Multiple Contract Pharmacies in a Disproportionate Share Hospital System

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APhA2010 Presentation on Multiple Contract Pharmacies

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  • Increased visualization of central fill transactions - Increased visualization of central fill transactions
  • Reporting, dispensing software//cost containment, diversionary precautions//
  • Multiple Contract Pharmacies in a Disproportionate Share Hospital System

    1. 1. Multiple Contract Pharmacies in a DSH Hospital System Anthony L. Lesser, MSHA Pharmacy Inventory Manager, Harris County Hospital District March 13, 2010 APhA 2010 Annual Meeting
    2. 2. CPE Information and Disclosures <ul><li>Anthony Lesser declare(s) no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. </li></ul>Professional Resources & Business Development To receive credit for this activity, you must attend this activity in its entirety and complete your CPE information and program evaluation online using the voucher code assigned to this session. The American Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
    3. 3. Voucher Code Professional Resources & Business Development [FOR APHA USE ONLY] You will need this voucher code in order to access the evaluation and CPE form for this activity. Your CPE must be filed by April 30, 2010 at 11:59 pm EDT in order to receive credit.
    4. 4. Learning Objectives Professional Resources & Business Development List 3 Challenges of Central Fill Describe Harris County Hospital District 1 Understand why HCHD chose to apply for an AMDP 2 4 Explain Central Fill and its support structure 3 List 5 Opportunities with Central Fill 5
    5. 5. Harris County Hospital District <ul><li>Three major hospital facilities: Ben Taub, Lyndon Baines Johnson (LBJ), Quentin Mease </li></ul><ul><li>Recognized as one of the leading trauma centers in the nation </li></ul><ul><li>15 ambulatory pharmacies </li></ul><ul><li>Plans to expand ambulatory services </li></ul>
    6. 6. Harris County Hospital District <ul><li>Harris County Hospital District </li></ul><ul><li>Ambulatory Pharmacy Services </li></ul><ul><ul><li>Annual Pharmaceutical Budget: $77 Million </li></ul></ul><ul><ul><li>Outpatient Pharmaceutical Budget:$61 Million </li></ul></ul><ul><ul><li>Outpatient Visits/Encounters per year: 1.6 Million </li></ul></ul><ul><ul><li>Outpatient Prescriptions per year: 2.5 Million </li></ul></ul><ul><ul><li>Ambulatory Pharmacy FTEs: 254 </li></ul></ul>
    7. 7. Why HCHD needed a non-traditional pharmacy model <ul><li>High volume pharmacies in need of greater efficiency (lack of automation) </li></ul><ul><li>Meet greater demand for pharmacy services </li></ul><ul><li>Advantages to patient </li></ul><ul><ul><ul><li>Wait times </li></ul></ul></ul><ul><ul><ul><li>Patient access </li></ul></ul></ul><ul><ul><ul><li>Clinical services </li></ul></ul></ul>
    8. 8. AMDP Application <ul><li>Designed to have selected prescriptions filled at an off-site contracted pharmacy and delivered to HCHD pharmacies </li></ul><ul><li>Application filed November 2006 </li></ul><ul><li>Project approved December 15, 2007 </li></ul><ul><li>“ Go-Live” - August 2008 </li></ul><ul><li>First productive use - November 2008 </li></ul><ul><li>IT infrastructure to support regulatory requirements </li></ul><ul><li>Third party management and audit </li></ul>
    9. 9. Central Fill Inventory <ul><li>Fully automated, off-site facility located in Fort Worth, Texas </li></ul><ul><li>Closed formulary consisting of approximately 200 solid oral dose forms and 50 unit of use packages. </li></ul><ul><li>Replenishment model with prescriptions filled from an initial seed inventory </li></ul><ul><li>Strict formulary and inventory controls necessary for cost containment and regulatory compliance </li></ul><ul><li>Complemented central fill “go-live” with strong inventory management initiatives </li></ul>
