Montana Department of Corrections Clinical Services Division - PowerPoint PPT Presentation

Montana Department of Corrections Clinical Services Division Prescription Medication Costs Connie Winner, Administrator 1

DOC DOC Secur Secure Facilities cilities Montana State Prison • Clinical Services Division is responsible for oversight and payment of all medical, dental, vision, and Montana Women’s Prison mental health services provided at DOC secure facilities Riverside • Approximately 1900 individuals Pine Hills 2

Contract Con acted ed Secur Secure Facilities cilities • Clinical Services Division is responsible for Shelby oversight and payment for all medical, Glendive dental, vision, and mental health services provided at contracted secure facilities – Great Falls regional prisons/jails and treatment facilities. and • Approximately 1400 individuals Treatment Facilities 3

• The clinical services division IS NOT Pre ‐ release centers responsible for oversight and payment for (approximately 800) medical, dental, vision, and mental health AND services provided at Pre ‐ Release Centers or those individuals on probation or parole Probation/Parole (approximately 10,000) • Many of these individuals are eligible for medical coverage through Medicaid Expansion 4

• DOC along with other state Minnesota Multi ‐ agencies contract with MMCAP for state Contracting the provision of medications Alliance for • This is a coalition of states formed Pharmacy (MMCAP) to maximize Rx costs and reduce and administrative costs Diamond Pharmacy • Medication costs are negotiated through MMCAP • Medications are ordered and received from Diamond Pharmacy 5

DOC PRESCRIPTION EXPENDITURES 2012 ‐ 2017 $4,500,000 $3,980,794 $4,000,000 $3,500,000 $3,245,819 $3,050,527 $3,000,000 $2,497,206 $2,500,000 $2,278,104 $2,237,029 $2,000,000 $1,500,000 $1,000,000 $384,551 $500,000 $338,943 $343,999 $327,402 $329,530 $309,257 $0 2012 2013 2014 2015 2016 2017 Pharmaceuticals Fill Fees 6

Therapeutic Class Prescriptions (1 month usage – July 2017) ASTHMA 250 4% ANTI ‐ INFECTIVE 215 3% CARDIAC 1121 17% ANALGESIC ANTI ‐ INFECTIVE ASTHMA ANTIHYPERLIPIDEMIC 278 4% ANALGESIC 944 14% CARDIAC ANTIHYPERLIPIDEMIC DIABETES 169 3% DIABETES OTHER 271 4% GASTROINTESTINAL ENDOCRINE ‐ METAB PSYCHOTROPIC GASTROINTESTINAL 888 13% SEIZURE DERMATOLOGICAL 172 3% NUTRITIONAL THYROID 103 2% THYROID DERMATOLOGICAL OTHER NUTRITIONAL 451 7% SEIZURE 201 3% ENDOCRINE ‐ METAB 124 2% PSYCHOTROPIC 1419 21% 7

Therapeutic Class Expenditures 1 month snapshot – July 2017 ANTI ‐ INFECTIVE $2,911.00 2% CARDIAC $9,004.84 6% ASTHMA $25,492.10 16% BIO ‐ IMMUNO ANALGESIC $6,559.05 4% ANTIHYPERLIPIDEMIC $2,781.73 2% ANALGESIC ANTI ‐ INFECTIVE BIO ‐ IMMUNO $11,411.40 7% ASTHMA CARDIAC ANTIHYPERLIPIDEMIC OTHER $7,415.14 5% DIABETES $17,099.38 11% DIABETES GASTROINTESTINAL ANTINEOPLASTIC HEPATITIS C DERMATOLOGICAL $3,790.26 2% GASTROINTESTINAL $10,513.98 6% HIV PSYCHOTROPIC NUTRITIONAL $3,974.09 2% SEIZURE PSYCHOTROPIC $25,635.82 16% ANTINEOPLASTIC $3,209.05 2% SEIZURE $2,681.16 2% NUTRITIONAL DERMATOLOGICAL HEPATITIS C $4,163.52 3% HIV $26,089.89 16% OTHER 8

Top 10 Medications Cost Per Prescription and Total Paid Medication Medical Condition Cost Per Rx Total Paid HUMIRA (2 INJECTIONS PER KIT) Rheumatoid Arthritis $4,399.64 $492,760.21 LANTUS Diabetes $1,127.43 $296,513.43 ENBREL Rheumatoid Arthritis $3,152.34 $223,816.29 EPCLUSA HepC $24,374.91 $219,374.19 COPAXONE MS $5,279.52 $174,224.04 HARVONI HepC $16,330.86 $163,308.60 DULERA Pulmonary $230.87 $126,746.93 TRUVADA HIV $1,477.92 $116,755.65 INVEGA SUST Psych $1,858.09 $100,336.67 LATUDA Psych $1,081.35 $81,101.13 9

