pharmacy data mark w. smith, phd july 13, 2005 health economics teleconference seminar...
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Pharmacy Data
Mark W. Smith, PhDJuly 13, 2005
Health Economics Teleconference Seminar1-800-767-1750 access code 45043
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Topics
• Overview of Data Sources
• Access & File Names
• Highlights of Contents
• Guidance for Use
• Non-VA Pharmacy Data
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Abbreviations
• AAC: Austin Automation Center• BPA: Blanket Purchase Agreement• CMOP: Centralized Mail-Order Pharmacy• DSS: Decision Support System• MCRR: Medical Care Cost Recovery program• NDE: National Data Extract• PBM: Pharmacy Benefits Management• VAMC: Veterans Affairs Medical Center• VISTA: Veterans Health Information Systems and
Technical Architecture
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Overview - 1
• VISTA– Repository of primary data: clinicians enter data directly – Many files comprise pharmacy data “package” – Separate VISTA system at each VAMC
• PBM v3.0 Database – Data from local VISTA systems + new elements– National coverage: all VA pharmacies– Only outpatient prescriptions available currently
• DSS National Pharmacy Extract – Data from local DSS systems + new elements – National coverage: all VA (local) DSS systems– Inpatient and outpatient prescriptions available
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Overview - 2
• DSS National Data Extracts – Contains all types of care (inpatient, outpatient,
pharmacy)
– Separate from DSS Pharmacy Extract
– Data from local DSS systems + new elements
– National coverage
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Additional Pharmacy Data Sources
• Fee Basis files– Data from non-VA pharmacies paid by VA
– National coverage
• DSS Production Data – Contains finer detail than national DSS extracts
– Pertains to local DSS system only
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A Record Represents
• VISTA, PBM database, DSS national pharmacy extract, Fee Basis:– a single prescription or supply for an
individual
• DSS NDE for inpatient/outpatient care: – all prescriptions and supplies for a person
on a particular day
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A Record Represents
• DSS production data: – All prescriptions and supplies for a person handled
by a particular production unit on a particular day
– examples of production units: on-site pharmacy, CMOP
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Data Format
• VISTA: ASCII
• PBM: You may request SAS, MS Access, or Visual FoxPro
• DSS NDEs at AAC: SAS
• KLF Menu (DSS): Spreadsheet
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Access -- Summary
• PBM: Extracts made by PBM staff (www.vapbm.org)
• DSS Rx NDEs: detailed files stored at AAC and accessed through timeshare accounts; some summary data available for free via KLFMenu
• VISTA: Difficult to obtain direct access; easier to request data from local IRMS.N.B.: IRMS staff cannot accept Research funds. They do you a favor by making an extract.
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Access -- Reference
• See Table 1 of:MW Smith, G Joseph. Pharmacy Data in the VA Health Care System. Medical Care Research and Review 2003;60(3 Suppl): 92S-123S.
www.herc.research.med.va.gov/Pubs_medcare2.htm
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Cost of Obtaining Data
• PBM– Managerial & oversight projects: no charge
– Unfunded pilot studies: usually no charge
– Funded studies: charges for programmer time + optional consulting on study design
– Ask PBM/SHG staff ahead of time
• Other sources– No charge to user; AAC charges billed to VAMC
– KLF Menu: free unless you need to put in your ID # and password
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Contents
For PBM and DSS Pharmacy Extract: VIReC research user guide: VHA pharmacy prescription
data. Hines, IL: Veterans Affairs Information Resource Center (VIReC). 2005.
URL:www.virec.research.med.va.gov
For all sources (but somewhat dated): Table 2 in Smith and Joseph Med Care Res Rev article.
