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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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DoD Pharmacoeconomic Centerwww.pec.ha.osd.mil
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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DoD Pharmacoeconomic Centerwww.pec.ha.osd.mil
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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DoD Pharmacoeconomic Centerwww.pec.ha.osd.mil
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
DoD Pharmacoeconomic Centerwww.pec.ha.osd.mil
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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DoD Pharmacoeconomic Centerwww.pec.ha.osd.mil
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
DoD Pharmacoeconomic Centerwww.pec.ha.osd.mil
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
DoD Pharmacoeconomic Centerwww.pec.ha.osd.mil
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
DoD Pharmacoeconomic Centerwww.pec.ha.osd.mil
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.
DoD Pharmacoeconomic Centerwww.pec.ha.osd.mil
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
LORAZEPAM 4 MG/ML DISP SYRIN
0000003 00074677701LORAZEPAM
LORAZEPAM 4 MG/ML DISP SYRIN
CHCS
PDTS RX# MEDICATION
0000001 WTU PATIENT(NOTE RISK LEVEL & QTY L
0000002 WTU PATIENT(NOTE RISK LEVEL & QTY L
0000003 WTU PATIENT(NOTE RISK LEVEL & QTY L
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DoD Pharmacoeconomic Centerwww.pec.ha.osd.mil
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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DoD Pharmacoeconomic Centerwww.pec.ha.osd.mil
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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DoD Pharmacoeconomic Centerwww.pec.ha.osd.mil
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
DoD Pharmacoeconomic Centerwww.pec.ha.osd.mil
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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DoD Pharmacoeconomic Centerwww.pec.ha.osd.mil
Additional Considerations:Formulary Management Fields
• 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:Formulary Management Fields
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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Additional Considerations:Prescription Information
DoD Pharmacoeconomic Centerwww.pec.ha.osd.mil
Additional Considerations:Prescription Information
• 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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DoD Pharmacoeconomic Centerwww.pec.ha.osd.mil
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
DoD Pharmacoeconomic Centerwww.pec.ha.osd.mil
Contact Info
TMA POC
1-866-275-4732
DSN (312) 471-8274 Option 8
Libby Hearin
210-295-2452
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