TOP 10 EXPENSIVE PATIENTS WITH HEP C WITHOUT HEP C • Makes up 17% of Prescription • Makes up 32% of Prescription Costs Costs 10

5 Year Drug Inflation Rate by Fluctuation Percentage ‐ Top 10 Medications 67.6177 66.9807 69.9304 60.5974 69.792 Percent Increase in Top 20 Medications (All Brand Name) 77.5048 Medication % AAC Fluctuation 109.3453 Doxycycline Hyc 100mg Cap 3664.2119 169.8597 carBAMazepine 200mg Tab 855.9006 Levemir 100 Units/ml Vial 169.8597 Levemir 100 Units/ml Vial 109.3453 Enbrel 50mg/ml Syringe 77.5048 Lantus (insulin Glargin) 69.9304 Lantus (insulin Glargin) 69.792 Humira Pen 40mg/0.8 Kit 67.6177 855.9006 Enbrel Sureclick 50mg/ml 66.9807 Xifaxan 550mg Tablet 60.5974 Humira 40mg/0.8ml Syringe 60.4574 Latuda 80mg Tablet 51.3266 Invega Sust 234/1.5 Inj 39.9667 Atrovent HFA Inhaler 28.3906 3664.2119 Dulera 200 ‐ 5mcg Aer 22.8071 Risperdal Cons 50mg Kit 21.4832 Dulera 100 ‐ 5mcg Aer 21.3464 Complera Tablet 19.4887 Truvada 200 ‐ 300mg Tablet 18.3001 Atripla 600 ‐ 200 ‐ 300mg Tab 13.852 Doxycycline Hyc 100mg Cap carBAMazepine 200mg Tab Levemir 100 Units/ml Vial Levemir 100 Units/ml Vial Enbrel 50mg/ml Syringe Lantus (insulin Glargin) Lantus (insulin Glargin) Humira Pen 40mg/0.8 Kit Enbrel Sureclick 50mg/ml Xifaxan 550mg Tablet 11

5 Year Drug Inflation Rate by Fluctuation Percentage ‐ Bottom 10 Medications Percent Decrease in Bottom 20 Medications (All Generic) Medication % AAC Fluctuation Escitalopram 10mg Tablet ‐ 97.1855 Acyclovir 200mg Capsule ‐ 83.5011 ‐ 40.9862 Meloxicam 7.5mg Tab ‐ 81.8391 ‐ 97.1855 ‐ 41.9852 Enoxaparin 80mg/0.8ml Inj ‐ 68.6274 Tolterodine 1mg Tablet ‐ 63.5225 Vancomycin 125mg Capsule ‐ 51.4156 ‐ 44.893 Tramadol 200mg ER Tab ‐ 48.372 Enoxaparin 100mg/ml Inj ‐ 44.893 ‐ 83.5011 Desmopressin 0.01% Spray ‐ 41.9852 ‐ 48.372 Alvesco 80mcg Inhaler ‐ 40.9862 Alvesco 160mcg Inhaler ‐ 37.6276 Modafinil 100mg Tablet ‐ 32.2278 ‐ 51.4156 Abacavir 300mg Tablet ‐ 31.5482 ‐ 81.8391 Sprintec 0.25/0.035mg Tab ‐ 28.9315 Modafinil 200mg Tablet ‐ 27.8566 ‐ 63.5225 Haloperidol Dec 100mg/ml ‐ 26.6961 ‐ 68.6274 Ziprasidone 80mg Capsule ‐ 25.3087 Omeprazole 20mg Capsule ‐ 13.4372 Flunisolide 0.025% Nasal ‐ 12.4786 Escitalopram 10mg Tablet Acyclovir 200mg Capsule Meloxicam 7.5mg Tab Ventolin HFA Inhaler ‐ 5.7137 Enoxaparin 80mg/0.8ml Inj Tolterodine 1mg Tablet Vancomycin 125mg Capsule Tramadol 200mg ER Tab Enoxaparin 100mg/ml Inj Desmopressin 0.01% Spray Alvesco 80mcg Inhaler 12

OVERALL INFLATION OF TOP 20 MEDICATIONS • 33.5 % OVERALL INFLATION RATE FOR 5 Year PERIOD • BOTTOM 20 MEDICATIONS BROUGHT DOWN OVERALL INFLATION RATE 13

• Created a pain management What are we doing to committee to review all offenders on combat costs pain medications to ensure the current CDC guidelines are being followed • Working with Mountain Pacific Quality Health on pre ‐ authorization process for treatment of Hep C to ensure offenders are screened and meet criteria for treatment • Working with hospitals/clinics to provide out ‐ reach services for specialty needs (cardiology, orthopedics, nephrology) 14

• Explore joining Louisiana’s Health Secretary to encourage federal Ideas: government involved in reducing the price of Hep C treatment • Explore state ‐ owned pharmacy • Collaborate with University of Montana’s School of Pharmacy to create a state pharmacy? 15

Ques Questions? ons? 16