ukcmc managed care pharmacy work group recommendations approved by the uk college of pharmacy...

UKCMCMANAGED CARE PHARMACY

WORK GROUP RECOMMENDATIONS

Approved by the UK College of Pharmacy Executive Committee

UKCMCMANAGED CARE PHARMACY

WORK GROUP RECOMMENDATIONS

Approved by the UK College of Pharmacy Executive Committee

9/18/01 Edition9/18/01 Edition

Current IssuesCurrent Issues

Therapeutic medication breakthroughs continueTherapeutic medication breakthroughs continue Rapidly escalating drug costs/expendituresRapidly escalating drug costs/expenditures

15-20% per year, Kentucky rate one of the highest in the US15-20% per year, Kentucky rate one of the highest in the US UKHMO was 19.7% in FY01UKHMO was 19.7% in FY01

PMPY Plan Cost went from $296.75 (99-00) to $355.21 (00-01)PMPY Plan Cost went from $296.75 (99-00) to $355.21 (00-01) Expected to double in 5 yearsExpected to double in 5 years

Greater societal dependence on drug therapy for treatment and prevention Greater societal dependence on drug therapy for treatment and prevention of diseaseof disease

Promotion of high cost drugs by pharmaceutical manufacturersPromotion of high cost drugs by pharmaceutical manufacturers Rising health insurance premiums and co-payments for pharmaceuticalsRising health insurance premiums and co-payments for pharmaceuticals Employee dissatisfaction with costs and perceived benefit reductionEmployee dissatisfaction with costs and perceived benefit reduction Inattention to the problem by practitioners and lack of involvement in Inattention to the problem by practitioners and lack of involvement in

addressing these issuesaddressing these issues

Utilizing IncreasingUtilizing Increasing

UK-HMO PRESCRIPTION UTILIZATION RATE PER MEMBER PER YEAR

8.86

9.43

10.38

8.00

8.50

9.00

9.50

10.00

10.50

98-99 99-00 00-01

10.0% INCREASEOVER PRIOR YEAR

6.5% INCREASEOVER PRIOR YEAR

Utilization Increasing Another Slice of the DataUtilization Increasing Another Slice of the Data

1998-1999 1999-2000 2000-2001Percent Ulilization 34% 35% 37%Prescriptions per Utilizing Member per Month 2.19 2.23 2.32Prescriptions per Utilizing Member per Year 26.24 26.77 27.82Prescriptions per Eligible Member per Month 0.74 0.79 0.87Prescriptions per Eligible Member per Year 8.87 9.43 10.38

Cost Per Prescription RisingCost Per Prescription Rising

UK-HMO AVERAGE PRESCRIPTION COST TO THE PLAN (after co-pays)

PER MEMBER PER MONTH

$21.82

$24.73

$29.60

$15.00

$17.00

$19.00

$21.00

$23.00

$25.00

$27.00

$29.00

$31.00

98-99 99-00 00-01

13.3% INCREASE

OVER PRIOR YEAR

19.7% INCREASE

OVER PRIOR YEAR

Managed Care Pharmacy Work GroupManaged Care Pharmacy Work Group

Problem StatementProblem StatementWhat recommendation or information can the UK College of What recommendation or information can the UK College of Pharmacy and faculty provide to assist in maximizing medication Pharmacy and faculty provide to assist in maximizing medication effectiveness and economic efficiency?effectiveness and economic efficiency?

GoalsGoals1.1. Reduce rate of escalating drug cost trends Reduce rate of escalating drug cost trends

2.2. Reduce impact of drug costs on co-payments and premiums in FY03 Reduce impact of drug costs on co-payments and premiums in FY03

3.3. Establish and educate individuals in controlling cost / quality of care (long term)Establish and educate individuals in controlling cost / quality of care (long term)

4.4. Incorporate cost effective utilization of pharmaceuticals into future role of College of Incorporate cost effective utilization of pharmaceuticals into future role of College of PharmacyPharmacy

5.5. Promote the “Best Practice” in pharmacotherapy and pharmacoeconomicsPromote the “Best Practice” in pharmacotherapy and pharmacoeconomics

In Which Aspects Can the College of Pharmacy Contribute?In Which Aspects Can the College of Pharmacy Contribute?

