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
Topics
• Overview of Data Sources
• Access & File Names
• Highlights of Contents
• Guidance for Use
• Non-VA Pharmacy Data
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
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
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
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
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
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
Data Format
• VISTA: ASCII
• PBM: You may request SAS, MS Access, or Visual FoxPro
• DSS NDEs at AAC: SAS
• KLF Menu (DSS): Spreadsheet
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.
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
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
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.
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)
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
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
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)
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
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
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
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
Choosing a Source: DSS National Pharmacy Extract
• Advantages– National coverage – Detailed cost data
• Disadvantages– Limited prescription characteristics– Cost data do not show purchase price
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
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
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.
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.
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
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
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
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.
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
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
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
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
Questions on Pharmacy Data?