DoD Pharmacoeconomic Center The Impact of Sole Provider Program (SPP) / Warrior in Transition (WT)...

DoD Pharmacoeconomic Centerwww.pec.ha.osd.mil

The Impact of Sole Provider Program (SPP) /

Warrior in Transition (WT) CHCS Drug Entries

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Global Guidance

• We do not recommend using Sole Provider Program, Warrior in Transition, or any other “dummy” drug entries in CHCS– Rationale: Prescriptions for these “drugs” generate

valid, legal prescriptions on PDTS patient profiles

• We recommend utilizing the MTF Prescription Restriction Program which triggers MTF Lock-in warnings in CHCS/AHLTA when using SPP and/or WT entries

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Global Guidance

• If you continue to “dummy” drug entries for prescriptions, we recommend setting up the drugs in a way that minimizes the impact of the associated valid prescription.– You can control the NDCs and costs that are reported

for “dummy” drug entries and prescriptions.

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Minimizing the Impact of “Dummy” Drug Entries and Prescriptions

• Objective: maintain the effectiveness of the drug entry and minimize the impact on PDTS patient, provider, and site profiles.

• Solution: Multi-ingredient compound entry– Performs DUR checks and produces applicable drug

class warnings for each component NDC; must ENABLE Drug Checks

– Limitation: does not generate the DEA Overlap warning

– Presents on PDTS/M2 with a Pseudo NDC; components (e.g. morphine) are not included in reports

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SPP/WTU Drug Entry: Why are they used?

• Mechanism to warn providers and pharmacy staff at the point of order entry and dispensing that this patient is on a sole provider program and/or a WT

• Mechanism to communicate the details of the situation, such as the PCM, secondary provider, contact number, risk status, and quantity limits


Pharmacy Data Transaction Service (PDTS)/ MHS Mart (M2)

• PDTS:– Contains prescription data from MTF’s, Mail Order

Pharmacy, and retail network pharmacies

• M2:– Contains medical and prescription information from

MTFs and purchased care sector– Prescription information originates from PDTS

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What are PDTS and M2 used for?

• Reporting: Utilization and cost reports generated from PDTS or M2 are used by local, service, and DoD level leadership– Monitoring prescribing and utilization trends– Projecting the impact of proposed changes

• Patient Safety: • Safety edits that automatically review the patient’s

profile for appropriate therapy• Identification of issues related to use of controlled

substances


What is the Impact on PDTS/M2?

• ALL of these entries show up as valid prescriptions

• NDCs, Drug Quantity, and Costs have the most meaningful impact on PDTS/M2


Impact on decision-making:Real life examples

• NDC: – Increased number of Rx’s for controlled substances, including cocaine and

morphine, for active duty members

– Example: identified during the preparation in response to a Congressional

inquiry and media question • Cost/Quantity:

– Rx costs are used in determining drug expenditures and data integrity issues

– Example: $284,353.80/Rx for a SPP drug entry was identified by data integrity reports and review of expenditures for controlled substances

• Provider/Pharmacy IDs:– Used to identify fraud, abuse, and prescribing trends

– Example: X% of controlled substance prescriptions were written by Provider Y

Example:Single ingredient drug entry


Example:Single ingredient drug entry

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Example:Multi-ingredient drug entry

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Quantities equal to zero trigger the first NDC to be reported.


Example:Multi-ingredient drug entry

PDTS and M2

PDTS Rx # NDC Brand Name Generic Name Strength Dosage Form

0000001 00074677701LORAZEPAM

LORAZEPAM 4 MG/ML DISP SYRIN

0000002 00074677701LORAZEPAM


0000003 00074677701LORAZEPAM


CHCS

PDTS RX# MEDICATION

0000001 WTU PATIENT(NOTE RISK LEVEL & QTY L



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How do I trigger the pseudo NDC in CHCS?

• Legal status: 0 – manufactured in pharmacy; compound

• NDC and quantities– Must add 2-8 NDCs

• Component quantities– Each NDC added must have a quantity greater than 0

– 0.001 (CHCS will not accept the leading 0) is the smallest quantity accepted

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Triggering the pseudo NDC:Add New Drug to Formulary

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How do I minimize the cost of the prescription?

• Component quantities (ADN menu)– 0.001 (CHCS will not accept the leading 0) is the

smallest quantity accepted

• Local Cost = 0• Cost Flag

– Set to Local

• Prescription Quantity – 0.01 (CHCS will not accept the leading 0) is the

smallest quantity accepted

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Minimizing prescription costs:Formulary Maintenance

Minimizing prescription costs:Formulary Maintenance

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Drug File Template Summary

• Legal status: set up as a compound (0)

• NDCs: must be more 2-8 NDCs

• Quantities for each component: must be 1 or more (.001 recommended)

• Local cost = $0

• Cost flag = Local

• Prescription quantity = .01


Additional Considerations:Formulary Management Fields

• Formulary Status = FORMULARY• Inactive Date = populated or blank

– Some SPP processes rely on the drug entry being visible and available to providers and others rely on it being available only to pharmacy staff

• Comment = Reminder to determine RISK STATUS and QUANTITY LIMITS

• Max quantity = .01 or 1 (something low)• Max days supply = 365

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• Dispense complete container = YES, if you are using a default quantity of 1 or NO, if you are using .01

• Default Days Supply = 365• Default Quantity = .01 or 1 (something low)• Default Sig = Reminder to perform a profile

review• Continuable = YES, in case the patient is

admitted and is transferred

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Additional Considerations:Prescription Information

• Sig = Sole provider and alternate name/contact info, in addition to risk status and quantity limits

• Provider = Sole provider, pharmacist involved in the SPP process, default provider– Default providers:

• MTF, OTHER (BM6666664): intended to be used for transfers of non-controlled substance prescriptions from one MTF to another MTF

• OTC, SELF CARE (BO6666664): intended to be used for OTC preparations

– Pros for using default provider: does not assign a valid prescription to a person; known default to exclude when tracking prescribing

– Cons for using default provider: not intended use, does not meet the needs of processes relying on the provider field to indicate the sole provider

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• Non-compliance:– Some processes include marking the prescription as

“non-compliant”– Keeps the prescription on the active CHCS/AHLTA

profile– Reverses the prescription from PDTS

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Summary• Using a multi-ingredient compound set-up in CHCS will:

• Generate DUR warnings identifying Sole Provider patients• Minimize the impact on reporting systems

• To trigger the multi-ingredient logic, you must:• Legal status: set up as a compound (0)• NDCs: must be more 2-8 NDCs• Quantities for each component: must be 1 or more (.001

recommended)

• To minimize the costs reported for these entries, you can:• Local cost = $0• Cost flag = Local• Prescription quantity = .01


Contact Info

TMA POC

1-866-275-4732

DSN (312) 471-8274 Option 8

Libby Hearin

[email protected]

210-295-2452

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DoD Pharmacoeconomic Center The Impact of Sole Provider Program (SPP) / Warrior in Transition (WT)...

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