Expertise in drug therapy, consultation on coverage Expertise in drug therapy, consultation on coverage Pharma-Copay-Therapy Clinic - collaborative effort with medical staff Pharma-Copay-Therapy Clinic - collaborative effort with medical staff Programs and research projects targeted to reduce managed care expensesPrograms and research projects targeted to reduce managed care expenses Educational tools (computer support, dedicated time)Educational tools (computer support, dedicated time) Conduct C.E. programs to target UK Physicians and UK-HMOConduct C.E. programs to target UK Physicians and UK-HMO Development of a data warehouse to support best practice in drug use, Development of a data warehouse to support best practice in drug use,

treatment options/guidelines treatment options/guidelines Medication use strategies, creation of a Medication Use Management CenterMedication use strategies, creation of a Medication Use Management Center Potential to contract with UK-HMO in risk-sharing agreement for cost-Potential to contract with UK-HMO in risk-sharing agreement for cost-

reduction reduction Commitment and dedication to the projectCommitment and dedication to the project Integrate cost-effective therapy as an active part of College Integrate cost-effective therapy as an active part of College

mission/curriculum and pharmacist’s rolemission/curriculum and pharmacist’s role

Outline for Presentation of a PlanOutline for Presentation of a Plan

College of Pharmacy College of Pharmacy ContributionContribution

Co-payment/MemberCo-payment/MemberCost SharingCost SharingModificationModification

Medication UseMedication UseStrategiesStrategies

Academic DetailingAcademic DetailingSolutionsSolutions

Drug SampleDrug SampleSolutionsSolutions

Consumer AdvertisingConsumer AdvertisingSolutionsSolutions

Preventive ServicePreventive ServiceOfferingsOfferings

Which options should be pursued? What are the next steps?Which options should be pursued? What are the next steps?

Co-Payment/Member Cost Sharing Strategy Modification

Co-Payment/Member Cost Sharing Strategy Modification

Health Plan Coverage of PharmaceuticalsHealth Plan Coverage of Pharmaceuticals

UK has opted to utilize the co-payment coverage UK has opted to utilize the co-payment coverage option for pharmaceutical benefits in the UK-HMO option for pharmaceutical benefits in the UK-HMO and PPO products.and PPO products.

No No CoverageCoverage

Co-Payment Co-Payment CoverageCoverage

Full Full CoverageCoverage

UK-HMO Prescription Co-Payment Coverage Options

UK-HMO Prescription Co-Payment Coverage Options


TieredTieredGeneric, Preferred, Generic, Preferred, Non-Preferred; Non-Non-Preferred; Non-

Covered DxCovered DxExpandedExpanded

Non- FormularyNon- Formulary

Flat RateFlat RateNot Not

RecommendedRecommended

Tiered Tiered Generic, Generic,

Preferred, Preferred, Non-Preferred; Non-Preferred;

Few Few Non-Covered Non-Covered DiagnosisDiagnosis

Sliding Sliding Percentage Percentage

RateRate(Or mix with Tiered)(Or mix with Tiered)

UK-HMO Prescription Co-Payment Current Coverage Option

UK-HMO Prescription Co-Payment Current Coverage Option


Tiered Tiered Generic, Preferred, Generic, Preferred,

Non-Preferred; Non-Preferred; FewFew Non-Covered Non-Covered

DiagnosisDiagnosis

This is our current structure, however thereThis is our current structure, however thereare options that remain that lead to escalatingare options that remain that lead to escalatingprescription drug costs:prescription drug costs:

1. Should the non-preferred1. Should the non-preferred drugs be discourageddrugs be discouraged by a larger differentialby a larger differential in costs?in costs? 2. Are too many drugs 2. Are too many drugs covered?covered? 3. Are generic drugs promoted? 3. Are generic drugs promoted? 4. The co-payments have been adjusted to $8, $20 and $40. 4. The co-payments have been adjusted to $8, $20 and $40. Can we drive drug therapy to the lower co-pay drugs Can we drive drug therapy to the lower co-pay drugs (generic and preferred)?(generic and preferred)?

UK-HMO Prescription Co-Payment Recommended Coverage Option

UK-HMO Prescription Co-Payment Recommended Coverage Option


TieredTieredGeneric, Preferred, Generic, Preferred, Non-Preferred; Non-Non-Preferred; Non-

Covered DxCovered Dx

ExpandedExpanded Non-FormularyNon-Formulary

This strategy could result in lower overall drug costs.This strategy could result in lower overall drug costs.More drugs could be moved to a non-formulary status.More drugs could be moved to a non-formulary status.1.1. ChangeChange the Certificate of the Certificate of

Coverage to add a Coverage to add a non-formulary status.non-formulary status. 2. Will the system be 2. Will the system be responsive to responsive to changes?changes? 3. Is support present 3. Is support present throughout the throughout the enterprise?enterprise? 4. Is medical staff willing4. Is medical staff willing to make adaptations?to make adaptations?

