Outpatient Pharmacy Program (CMOP) CAPT Todd Warren VA-IHS - PowerPoint PPT Presentation

VA-IHS Consolidated Mail Outpatient Pharmacy Program (CMOP) CAPT Todd Warren VA-IHS National CMOP Coordinator

CMOP Business Model CMOP does not function like private sector mail out pharmacies

CMOP Business Model  The Pharmacy which sends the prescription to CMOP has the primary responsibility for their beneficiaries care and uses CMOP only for prescription fulfillment.  Beneficiary contacts local Pharmacy to request prescription refills and with any questions  Beneficiaries care remains coordinated because prescription information is all in one place  Pharmacy reimburses CMOP for the service provided.  CMOP sends prescription fulfillment information electronically back to the Pharmacy.

Chelmsford sford Hines Leavenwo nwort rth Murfre freesbo sboro ro Charle rleston Tucson Lancast aster Each CMOP is accredited individually by TJC 4

The CMOP Prescription Filling Process in a Nutshell:  Patient notifies their local IHS pharmacy they need a prescription refilled  Refill requests are screened and processed in the IHS Pharmacy Computer Package by an IHS Pharmacist  Prescription information is sent electronically to the VA Central Fill Center (CMOP)  The CMOP fills the prescription and mails it directly to the patient’s address  Patients receives meds in 4-7 business days

Mailing Prescriptions using VA CMOP IHS PATIENT Transmitted to -IHS site determines VA CMOP -Enrolls in IHS which drugs can be facility mail-out VA CMOP mailed. program Leavenworth -pharmacy sets date -Requests prescription can be prescription refill Screens & Fills the filled (suspense date) from IHS facility. Cancel Back Rx prescription within 48 -Prescription refill hours processed by pharmacy If needed, patient can contact IHS pharmacy -Pharmacy can view to check on status of fill/package information. mailed prescription - Pharmacy bill (RPMS Return prescription fill and package POS) generated. tracking information to IHS RPMS MAIL VENDOR (USPS, UPS, FedEx) delivers to patient’s address on file. Package tracked.

CMOP Pharmacist Verification 7

VA National CMOP Statistics: FY2016  Workload = 119.7 million prescriptions  470,000 prescriptions/work day  83.1 million parcels shipped  330,000 parcels/work day  Expenditures = $3.4 billion  CMOP fills 80% of all Outpatient Rx’s filled by the VA

IHS CMOP Timeline  June 2010 - alpha test site: Rapid City  Sep 2011 - beta site: Phoenix  Jan 2012 – beta sites: Claremore & Yakama  FY2012: 21 new IHS sites  FY2013: 5 new IHS sites  FY2014: 3 new IHS sites  FY2015: 15 new IHS sites  FY2016: 16 new IHS sites  FY2017: 4 new IHS sites added so far …  FY2017: IAA signed allowing Tribal Participation

Current Status of CMOP • 79 of 84 IHS sites (with a pharmacy) have been configured in RPMS to utilize CMOP • Of these 79 sites …  60 sites are currently in production with CMOP  15 sites have transmitted at least 1 test Rx, but have not yet entered into CMOP production  4 IHS sites have been configured for CMOP, but have not yet been tested • Over 2.2 million IHS Rx’s have been processed by CMOP so far

IHS CMOP Rx’s by Fiscal Year FY2017 - 173,175 Rx’s (1 st Qtr) FY2016 - 608,496 Rx’s FY2015 - 481,472 Rx’s FY2014 - 440,575 Rxs FY2013 - 350,699 Rxs FY2012 - 110,695 Rxs FY2011 - 23,959 Rxs FY2010 - 1,972 Rxs The 2 millionth IHS CMOP Rx was processed in September 2016

IHS CMOP Prescriptions by Month

CMOP Directly Impacts IHS Agency Priorities  To renew and strengthen our partnership with Tribes  To reform the IHS  To improve the quality of care  To improve access to care  To make all our work accountable, transparent, fair and inclusive

Why CMOP? Reasons for Mailing Out Rx’s  Improves Adherence to Chronic Medication Therapy  Customer Service & Patient Convenience  Pharmacy care benefit often requested by patients  Provides alternative to patients with transportation challenges  Decreases patient’s transportation costs  Difficulty in synchronizing chronic prescription refills (more trips)  Decreased waiting times for prescriptions  Reduces congestion at the outpatient pharmacy dispensing area  Reduces the number of Rx’s which are never picked up

