UF Implementation:UF Implementation:Best Practices from Best Practices from MTFsMTFs

● ● Brian WhiteBrian WhiteTripler Army Medical Center/Hawaii Tripler Army Medical Center/Hawaii Multi-Service MarketMulti-Service Market

Implementing the Uniform Formulary:Implementing the Uniform Formulary: Methods for a DoD Medical Center Methods for a DoD Medical Center

and Multi-Service Marketand Multi-Service Market

Brian White, Pharm.D. Tripler Army Medical Center

44 miles

30 miles

Hawaii Multi-Service Market

Army MTF

Navy MTF

Air Force MTF

USCG MTF

Monthly Outpatient Workload

Tripler Army Medical Center

Hawaii Multi-Service Market

New Rxs 32,100 74,500

Refills 11,100 23,500

Total 43,200 98,000

The MTFs’ UF Challenge

DoD Uniform Formulary

BCF / ECF / UF Non-formulary

Formulary Non-formulary M

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The Mission

• Efficient market share shift• Preserve integrity of medical necessity criteria• Minimize risk to the patient• Optimize therapeutic outcomes

BCF / ECF / UF DoD Non-formulary

Drug B Drug A

Desired Market Shift?U

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• Decreased utilization of NF drug

• Adhere to medical necessity criteria

Drug A (NF) Drug B

Desired Market Shift

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• Suggestive of a coordinated, clinically-sound conversion strategy

Drug A (NF) Drug B Total A+B

• Regional MTF coordination

• Aggressively prevent initiation of NF drug therapy not meeting MN criteria

• Promote use of UF alternative

• Provide convenient access to NF drugs when indicated

• Apply proactive, clinically-sound patient conversion strategy

Implementing UF Decisions

Regional Coordination

DoD P&T Committee

Oahu Regional P&T Committee

Single CHCS formulary

Army

Air Force

Navy

USCG

• Consistent UF implementation strategy across MTFs

• Shared administrative resources

• Regional P&T coordinator / formulary manager

Prevent Unauthorized NF Drug Use

• Provider communication– “Shotgun approach”– Newsletter– Broadcast e-mails– P&T representatives– Clinical pharmacist inservices

• CHCS configuration

Prevents provider Rx order entry/renewal

Allows pharmacy staff order entry

Allows refill patient-initiated refill processing

Provider Interface (AHLTA)

Facilitate Authorized NF Drug Use

• Grandfather pre-existing patients meeting medical necessity criteria

• Non-formulary drug request process– Convenient– Quick– Effective – Educational– Perceived clinical value

Promote Use of UF Alternative

• Medication Management Portal

• Newsletter

• Broadcast e-mails

• Clinical pharmacist presentations/detailing

• Targeted pharmaceutical rep detailing

Active Patient Conversion Strategy

• Magnitude of target patient population

• Demographics of target population

• Goal timeline

• Clinical risk– Adverse effects (toxicity)– Loss of therapeutic control/efficacy– Patient education requirements

anitdepressants

Clinical Pharmacists

BPH α-blockers PPIs

ACE inhibitors

.PCMs

Converting MTF Rxs/Patients

Specialists

No conversion (Grandfathered)

Clinical risk associated with conversion

Tim

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Outpatient Pharmacy

Converting Non-MTF Rxs/Patients

• Mailers– Personalized– Avoid blind-siding the patient at the patient– MTF formulary alternatives– Tricare phamacy benefit options– Give patient an opportunity to be proactive

• Handout for patient/physician– Explanation– Formulary alternatives– On-line formulary URL

Pharmacy Informatics Support

• Identify affected patients– Conversion targets Patient list for PCMs and clinic

pharmacists t-cons, appointments– Pts meeting MN document local non-formulary approval – Patients with non-MTF prescriptions mailers

• CHCS ad hocs and database analysis– Active Rxs for target drug– Filled within last 4-6 months– Retrieve assigned PCM and associated clinic– Retrieve mailing address and phone numbers– Retrieve relevant lab values or prescription history

• Service for whole MTF market

Conclusion

• Goal: Move market share– Extensive– Efficiently– Clinically sound process– Customer satisfaction

• Tools– Regional coordination/standardization– Diverse communication venues– Managing CHCS– Effective non-formulary drug request process– Proactive formulary conversions– Hands-on pharmacy involvement– Local CHCS data