Pharmacy VariationUtilization and variation for maintenance and

scheduled drugs

Nevin Aragam, CNA Analysis and Solutions

Outline

• We investigate Navy pharmacy utilization and variation for FY 2011 to identify and understand patterns among our population of maintenance and scheduled pharmaceutical users Methods All drugs Maintenance drugs Scheduled drugs

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Methods

• FY 2011 PDTS via MDR• Used catchment area of record to identify the

eligible populations surrounding navy catchment regions

• Identified all eligible beneficiaries in FY 2011 using DEERS and the demographic information from the most recent FM the beneficiary appeared

• Maintenance drugs are identified with the MDR PDTS field Maintenance Drug = ‘Y’

• Scheduled drugs and identified using the MDR PDTS field DEA Class = 1, 2, 3, 4, or 5*

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* note, there were no drugs identified as having DEA class 1 in PDTS

All pharmacy age distribution

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Age distribution for all pharmacy users

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All pharmacy utilization

30 day supplies per 1,000 Navy region beneficiaries by age

60,000 30 days supplies implies the average 80 year old takes about 5 medications daily

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Popular fill source

• AD beneficiaries fill almost exclusively at MTF pharmacies

• Active duty family members and retirees fill mostly at MTFs and a sizable proportion at retail pharmacies

• Retirees and their dependents fill fairly evenly across MTFs and retail pharmacies

Source System AD ADFM RETRETDEP/

Other TotalDirect 93.6% 61.3% 48.4% 40.1% 53.8%Retail 5.3% 37.4% 40.6% 50.9% 39.2%Mail order 0.3% 0.7% 6.4% 5.3% 4.1%Other 0.8% 0.6% 4.5% 3.6% 3.0%Total 100.0% 100.0% 100.0% 100.0% 100.0%

Source: MHS Data Repository (MDR PDTS table FY2011).

Types of maintenance drugs

• Top 5 Maintenance drugs (15% of all maintenance drugs prescribed)1. IBUPROFEN2. SIMVASTATIN3. LISINOPRIL4. NEXIUM5. LIPITOR

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Maintenance drug age distribution

Age distribution for maintenance pharmaceutical users

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Maintenance drug utilization

30 day supplies of maintenance drugs per 1,000 Navy region beneficiaries by age

50,000 30 days supplies implies the average 80 year old takes about 4 maintenance medications daily

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Maintenance drug regional variation

High: NH Pensacola (13,307 30 day supplies)

Low: NCA MSMA (9,460 30 day supplies)

High/Low: 1.41 (Beneficiaries in NH Pensacola use 1.4 times as many maintenance drugs as those in the NCA MSMA)

Regional variation for maintenance drug prescriptions per 1,000 beneficiaries

Scheduled drugs

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Schedule

Abuse potentia

l

Accepted

medical use

Likelihood of psychological

or physical Dependence

Examples

I High No No accepted safety for use

Heroin, LSD, marijuana

II High Yes High Amphetamine (Adderall®),

methamphetamine (Desoxyn®), cocaine

III Moderate Yes Moderate Vicodin®, Tylenol with codeine®, ketamine

IV Low Yes Limited Alprazolam (Xanax®), diazepam (Valium®)

V Low Yes Limited Robitussin AC®,Phenergan with Codeine®

Types of scheduled drugs

• Top 5 Scheduled drugs (55% of all schedules drugs prescribed)1. HYDROCODONE-ACETAMINOPHEN2. ZOLPIDEM TARTRATE3. OXYCODONE-ACETAMINOPHEN4. ALPRAZOLAM5. DIAZEPAM

• Scheduled drugs can also be maintenance drugs:1. CLONAZEPAM 2. CONCERTA3. LYRICA4. ADDERALL XR 5. VYVANSE

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Scheduled drug age distribution

Age distribution for scheduled pharmaceutical users

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Scheduled drug utilization

30 day supplies of scheduled drugs per 1,000 Navy region beneficiaries by age

1,900 30 days supplies implies the average 80 year old takes about 1.5 scheduled drug medications daily

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Scheduled drug regional variation

High: NH Pensacola (1,073 30 day supplies)

Low: NCA MSMA (567 30 day supplies)

High/Low: 1.89 (Beneficiaries in NH Pensacola use nearly twice as many scheduled drugs as those in the NCA MSMA)

Regional variation for scheduled drug prescriptions per 1,000 beneficiaries

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Questions?

Nevin AragamAragamN@CNA.org

Appendix

Navy region definitions by catchment area DMIS ID:

0067 0066 0037 0123 - NCA MSMA 0124 0120 – Tide Water MSMA 0024 0029 - San Diego MSMA 0125 126 127 - Puget Sound MSMA 0104 - NH Beaufort 0091 - NH Camp Lejeune 0039 - NH Jacksonville 0028 - NH Lemoore 0038 - NH Pensacola 0030 - NH Twentynine Palms

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