Member / UK-HMO Cost Sharing for 2000-2001 Plan YearMember / UK-HMO Cost Sharing for 2000-2001 Plan Year

Drug TypeMember Share %

Plan Share %

% of all RX Plan Cost

generic 30 70 36 $660,000brand preferred 24 76 56 $4.1 millionnon-preferred 39 61 8 $560,000non-formulary 100 0 N/A N/A

UK-HMO Prescription Co-Payment Alternative Coverage Option

UK-HMO Prescription Co-Payment Alternative Coverage Option


This strategy could result in lower overall drug costs.This strategy could result in lower overall drug costs.Some managed care plans are experimenting with this option.Some managed care plans are experimenting with this option.

1. Generally perceived as 1. Generally perceived as a reduction in benefits. a reduction in benefits. 2. An example would be 2. An example would be 10% for generic, 10% for generic, 25% for brand and 25% for brand and 50% for non-preferred 50% for non-preferred with caps for each type. with caps for each type.3. Not recommended at 3. Not recommended at this time. this time.

Sliding Sliding Percentage Percentage

RateRate(Or mix with Tiered)(Or mix with Tiered)

Branded Product Costs RisingBranded Product Costs Rising

UK-HMO Ingredient Costs for Branded Drugs

$50.00

$55.00

$60.00

$65.00

1999-2000 51.7 52.1 53.1 55.4 54.3 55.7 55.2 54.2 57.6 60.6 59.4 58.8

2000-2001 59.5 59.1 58.3 59 59.5 59.3 58.6 61.5 63 62.7 62.5 63.6

$51.66

$52.07

$53.10

$55.39

$54.28

$55.69

$55.17

$54.24

$57.63

$60.62

$59.43

$58.77

2000-2001

1999-2000

Generic Costs Not Rising As FastGeneric Costs Not Rising As Fast

UK-HMO RX Ingredient Cost for Generic Drugs

$-

$5.00

$10.00

$15.00

$20.00

$25.00

1999-2000 14.1 14.6 15.2 17.8 15.8 14.7 13.7 14.1 14.7 17.3 17 15.9

2000-2001 16.3 15.4 15.7 17.4 18.5 19.4 19 19.2 18.7 22 21.9 23

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

2000-2001

1999-2000

Medication Use StrategiesMedication Use Strategies


Review therapeutic drug groups with specific activities targeted Review therapeutic drug groups with specific activities targeted to that groupto that group

Focus on high cost drug categoriesFocus on high cost drug categories Use Proton Pump Inhibitors (PPIs) as a pilot for programUse Proton Pump Inhibitors (PPIs) as a pilot for program Evaluate potential for Selective Serotonin Reuptake Inhibitors Evaluate potential for Selective Serotonin Reuptake Inhibitors

(SSRIs) or lipotropic agents (“Statins”)(SSRIs) or lipotropic agents (“Statins”) Develop a structure/strategy accepted within the UKCMC Develop a structure/strategy accepted within the UKCMC

enterpriseenterprise Program must be approved by the UK Managed Care Program must be approved by the UK Managed Care

Committee and Clinical Board prior to implementationCommittee and Clinical Board prior to implementation


Process Dosing Duration Selection Change

Lifestyle Modifications

PPI

X

X

X

X

SSRI

X

X

Lipotropics

X

X

X

UKHMO Where are the drug costs rising?UKHMO Where are the drug costs rising?

