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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
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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
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44 miles
30 miles
Hawaii Multi-Service Market
Army MTF
Navy MTF
Air Force MTF
USCG MTF
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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
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The MTFs’ UF Challenge
DoD Uniform Formulary
BCF / ECF / UF Non-formulary
Formulary Non-formulary M
TF
For
mul
ary
#*%!
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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
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Desired Market Shift?U
niq
ue
Pa
tien
tsU
niq
ue
Pa
tien
ts
• Decreased utilization of NF drug
• Adhere to medical necessity criteria
Drug A (NF) Drug B
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Desired Market Shift
t
Un
iqu
e P
atie
nts
t
• Suggestive of a coordinated, clinically-sound conversion strategy
Drug A (NF) Drug B Total A+B
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• 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
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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
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Prevent Unauthorized NF Drug Use
• Provider communication– “Shotgun approach”– Newsletter– Broadcast e-mails– P&T representatives– Clinical pharmacist inservices
• CHCS configuration
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Prevents provider Rx order entry/renewal
Allows pharmacy staff order entry
Allows refill patient-initiated refill processing
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Provider Interface (AHLTA)
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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
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Promote Use of UF Alternative
• Medication Management Portal
• Newsletter
• Broadcast e-mails
• Clinical pharmacist presentations/detailing
• Targeted pharmaceutical rep detailing
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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
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anitdepressants
Clinical Pharmacists
BPH α-blockers PPIs
ACE inhibitors
.PCMs
Converting MTF Rxs/Patients
Specialists
No conversion (Grandfathered)
Clinical risk associated with conversion
Tim
e re
quire
d fo
r co
nver
sion
Outpatient Pharmacy
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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
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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
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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