    10. 10. Central Fill Prescriptions Receive Refill Request From Patient Is item available in central fill formulary? YES No Fill Prescription Locally Send to Central Fill Central Processing Center Reviews IVR Process Prescription -DUR -Billing
    11. 11. Central Fill Pharmacy Central Fill Pharmacy Receives Request Is item in stock and available to fill? YES No Complete Filling Process Return to Pharmacy for Local Fill Send to Originating Pharmacy for Pick-up by Patient
    12. 12. Receiving of Prescriptions Packages Arrive From Central Fill Pharmacy Electronically Receive Prescriptions and Place in Will-call Area <ul><li>Pick-up duties: </li></ul><ul><li>Collect appropriate payment </li></ul><ul><li>Counsel as required </li></ul><ul><li>Obtain signature to document transaction </li></ul>Did customer pick up prescription? YES No Follow RTS Procedure
    13. 13. Ensuring Compliance <ul><li>Closed system (340B eligibility) </li></ul><ul><li>Focus on anti-diversion safeguards </li></ul><ul><li>Comprehensive reporting system covering inventory reconciliation and cost allocation </li></ul><ul><li>Internal audits (quarterly) </li></ul><ul><ul><ul><li>Verify process integrity </li></ul></ul></ul><ul><li>External audit (annual) </li></ul><ul><ul><ul><li>Eligibility </li></ul></ul></ul><ul><ul><ul><li>No duplicate discount on Medicaid claims </li></ul></ul></ul><ul><ul><ul><li>Drug dispensed versus quantity purchased </li></ul></ul></ul><ul><li>Third Party consultant assists with reporting, audits, and formulary/inventory management </li></ul>
    14. 14. Central Fill Reporting <ul><li>Fully automated reports resulting in greater efficiency </li></ul><ul><li>Inventory reconciliation </li></ul><ul><ul><li>Daily reconciliation of items received in dispensing software versus items shipped from central fill pharmacy </li></ul></ul><ul><ul><li>Daily reconciliation of discrepancies </li></ul></ul><ul><ul><li>Daily verification of central fill pharmacy receipt of product </li></ul></ul><ul><li>Visualization </li></ul><ul><ul><li>Real-time access to seed inventory levels and fluctuations </li></ul></ul><ul><ul><li>Daily reporting of inventory levels and products dispensed from central fill pharmacy </li></ul></ul><ul><ul><li>Daily reporting of items not in stock at central fill pharmacy </li></ul></ul>
    15. 15. Program Challenges
    16. 16. Contract Pharmacy Successes and Opportunities <ul><li>Operational Efficiency </li></ul><ul><ul><ul><li>70% of duties transferred off-site (40% to Rx.com) </li></ul></ul></ul><ul><ul><ul><li>23% improvement in wait times </li></ul></ul></ul><ul><li>Focus on Critical/Immediate-Need Prescriptions </li></ul><ul><li>Clinical Opportunities </li></ul><ul><ul><ul><li>Basic lab monitoring pilot </li></ul></ul></ul><ul><ul><ul><li>Ultimate goal of decentralization </li></ul></ul></ul><ul><li>Staff Reduction (nearly 10%) </li></ul><ul><li>Waste Reduction </li></ul>
    17. 17. Helpful hints for multiple contract pharmacy <ul><li>Develop a strong IT support structure </li></ul><ul><li>Ensure adequate inventory control and maximize operational efficiency </li></ul><ul><li>Launch aggressive patient marketing campaign </li></ul><ul><li>Maintain staff support and moral </li></ul><ul><li>Establish effective contractual relationships </li></ul><ul><li>Don’t leave pharmaceutical wholesaler out of the picture </li></ul>
    18. 18. Self-Assessment Questions <ul><li>What is an Alternative Methods Demonstration Project? </li></ul><ul><li>Describe two analytical imperatives when implementing a multiple contract pharmacy program? </li></ul><ul><li>What are three advantages of a multiple contract pharmacy arrangement? </li></ul>
    19. 19. Thank You! Anthony Lesser [email_address] (713)873-2572

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