PRESCRIPTIONS PMPY

UK-HMO: 2000 2001 % IncreaseLipotropics 0.32 0.45 41.9%Antidepressants 0.81 0.92 13.3%Anti-ulcer/Gastric Acid Reducers 0.43 0.48 10.5%NSAIDs 0.46 0.49 7.3%Anticonvulsants 0.14 0.15 7.3%Overall 9.43 10.38 10.1%

Express Scripts: 2000 2001 % IncreaseLipotropics 0.32 0.37 17.0%Antidepressants 0.46 0.51 9.9%Anti-ulcer/Gastric Acid Reducers 0.32 0.35 7.5%NSAIDs 0.30 0.34 12.0%Anticonvulsants 0.11 0.12 12.5%Overall 8.28 8.57 3.6%


Proton Pump Inhibitor (PPI) Program ExampleProton Pump Inhibitor (PPI) Program Example DosingDosing: Should dosing (QD versus BID) and utilization undergo closer : Should dosing (QD versus BID) and utilization undergo closer

scrutiny?scrutiny? DurationDuration: Should a three month plan limit be placed on PPI therapy?: Should a three month plan limit be placed on PPI therapy? Selection ChangeSelection Change::

Should a step down to H-2 Antagonists (generic) be required for duration of Should a step down to H-2 Antagonists (generic) be required for duration of therapy greater than 3 months?therapy greater than 3 months?

Should antacids be advocated?Should antacids be advocated? Should use of pantoprazole (Protonix) be required if a PPI is prescribed?Should use of pantoprazole (Protonix) be required if a PPI is prescribed?

Effective July 1, pantoprazole is preferred but the others are available as non-Effective July 1, pantoprazole is preferred but the others are available as non-preferred; should they be non-formulary?preferred; should they be non-formulary?

Lifestyle ModificationLifestyle Modification: Should these be promoted?: Should these be promoted? Educational components for prescribers and patientsEducational components for prescribers and patients Cost avoidance estimates can be projected if this option is to be pursuedCost avoidance estimates can be projected if this option is to be pursued

Estimated PPI Overuse (2001 dollars)

Estimated PPI Overuse (2001 dollars)

$250,000

$125,000

$125,000

Patients requiring PPIs >3 months

Estimated overuse of PPIs

Patients requiring PPIs < 3 months

Academic Detailing SolutionsAcademic Detailing Solutions


Formulary pocket guideFormulary pocket guide Counter-detailing teamsCounter-detailing teams Targeted CE ProgramsTargeted CE Programs Provider feedback on utilization ratesProvider feedback on utilization rates


Formulary Pocket GuideFormulary Pocket GuidePLAN DESCRIPTION:PLAN DESCRIPTION: Develop global formulary guides (all plans)Develop global formulary guides (all plans) Distribute printed pocket guides and PDA download Distribute printed pocket guides and PDA download

version (via website access)version (via website access) Target certain providers (i.e. residents)Target certain providers (i.e. residents) Pro-active selection of the “plan drugs” Pro-active selection of the “plan drugs” CRITICAL SUCCESS FACTOR(S):CRITICAL SUCCESS FACTOR(S): Ease and availability of web site update design / Ease and availability of web site update design /

designerdesigner


““Counter-Detailing” TeamsCounter-Detailing” TeamsPLAN DESCRIPTION:PLAN DESCRIPTION: Assign team(s) of detailers according to therapeutic categoryAssign team(s) of detailers according to therapeutic category Team may consist of students, residents, faculty and pharmacists w/DI center Team may consist of students, residents, faculty and pharmacists w/DI center

assistanceassistance Teams would develop detail pieces to inform providers of evidence-based Teams would develop detail pieces to inform providers of evidence-based

practices and medication costspractices and medication costs Teams would plan regular times for face-to-face discussion with providersTeams would plan regular times for face-to-face discussion with providers Communication piece is left with the prescriberCommunication piece is left with the prescriber Communication via email to providers or via web siteCommunication via email to providers or via web site Points to be emphasized: Efficacy, Safety, Cost-effectiveness Points to be emphasized: Efficacy, Safety, Cost-effectiveness CRITICAL SUCCESS FACTOR(S)CRITICAL SUCCESS FACTOR(S): : Manpower and distribution of effort and Manpower and distribution of effort and

targeting certain provider groups and drug classes firsttargeting certain provider groups and drug classes first


Internal CE ProgramsInternal CE ProgramsPLAN DESCRIPTION:PLAN DESCRIPTION: Counter detail teams and CE office would develop programsCounter detail teams and CE office would develop programs Programs would be given at grand round seminars, resident noon Programs would be given at grand round seminars, resident noon

conference, etc.conference, etc. Programs could be available on websitePrograms could be available on website Target medical and pharmacy staffsTarget medical and pharmacy staffs Expand training to Kroger pharmacists if applicableExpand training to Kroger pharmacists if applicable