Advantages of CMOP Pharmaceutical Care Aspects  Decreased Outpatient Rx workload at the Healthcare Facility  Expanded delivery of direct patient care activities through Clinical Pharmacy programs.  Expands pharmacists’ role in Improving Patient Outcomes  Increased pharmacist time to perform more cognitive and clinical functions  Participation on Multidisciplinary Clinic Teams  Pre-visit medication review and screenings, by phone or in person  Pharmacist run clinics (Anticoagulation, Asthma, Hyperlipidemia, Hypertension, Diabetes, etc.)  Pharmacists assisting providers with medication refill requests  Medication Reconciliation / Medication Profile Upkeep  Provide patient education right in the clinic, while prescriptions are being processed

CMOP is Cost Effective  VA Buying Power – 1% Savings in Drug Cost is passed on to the Healthcare Facility  CMOP Rx cost = ( drug cost + non-drug cost )  Non-Drug Costs of a CMOP prescription include: vial, Rx label, packaging for mail, actual postage, personnel, building overhead, and equipment capitalization.  FY2015 non-drug cost per IHS Rx = $2.69  FY2016 non-drug cost per IHS Rx = $2.67  CMOP charges and fees are typically much less than your current local costs

Requirements for Tribal Participation in CMOP  Use RPMS & meet Minimum Technical Requirements  Sign Site-Specific Agreement with IHS NSSC  NSSC New Customer Agreement  The tribe must utilize Pharmaceutical Prime Vendor (PPV)  Agree to PPV terms & conditions of use  Agree to IHS Pharmaceutical Procurement Management Function (PPMF) Fee & Payment Intermediary Function (PIF) Fee  NSSC CMOP Agreement (Addendum to customer Agreement)  Agree to CMOP conditions of use  Agree to CMOP applicable fees  CMOP Drug costs  CMOP Non-drug costs

Technical Requirements for Tribal Participation in CMOP  EHR/RPMS current software and up-to-date with all Pharmacy Package versions/patches, and National Drug File patches.  The facility is part of the IHS (D1) network  RPMS Server’s IP Address has been added to the VA -IHS Connectivity Tunnel Agreement  RPMS Server’s domain name ends with the suffix “ihs.gov”, “nsn.gov”, or “tribe.gov”. (This is not to be confused with the facility’s main server domain name. The RPMS server domain name only affects RPMS Mailman.)  RPMS Server has been configured and set-up to utilize CMOP by an IT Specialist familiar with RPMS  Round trip connectivity with the VA is established and successful CMOP testing has been accomplished

Estimated Timeline for CMOP Implementation at Tribal Sites • Sites which formerly used CMOP:  March 2017 to June 2017 (if RPMS server parameters have not changed) • Sites where the RPMS Server has already been configured to utilize CMOP:  July 2017 to December 2017 (if RPMS server parameters have not changed) • Sites where the RPMS Server has not yet been configured to utilize CMOP:  October 2017 to September 2021 (depending on order of the request)

CMOP “Myths”  It takes longer to process an Rx for CMOP  CMOP won’t mail to a PO Box  CMOP won’t mail refrigerated items  A site must have an “IVR” in place first  Must be a high-volume site  Must be locally mailing Rx’s first  CMOP will negatively impact Pharmacy POS  Preparing the RPMS Drug File is difficult  Pharmacists will have less contact with patients

CMOP Successes  High Patient Satisfaction  Pharmacy, Nursing, & Provider satisfaction  Financial Reimbursement Process  RPMS Pharmacy POS billing  Product Oversight – NSSC  Ability to Track Mailed Packages  Detailed Cost and Workload Reports from the VA sent to Facilities every month

Key Points The healthcare facility "owns" the Rx and the patient's prescription records, and all Rx  fill data is maintained on the local Pharmacy’s system, not the VA’s. The VA cannot view the patient’s medical record.  The local pharmacy utilizes CMOP as a "central fill" pharmacy; the VA CMOP does  not act like a retail mail-out pharmacy The VA CMOP is only filling and mailing an already processed prescription, and all  other pharmaceutical care is being provided by the local pharmacy. It is the local pharmacist, not a VA pharmacist, who is contacted to have the Rx  refilled, for any questions or advice about the Rx, and what to do in cases where the Rx has run out of refills, etc. Patients do not contact a VA pharmacist for anything, unless they happen to be actual  beneficiaries of the VA health system as well. It is the local pharmacist who screens each prescription for: therapeutic duplications,  drug-drug interactions, drug-disease interactions, etc., and not a VA pharmacist. It is the local pharmacy's name, address, and telephone number on all materials sent  from the VA CMOP (prescription labels, all patient information leaflets, and mailing labels, including the return address). The VA CMOP is not named on any materials and it's contact information is not included on any labels or leaflets sent with a patient's prescriptions.