Multiple Contract Pharmacies in a DSH

Hospital System

Anthony L. Lesser, MSHAPharmacy Inventory Manager, Harris County Hospital District

March 13, 2010APhA 2010 Annual Meeting

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Professional Resources & Business DevelopmentCPE Information and Disclosures

• Anthony Lesser declare(s) no conflicts of interest, real or apparent, and no financial interests in any company, product, or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria.

To receive credit for this activity, you must attend this activity in its entirety and complete your CPE information and program evaluation online using the voucher code assigned to this session.

The American Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

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Professional Resources & Business Development

Voucher Code

[FOR APHA USE ONLY]

You will need this voucher code in order to access the evaluation and CPE form for this activity. Your CPE must be filed by April 30, 2010 at 11:59 pm EDT in order to receive credit.

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Professional Resources & Business Development

Learning Objectives

List 3 Challenges of Central Fill

Describe Harris County

Hospital District

1Understand

why HCHD chose to apply for

an AMDP

2

4

Explain Central Fill

and its support

structure

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List 5 Opportunities with Central

Fill

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Harris County Hospital District

• Three major hospital facilities: Ben Taub, Lyndon Baines Johnson (LBJ), Quentin Mease

• Recognized as one of the leading trauma centers in the nation

• 15 ambulatory pharmacies

• Plans to expand ambulatory services

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Harris County Hospital District

Harris County Hospital DistrictAmbulatory Pharmacy Services

Annual Pharmaceutical Budget: $77 MillionOutpatient Pharmaceutical Budget:$61 MillionOutpatient Visits/Encounters per year: 1.6 MillionOutpatient Prescriptions per year: 2.5 MillionAmbulatory Pharmacy FTEs: 254

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Why HCHD needed a non-traditional pharmacy model

• High volume pharmacies in need of greater efficiency (lack of automation)

• Meet greater demand for pharmacy services• Advantages to patient

• Wait times• Patient access• Clinical services

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AMDP Application

• Designed to have selected prescriptions filled at an off-site contracted pharmacy and delivered to HCHD pharmacies

• Application filed November 2006• Project approved December 15, 2007• “Go-Live” - August 2008• First productive use - November 2008 • IT infrastructure to support regulatory

requirements• Third party management and audit

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Central Fill Inventory

• Fully automated, off-site facility located in Fort Worth, Texas

• Closed formulary consisting of approximately 200 solid oral dose forms and 50 unit of use packages.

• Replenishment model with prescriptions filled from an initial seed inventory

• Strict formulary and inventory controls necessary for cost containment and regulatory compliance

• Complemented central fill “go-live” with strong inventory management initiatives

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Central Fill PrescriptionsReceive Refill Request From

Patient

Is item available in central fill formulary?

YESNo

Fill Prescription Locally

Send to Central Fill

Central Processing Center Reviews IVR

Process Prescription

-DUR

-Billing

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Central Fill Pharmacy

Central Fill Pharmacy Receives Request

Is item in stock and

available to fill?

YESNo

Complete Filling Process

Return to Pharmacy for

Local Fill

Send to Originating

Pharmacy for Pick-up by

Patient

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Receiving of Prescriptions

Packages Arrive From Central Fill

Pharmacy

Electronically Receive

Prescriptions and Place in Will-call Area

Pick-up duties:

•Collect appropriate payment

•Counsel as required

•Obtain signature to document transaction

Did customer pick up

prescription?

YES

NoFollow RTS Procedure

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Ensuring Compliance

• Closed system (340B eligibility) • Focus on anti-diversion safeguards• Comprehensive reporting system covering inventory

reconciliation and cost allocation• Internal audits (quarterly)

• Verify process integrity

• External audit (annual)• Eligibility• No duplicate discount on Medicaid claims• Drug dispensed versus quantity purchased

• Third Party consultant assists with reporting, audits, and formulary/inventory management

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Central Fill Reporting• Fully automated reports resulting in greater efficiency• Inventory reconciliation

– Daily reconciliation of items received in dispensing software versus items shipped from central fill pharmacy

– Daily reconciliation of discrepancies– Daily verification of central fill pharmacy receipt of product

• Visualization– Real-time access to seed inventory levels and fluctuations– Daily reporting of inventory levels and products dispensed

from central fill pharmacy– Daily reporting of items not in stock at central fill pharmacy

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Program Challenges

real-time seed inventory management

shortages

IVR campaignpatient buy-in

centralized processingworkflow inefficiencies

- visibility- discrepancies

- daily reconciliation - system development

- automation- concurrent go-live

reporting enhancementsdispensing software

SolutionsChallenges

real-time seed inventory management

shortages

IVR campaignpatient buy-in

centralized processingworkflow inefficiencies

- visibility- discrepancies

- daily reconciliation - system development

- automation- concurrent go-live

reporting enhancementsdispensing software

SolutionsChallenges

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Contract Pharmacy Successes and Opportunities

• Operational Efficiency• 70% of duties transferred off-site (40% to Rx.com)• 23% improvement in wait times

• Focus on Critical/Immediate-Need Prescriptions• Clinical Opportunities

• Basic lab monitoring pilot• Ultimate goal of decentralization

• Staff Reduction (nearly 10%)• Waste Reduction

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Helpful hints for multiple contract pharmacy

• Develop a strong IT support structure

• Ensure adequate inventory control and maximize operational efficiency

• Launch aggressive patient marketing campaign

• Maintain staff support and moral

• Establish effective contractual relationships

• Don’t leave pharmaceutical wholesaler out of the picture

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Self-Assessment Questions

• What is an Alternative Methods Demonstration Project?

• Describe two analytical imperatives when implementing a multiple contract pharmacy program?

• What are three advantages of a multiple contract pharmacy arrangement?

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Thank You!

Anthony Lesser

Anthony_Lesser@hchd.tmc.edu

(713)873-2572