CRITICAL SUCCESS FACTOR(S):CRITICAL SUCCESS FACTOR(S): Institutional support for programsInstitutional support for programs Manpower availability to create and provide programsManpower availability to create and provide programs


Provider Feedback on Utilization RateProvider Feedback on Utilization Rate

PLAN DESCRIPTION:PLAN DESCRIPTION: Develop reports on prescriber utilizationDevelop reports on prescriber utilization Present by department (peer) and by individual prescriber to the Present by department (peer) and by individual prescriber to the

medical staffmedical staff Create accountability of prescribing habitsCreate accountability of prescribing habits

Provide financial incentives for good utilization rates (tied to Provide financial incentives for good utilization rates (tied to departmental or division performance)departmental or division performance)

CRITICAL SUCCESS FACTOR(S):CRITICAL SUCCESS FACTOR(S): Ensure accuracy of prescribing dataEnsure accuracy of prescribing data Physician buy-in of programPhysician buy-in of program

Drug Sample SolutionsDrug Sample Solutions


Pharmacy Coordinated “Samples”Pharmacy Coordinated “Samples” Generic “Samples”Generic “Samples” Restrict Pharmaceutical Representative Restrict Pharmaceutical Representative

Access within ClinicsAccess within Clinics


Pharmacy Coordinated “Samples”Pharmacy Coordinated “Samples”PLAN DESCRIPTION:PLAN DESCRIPTION: Central location for storing and distributing all samplesCentral location for storing and distributing all samples Pharmacist will dispense samples like regular prescriptionsPharmacist will dispense samples like regular prescriptions Records can be kept about medication use by specific patients and prescribersRecords can be kept about medication use by specific patients and prescribers Patient education about new medication including co-pay informationPatient education about new medication including co-pay information Pharmacist may intervene before dispensing samples to ensure cost-effective Pharmacist may intervene before dispensing samples to ensure cost-effective

utilizationutilization Funding for pharmacy could be provided from pharmaceutical companiesFunding for pharmacy could be provided from pharmaceutical companies

CRITICAL SUCCESS FACTOR(S):CRITICAL SUCCESS FACTOR(S): Global institutional supportGlobal institutional support Space/locationSpace/location Manpower for staffingManpower for staffing

Generic “Samples” Generic “Samples” (UKHMO Funded Starter Prescriptions)(UKHMO Funded Starter Prescriptions)

PLAN DESCRIPTION:PLAN DESCRIPTION: Provide some low-cost generic drugs as samples in the clinic (ex. Provide some low-cost generic drugs as samples in the clinic (ex.

ibuprofen, enalapril, metoprolol, amoxicillin, hydrochlorothiazide)ibuprofen, enalapril, metoprolol, amoxicillin, hydrochlorothiazide) Samples provided through sample pharmacy with label Samples provided through sample pharmacy with label Up to a month supplyUp to a month supply Incorporate access to these “samples” with counter-detailing pieces Incorporate access to these “samples” with counter-detailing pieces

about generic utilizationabout generic utilization

CRITICAL SUCCESS FACTOR(S):CRITICAL SUCCESS FACTOR(S): Funding to provide starter prescriptionsFunding to provide starter prescriptions

Drug Sample Solutions


Restrict Pharmaceutical Representative Access Restrict Pharmaceutical Representative Access within Clinicswithin Clinics

PLAN DESCRIPTION:PLAN DESCRIPTION: Develop sign-in and sign-out policyDevelop sign-in and sign-out policy Utilize badge ID systemUtilize badge ID system Set limits on time allowed in clinic during any given week or monthSet limits on time allowed in clinic during any given week or month Set a policy for all industry sponsored lunches and eventsSet a policy for all industry sponsored lunches and events Restrict or ban promotion of non-approved products including information Restrict or ban promotion of non-approved products including information

and samples and samples

CRITICAL SUCCESS FACTOR(S):CRITICAL SUCCESS FACTOR(S): Universal agreement to action and policy enforcement from Clinical BoardUniversal agreement to action and policy enforcement from Clinical Board Alternative – control information and sample disseminationAlternative – control information and sample dissemination

Consumer Advertising SolutionsConsumer Advertising Solutions

Direct to Consumer Advertising(Jan to Sept 2000)*Direct to Consumer Advertising(Jan to Sept 2000)*

