Virginia Medicaid Preferred Drug List Educational Outreach Efforts:

Overview and Accomplishments

Presented to:PDL Implementation Advisory Group

March 16, 2004By: Barbara J. Dowd, R.Ph.

First Health Services Corporation

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Presentation Outline

Background on PDL Program

Communication Plan

PDL Implementation Advisory Group

Educational Efforts

Lessons Learned

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Virginia Medicaid PDL: Why and How?

Appropriations Act 2003 established the PDL with requirements for consumer and provider education both prior to implementation and ongoing as the program evolved.

Public Input– Beginning in March 2003, DMAS met with over 40

stakeholder groups to solicit input on program design.– DMAS established a web site for notices and information.– DMAS has an e-mail address for comments.– P&T Committee Meetings are public meetings allowing

attendance by the general public.

Request for Proposal (RFP) resulted in a contract with First Health Services Corporations(FHSC) to implement and administer the program.

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RFP Requires FHSC to Implement PDL Educational Outreach Program

Development and implementation of broad-based educational effort for prescribers, pharmacy providers and affected enrollees

Develop and, following State approval, provide program materials to providers, enrollees, local DSS, advocacy groups and other interested parties regarding PDL and PA program

Design and implement targeted educational efforts, with State approval, to improve compliance and maximize effectiveness

Monitor and report on outcomes of educational efforts

Develop and make available web-based information for providers and enrollees to aid in program understanding and compliance

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Communication Plan

Developed as a partnership between DMAS and FHSC with input from various stakeholders

Weekly meetings/conference calls for key DMAS and FHSC colleagues

– Timelines established

– Educational materials, both written and for presentation, developed, reviewed, and modified for DMAS Executive Management submission and approval

– Presentation strategy designed and approved

– Key groups identified for contact and presentation scheduling

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PDL Implementation Advisory Group Plays Key Role in Education

and PA Process

Established by DMAS to include representatives from pharmaceutical manufacturers, providers and advocates

First meeting of this group was September 2003 to summarize pharmacy programs and PDL concept with proposed PA process and educational plan

This Committee reviewed drafted written and presentation materials and the PA process as well as provided suggestions for the educational methods

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Educational Impact of PDL Implementation Advisory Group

Communication strategy revised to include sending information for newsletters to PDL IAG members

Reminder postcard for providers

Regional trainings established for pharmacy providers

Clarification of the Appeals Process

Process for review of new drugs approved by the FDA

72-hour supply of medication

Tri-fold for enrollees when medications changed as result of PDL

Members arranged training sessions for their colleagues and several participated in those sessions

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PDL Program Enhanced: Default Prescriber ID Eliminated

Accurate evaluation of the PDL program is facilitated

Prescription claims must be submitted with valid Prescriber Medicaid ID number

– Default numbers are available for use when Prescriber Medicaid ID number is unknown

– 23% (2 million) claims were being submitted with a specific default number

Effective December 15, 2003, use of this number was discontinued

– DMAS proactively worked with high utilizers of the number

– Disruption to pharmacy providers operations has been minimal

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FHSC Call Center Contributes to Smooth Program Implementation

Separate telephone lines established for providers and enrollees were operational on November 17, 2003 for PDL program questions

FHSC Call Centers were operational for pro-active PA requests on December 1, 2003

PA requests can be initiated by letter, by fax or by telephone

Call volume has been steady since early February after sharp increases through the month of January

– Length of calls has consistently been under 3.5 minutes with the most recent data less than an average of 3 minutes

– Average speed to answer consistently less than 30 seconds

– No abandonment activity in first three weeks of the program

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PDL Prior Authorization Statistics

During the first two months of the PDL Program:

No physician has been denied a prior authorization

Call center staff are handling calls efficiently

No Medicaid enrollee has been denied access to their prescribed medications

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Mailings:Key Component of Educational

Outreach News Release in October 2003 for publication in December

2003

Letters to State Agencies within Health and Human Resources Secretariat

Department of Social Services notified via DSS Alert

FHSC mailed enrollee materials on December 2, 2003 formatted in both English and Spanish

DMAS mailed provider materials on December 8, 2003 to include Medicaid Memo, PA Request Form, Provider FAQ Sheet, Hard-edit Phase-In Schedule and PDL “Quick List”

Reminder post card mailed the week of December 21, 2003

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Web Sites

DMAS web site updated with PDL implementation information on December 1, 2003

– Medicaid Memo

– PDL Quick List

– Hard-edit Phase-In Schedule

– PA Request Form

– PDL PA Criteria

– PDL PowerPoint Presentation

– P&T Committee Information

– General Assembly Presentations

FHSC web site maintained for DMAS with PDL information

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Training Presentations

FHSC Education Manager trained DMAS staff from multiple departmental divisions and several FHSC clinical pharmacists to serve on training teams

FHSC Education Manager trained DMAS help line colleagues on program details

Presentations, given by a training team of at least one DMAS and one FHSC member, were scheduled around the State beginning in early December

– Program goals were presented

– Operational procedures were presented

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Educational Outreach Presentations Target Key Groups

Regional Training Sessions for Pharmacy Providers

– Richmond

– Tidewater

– Roanoke

– Northern Virginia

Long-term Care Providers targeted by association presentations

Presentations to Community Service Board representatives

Presentations to major health systems reach prescribers, pharmacy providers, case managers and physician office administrators

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Telephone Contacts

Top 150 prescribers utilizing non-preferred drugs for at least 25 of their Medicaid patients in last quarter 2003– Particular focus to prescribers of Proton Pump

Inhibitors (PPIs) and COX-2 Inhibitors

Direct contact with prescribers or their agents– Subsequent faxed provider profiles allow

information on specific Medicaid enrollee utilizers for prescriber office use

This effort intervened on 36,794 claims for non-preferred drugs utilized by 11,582 enrollees

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Conclusion

PDL was implemented using soft-edits, messages at Point-of-Sale, on January 5, 2004.

Hard-edits, denials of non-preferred drugs, were phased in weekly beginning on January 19, 2004 through February 23, 2004.

Educational effort was far reaching and successful.

Smooth hard-edit implementation was achieved over a shorter than usual timeframe.

FHSC has coordinated the Educational Outreach effort to include the input and hard work of many people from both DMAS and FHSC as well as key people from stakeholders including the members of this PDL Implementation Advisory Group.

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Lessons Learned

Adherence to the past practice of mailing Medicaid Memos and related materials to chain drug store headquarters rather than to each individual pharmacy may be less efficient than desired.

Recipient calls to the FHSC Provider Call Center resulted in direct telephone contact by FHSC, at DMAS’ request, to the 15 pharmacies related to these recipients.

Action Plan: In the future, DMAS to incur expense of additional mailing costs to ensure that all pharmacy providers are efficiently informed of pharmacy program implementations and modifications.