ADDRESS PROBLEM 009 DUPLICATE RX IN ORDER 010 ABBREVIATION/MISSPELLING IN SIG 011 EXPIRED ADDRESS CORRECT & RESUBMIT 012 SITE REQUESTED CANCEL 013 TEMP OUT OF STOCK-PRIME VENDOR 014 SIG TO LONG TO PROCESS 015 REFRIGERATED ITEM TO PO BOX FILL LOCALLY 016 BAD ZIP CODE FOR ADDRESS/STATE 017 NOT STOCKED CONTACT CMOP WITH USAGE 018 CORRECT QTY & RESUBMIT 019 SPECIAL NEED PATIENT-FILL LOCALLY 020 DATABASE ERROR-PLEASE RESUBMIT 021 COULD NOT FILL IN DESIGNATED TIMEFRAME 022 PLEASE VERIFY DOSE 023 QUESTION/CONFUSION ON SIG 024 DUPLICATE DRUG THERAPY 025 DRUG RECALL BY MANUFACTURER 026 VERFY DRUG/DOSAGE IF CORRECT ADD ### 027 OTHER: 028 029 030 All Other codes CMOP Total Cancels 0.13% 0.55% 0.09% 0.13% 0.15% 1.14% 0.00% 0.02% 0.00% 31.31% 98,999 11.93% 8.58% 1.58% 0.93% 1.75% 0.76% 27.99% 0.38% 0.06% 0.65% 0.06% 2.05% 3.80% 1.24% 1.27% 0.01% 0.20% 1.43% 0.01% 0.53% 1.26% 0.11% 0.34% 0.04% 0.03% 0.07% 0.67% 0.02% 0.74% 0.00% 26.07% 150,233 9.99% 6.31% 1.17% 0.66% 0.79% 1.45% 37.23% 0.15% 0.15% 1.47% 0.37% 1.46% 1.34% 1.05% 1.29% 0.03% 0.38% 0.99% 0.01% 0.31% 5.34% 0.08% 0.59% 0.05% 0.01% 0.06% 7.36% 0.05% 0.90% 0.00% 0.07% 224,617 9.02% 5.89% 1.01% 0.71% 0.36% 0.79% 50.39% 0.17% 0.02% 1.84% 0.97% 1.40% 5.44% 1.07% 1.40% 0.04% 0.64% 1.71% 0.00% 0.25% 7.71% 0.09% 0.28% 0.06% 0.00% 0.05% 1.75% 0.04% 0.77% 0.00% 0.09% 202,358 12.47% 4.26% 1.10% 0.67% 0.21% 0.75% 60.55% 0.16% 0.04% 1.94% 0.52% 1.22% 5.43% 0.96% 1.36% 0.05% 0.69% 1.16% 0.00% 0.15% 3.17% 0.14% 0.37% 0.06% 0.03% 0.04% 0.46% 0.04% 0.81% 0.00% 0.06% 177,806 20.93% 4.99% 1.56% 0.88% 0.34% 0.60% 48.38% 0.34% 0.02% 1.82% 0.56% 1.21% 8.62% 1.03% 1.52% 0.06% 0.80% 1.02% 0.01% 0.22% 3.07% 0.15% 0.48% 0.04% 0.01% 0.08% 0.75% 0.04% 0.96% 0.15% 0.10% 156,944 20.70% 6.66% 3.20% 1.23% 0.91% 0.55% 43.06% 0.30% 0.03% 2.99% 1.66% 4.00% 2.65% 1.44% 2.14% 0.04% 1.08% 1.88% 0.01% 0.47% 2.24%

Top 10 Manufacturer Back Orders

FLUNISOLIDE 0.025% 200D NASAL INH SPRAY GEMFIBROZIL 600MG TAB FLUNISOLIDE 25MCG 200D NASAL INH SPRAY TRAZODONE HCL 100MG TAB SIMVASTATIN 20MG TAB ACYCLOVIR 200MG CAP PRAZOSIN HCL 2MG CAP PENTOXIFYLLINE 400MG SA TAB DOXAZOSIN MESYLATE 8MG TAB ALENDRONATE 70MG TAB

# Rx

16328 12235 3593 3519 2814 2251 2225 1832 1573 1405

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Just in Time products:

Do you know what products your CMOP has as Just in Time?

Can you utilize that process for your patients?

   Lowers local inventory holding cost and risks.

Usually overnight/next day service to the patient from the CMOP.

May in fact get to the patient at the same time local VA could get it to the patient.

Prod Code A1223 Pack Size 1.00

A1525 A1526 A1527 D0794 1.00

1.00

1.00

1.00

NDC Product 00173 0742 00 00003 3624 12 00003 3631 12 00003 3622 12 59676 0561 01 ABACAVIR SO4 600MG/LAMUVI DINE ATAZNAVIR 150MG CAP ATAZNAVIR 200MG CAP ATAZNAVIR 300MG CAP DARUNAVIR ETHANOLATAE 400MG TAB 17

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Med/Surg Items and Low Use Items.

◦ What does your CMOP carry?

◦ ◦ ◦ Are your items turned on?

Are you ordering the correct pack size?

Does your drug file reflect CMOP pk size?

Product Code A0120 A1016 A1020 VA Print Name ALCOH OL ISOPRO PYL 70% ALLCLE NZ TOP SPRAY 480 360 Dispens ing Pack Size Max Dispens e QTY 48 Outsou rce Catalog Numbe r PDL574 005716 H 12 HLP213 020012 H 8 SQ3249 08H BO580 ALOE VESTA PROTEC TIVE TOP OINT BARRIE R H1480 3 240 5 12 HTP148 03 18

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