COX – II (Vioxx, Celebrex) $193 million

Lipotropics $130.4 million

PPI $124 million

*Scott-Levin DTC Advertising Audit and Competitive Media Reporting, Third Quarter 2000


Pharma-Copay-Therapy ClinicPharma-Copay-Therapy Clinic Direct Patient MailersDirect Patient Mailers Update Website Information and AccessUpdate Website Information and Access Kentucky Clinic Pharmacy Labels and Bag Kentucky Clinic Pharmacy Labels and Bag

StuffersStuffers


Pharma- Copay-Therapy ClinicPharma- Copay-Therapy ClinicPLAN DESCRIPTION:PLAN DESCRIPTION: Pharmacist clinicPharmacist clinic

Create a Kentucky Clinic Pharmacy ModelCreate a Kentucky Clinic Pharmacy Model Help center for UKHMO patients to get advice on how to reduce Help center for UKHMO patients to get advice on how to reduce

out of pocket expense for drugs (and reduced Plan costs)out of pocket expense for drugs (and reduced Plan costs) May be staffed by students, residents, faculty, and pharmacistsMay be staffed by students, residents, faculty, and pharmacists Set certain clinic days and make appointmentsSet certain clinic days and make appointments Expand to Kroger Pharmacies after a model is establishedExpand to Kroger Pharmacies after a model is established

CRITICAL SUCCESS FACTOR(S):CRITICAL SUCCESS FACTOR(S): Institutional supportInstitutional support Clinic staffing and spaceClinic staffing and space

Direct Patient MailersDirect Patient MailersPLAN DESCRIPTION:PLAN DESCRIPTION: Use the PBM system to “informally” identify patients Use the PBM system to “informally” identify patients Send mailer about reducing out-of-pocket expenses by discussing with their Send mailer about reducing out-of-pocket expenses by discussing with their

provider the formulary alternativesprovider the formulary alternatives Target top 3-4 classes of drugsTarget top 3-4 classes of drugs Utilize advertising within KCP - Bag stuffer information disseminationUtilize advertising within KCP - Bag stuffer information dissemination Develop other mailers to educate patientsDevelop other mailers to educate patients

Ask their providers if this medication is covered on insurance? What does generic mean? Ask their providers if this medication is covered on insurance? What does generic mean? Can I ask for generic prescriptions from my provider? Why do drugs cost so much? Can I ask for generic prescriptions from my provider? Why do drugs cost so much? How much is my insurance really paying?How much is my insurance really paying?

CRITICAL SUCCESS FACTOR(S):CRITICAL SUCCESS FACTOR(S): Manpower to develop the informationManpower to develop the information Must stay within patient confidentiality guidelinesMust stay within patient confidentiality guidelines

Consumer Advertising Solutions

Update Website Information and AccessUpdate Website Information and Access

PLAN DESCRIPTION:PLAN DESCRIPTION: Include a “reduce your co-pay” sectionInclude a “reduce your co-pay” section

Include an “ask the pharmacist” sectionInclude an “ask the pharmacist” section e-mail questions about medications or how to reduce monthly out-of-pocket e-mail questions about medications or how to reduce monthly out-of-pocket

expensesexpenses DI center may be able to respondDI center may be able to respond

Include the formulary guide and PDA downloadInclude the formulary guide and PDA download Commonly asked drug questions (FAQs)Commonly asked drug questions (FAQs) Add CE pieces Add CE pieces Place website access shortcut on allPlace website access shortcut on all desktops in clinicdesktops in clinic

CRITICAL SUCCESS FACTOR(S):CRITICAL SUCCESS FACTOR(S): Ease and availability of web site update design and designerEase and availability of web site update design and designer Must stay within patient confidentiality guidelinesMust stay within patient confidentiality guidelines

Consumer Advertising Solutions


Kentucky Clinic Pharmacy Labels and Bag StuffersKentucky Clinic Pharmacy Labels and Bag StuffersPLAN DESCRIPTION:PLAN DESCRIPTION: Include drug specific messaging – focus on wellness or disease Include drug specific messaging – focus on wellness or disease

of the monthof the month Promote web site, include value added informationPromote web site, include value added information Identify drug costs on prescription bag Identify drug costs on prescription bag Expand to Kroger pharmacies after the model is establishedExpand to Kroger pharmacies after the model is establishedCRITICAL SUCCESS FACTOR(S):CRITICAL SUCCESS FACTOR(S): Counter direct to consumer advertisingCounter direct to consumer advertising Utilize monthly contact to promote cost-effective drug useUtilize monthly contact to promote cost-effective drug use