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Sample of Data Fields
• Medication: drug name, NDC, formulary indicators
• Dispensing: fill date, quantity dispensed, days supplied
• Cost: purchase price (PBM, VISTA) or VA cost including overhead (DSS NDEs, DSS Pharmacy Extract)
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Sample of Data Fields
• Patient: SCRSSN; date of birth, gender, age
• Provider: provider ID, provider treating specialty
• Note: Clinical information on related visits/stays can be linked to Rx data using SCRSSN
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Co-payments
• VA charges some copayments– Depends on income, disability percentage
– Rules & eligibility levels change year to year
– Rules available on VA internet
• Data sources do not show copayments; they show VA’s expense
• MCRR files could show reimbursement from private insurance, if collected
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Unit Costs - 1
• There may be a contract price– Federal Supply Schedule (FSS) – FSS Tier Schedule – Federal ceiling price (“Big 4”) schedule – VA Blanket Purchase Agreement (BPA)
• Price files available on PBM web site (www.vapbm.org)
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Unit Costs - 2• There will be discrepancies across sites
– Correct pricing requires *daily* updating of a VISTA price file at each VAMC, which does not occur
– BPAs are specific to individual VAMCs
• National VA formulary may limit use of selected medications – - see PBM website for current formulary, changes
to formulary since 1998, and current rules for particular medications
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Choosing a Source: VISTA• Advantages
– Greatest detail on costs, use of care– Access to data not available in extracts
• Disadvantages– Can access data from only the local VAMC– Most often, extracts must be made by IRMS staff
using specialized programs– Requires caution in interpreting differences
across sites
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Choosing a Source: PBM
• Advantages– National coverage in one extract– Only source that provides purchase price
(sometimes inaccurate!)– Optional fee-based consulting on pharmacy
data needs & use
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Choosing a Source: PBM
• Disadvantages– PBM staff must create the extract– Does not show pharmacy clinic costs
beyond purchase price– Limited clinical and demographic
information
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Choosing a Source: DSS National Pharmacy Extract
• Advantages– National coverage – Detailed cost data
• Disadvantages– Limited prescription characteristics– Cost data do not show purchase price
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Choosing a Source: DSS Inpatient/Outpatient NDEs
• Advantages– National coverage – Convenient summary cost data by treating
specialty or overall
• Disadvantages– Limited prescription characteristics– Only summary data: no data on individual
prescriptions or supplies
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Choosing a Source: DSS Data via KLFMenu
• Advantages– National coverage – Convenient summary cost data – Ease of access and use
• Disadvantages– Only summary data: no data on individual
prescriptions or supplies– Cannot select cases by SCRSSN
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Validation Studies: PBM vs. DSS
• Do PBM and DSS data sources contain the same prescription records?
• Study #1: 1,600 patients with hernias in CSP 456. Result: PBM and DSS Pharmacy Extract have >95% concordance in drug names, # scripts, # units dispensed.
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Validation Studies: PBM vs. DSS
Study #2: >300 patients with heart disease in CSP 424. Result: PBM and DSS NDE daily summary have very poor concordance in monthly or annual pharmacy costs.
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Grouping Prescriptions• DSS sometimes groups two prescriptions into
one record if they are for the same NDC and the same person on the same day
– PBM does not group prescriptions in this way
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Other Notes on Pharmacy Data
• KLF Menu provides summary DSS data on pharmacy spending – Pharmacy spending is one element of many DSS
reports
– Level: station, VISN, or nation
– No data on individuals
– Cannot be used to select data on a cohort of individuals
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Other Notes on Pharmacy Data
• VA utilization and spending patterns for individual medications is often confidential– E.g.: nationwide prescribing patterns for
branded antipsychotics for patients newly diagnosed with schizophrenia
– Drug manufacturers seek these data to aid in negotiations with VA
– Consult PBM before allowing private firms to see VA pharmacy data
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Cautions
• Validation is essential – Fields may have missing or inconsistent
values.– Different sites may complete fields
differently.– Not clear yet whether all prescriptions are
recorded, and how this varies by data source.
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Cautions
• Data elements change each year– Written guides become outdated quickly– Crosscheck data elements against printed
information: do you know what each field means?
• E.g.: fill date vs. release date
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Validity Checks
• Check data for erroneous values
• Missing values– If possible, fill in values based on consistency checks
(e.g., for gender, age)
– Imputing values adds statistical uncertainty: should account for it (or at least mention if used rarely)
• Inconsistent units– One 50ml bottle could be “50 units” in one record
but “1 unit” in another record
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Non-VA Pharmacy Data
• In CSP trials, we typically do not ask patients about non-VA pharmacy– Many VA users get all prescriptions
through VA– VA is likely to be used for most expensive
meds– Over-the-counter and occasional non- VA
prescription use is unlikely to affect total Rx spending much
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Non-VA Pharmacy Sources
1. Drug Topics “Red Book” Published annually
Offers “Average Wholesale Price” (AWP), the starting point for Medicaid drug payments
2. Private-sector claims data• Proprietary: must pay for access
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Questions on Pharmacy Data?