Preventive Service OfferingsPreventive Service Offerings

Preventive Service OfferingsPreventive Service Offerings

Partner with UK Wellness to integrate Partner with UK Wellness to integrate pharmaceutical information with Wellness pharmaceutical information with Wellness informationinformation

Provide health service information upon Provide health service information upon dispensingdispensing

Pro-active long term solutionPro-active long term solution Example – Pharmacy coordinated smoking Example – Pharmacy coordinated smoking

cessation program initiated in 2000cessation program initiated in 2000

Identify Patient

Health Improvementand Management Program /

Clinic

Prevention

Management

Self managed

•Lifestyle modifications

Professionally managed

•acute and chronic episodes of care

•DSM, MD and RPh interventions

•Education

•Lifestyle modifications

Preventive Service Offerings

Program Implementation TimelineProgram Implementation Timeline

September 1 - 3 months 3 - 6 months 6 - 12 months

Short-Term Plan

Direct Patient M

ailers

KC

P Labels and Bag Stuffers

Formulary Pocket G

uideU

pdate Website Inform

ation

Increase Website A

ccess

Counter D

etailing Teams

Generic Sam

ples

Drug Sam

ple Pharmacy

Pharma-C

opay-Therapy Clinic

Provider Feedback on Utilization R

ate

Finalize Long-Term Plan

Intro of Non-Form

ulary Status

Integration into Curriculum

Begin M

edication Use Strategies

Preventive Service Offerings

Restrict Pharm

Sales Reps

Begin Targeted C

E Programs

UK Managed Care Pharmacy Work GroupUK Managed Care Pharmacy Work Group

John Armitstead, MS, RPh, ChairJohn Armitstead, MS, RPh, Chair Margaret Nowak-Rapp, PharmDMargaret Nowak-Rapp, PharmD Bryan Yeager, PharmDBryan Yeager, PharmD Robert Littrell, PharmDRobert Littrell, PharmD Robert Kuhn, PharmDRobert Kuhn, PharmD

Alan Zillich, PharmDAlan Zillich, PharmD Eric Millheim, PharmDEric Millheim, PharmD Kelly Smith, PharmDKelly Smith, PharmD Julie Davis, PharmD (Resident)Julie Davis, PharmD (Resident) Kim Mitchell, PharmD StudentKim Mitchell, PharmD Student

Allen Woodward, MD Allen Woodward, MD (Advisory)(Advisory)Ken Roberts, PhD (Advisory)Ken Roberts, PhD (Advisory)

Approved by UK College of Pharmacy Executive Committee 7/12/01Approved by UK College of Pharmacy Executive Committee 7/12/01

Presented to UK Managed Care Committee 7/24/01Presented to UK Managed Care Committee 7/24/01

Presented to Chancellor Holsinger 8/13/01Presented to Chancellor Holsinger 8/13/01

The College of Pharmacy ContributionThe College of Pharmacy Contribution

College of Pharmacy College of Pharmacy ContributionContribution

Co-payment/MemberCo-payment/MemberCost SharingCost SharingModificationModification

Medication UseMedication UseStrategiesStrategies

Academic DetailingAcademic DetailingSolutionsSolutions

Drug SampleDrug SampleSolutionsSolutions

Consumer AdvertisingConsumer AdvertisingSolutionsSolutions

Preventive ServicePreventive ServiceOfferingsOfferings

Next Steps?Next Steps?

Which of the recommendations are feasible?Which of the recommendations are feasible? Which actions require medical staff buy-in?Which actions require medical staff buy-in? Which pharmacy staff members should be assigned to each Which pharmacy staff members should be assigned to each

recommendation?recommendation? Which recommendations can be implemented in Plan Year Which recommendations can be implemented in Plan Year

2002, 2003?2002, 2003? Further review Further review

UK Managed Care Committee in August for Budget ReviewUK Managed Care Committee in August for Budget Review Clinical Board in SeptemberClinical Board in September UK Health Benefits Task Force in SeptemberUK Health Benefits Task Force in September

ukcmc managed care pharmacy work group recommendations approved by the uk college of pharmacy...

Documents

high cost drugs

fy01pmpy plan cost

prescriptiongeneric

total drugs

rx ingredient cost

yearave plan cost pmpm21

utilizing member

eligible member