Florida Medicaid Program: Impact of ePrescribing

1. Florida MedicaidProgram: Impact of ePrescribing Christopher B. Sullivan, Ph.D. - AHCA Kathy Mosbaugh, Exec V.P. - Informed Decisions, LLC Tad Davis, PharmD - AHCA

2. Florida MedicaidWireless Handheld Clinical Pharmacology Drug Information Database and E-PrescribingChristopher B. Sullivan, Ph.D.Agency for Health Care Administration

3. Wireless Handheld PDA - the Opportunity for Change • In 2003, the Agency for Health Care Administration was authorized to implement its wireless handheld PDA program in the Pharmacy program. • AHCA developed a model in which clinical outcomes and Medicaid “over-prescribing” could be positively impacted at the point of care. • Florida, under the direction of AHCA, is at the forefront in using healthcare technology.

4. Wireless Handheld PDA - About the Program Florida uses wireless technology to make 100 days of our recipients’ prescription drug history available to practitioners. This medication history: is available at the point of service; permits immediate utilization and compliance review; provides information about coverage and restrictions; incorporates an e-prescribing function that permits immediate transmission of prescription authorization to the patient’s pharmacy.

5. Wireless Handheld PDA - About the Program The prescription program allows physician participation in prospective drug utilization review to: Minimize adverse drug reactions. Detect overuse or under use of drugs. Detect duplicate therapies. Detect potential allergic responses. Screen for appropriate dosage.

6. Wireless Handheld PDA - About the Program Phase 1: 1000 high-volume participating Medicaid providers Medicaid preferred drug list (PDL) 60-day patient specific prescription drug history Drug utilization reports (i.e. interaction alerts, etc.) Phase 2: Expanded to 3000 total participating Medicaid providers 100-day patient specific prescription drug history Included electronic prescribing (e-prescribing)

7. Wireless Handheld PDAFactors to Optimizing Utilization Three Components of the Wireless Handheld PDA Program: Drug Information Patient Information Fraud and Abuse Detection Wireless Handheld PDA - About the Program

8. Wireless Handheld PDA - About the Program The PDA program provides clinical benefits by alerting the provider to potential drug-drug interactions and providing electronic prescribing to avoid costly medication errors. This Prescribing System provides: comprehensive recipient drug histories, PDL status information, clinical drug information, drug-drug and drug-food interaction alerts and recommendations for alternative medications.

9. Ideal Electronic Prescription Available for any patient group Not an e-mail from electronic medical record NCPDP 5.1 compatible transmission Only requires pharmacist to: Confirm NDC selection Confirm the patient’s payor information Includes Controlled Substances, CIII - CV Wireless Handheld PDA - About the Program

10. E-Prescribing - General Overview The system is supported through a Web-based, real-time prescribing system: Allows providers to “write” prescriptions from a desktop computer or PDA – prompts for patient’s last pharmacy. Allows electronic prescription submission to any pharmacy for dispensing and adjudication. Is integrated with a clinical information database, which includes screening tools to reduce the potential for medication errors before they occur. Employs Clinical Pharmacology and clinical report tools, empowering clinicians to screen a prescription for adverse effects.

11. E-Prescribing - General Overview The Prescribing System is capable of tracking: who wrote the prescription, for which recipient, what was ordered, when it was ordered, where it was sent and what time it was filled. If the recipient does not pick up the prescription, the Prescribing System is capable of notifying the doctor.

12. E-Prescribing - Data Tracking Capabilities Doctors can: Track individual patients. Track prescription status – compliance, fraud and abuse. Pharmacies can: Track patient’s drug profiles – clinical review, fraud and abuse monitoring. Track incoming prescription – improve workflow, minimize wait times.

13. E-Prescribing - Data Tracking Capabilities AHCA can: Track prescriptions at the recipient, doctor, pharmacy or NDC level. Monitor outcomes resulting from drug therapy.

14. GSM’s User Interface 100-day Manifest PDL, Clinical PA, Drug Information Prescription Writing and Tracking Desktop PC Medicaid Provider 1 Wireless PDA Wireless Handheld PDAProject Approach 5 2 4 ACS 3 14

15. E-PrescribingResults Florida providers have sent 361,586 electronic prescriptions since the inception of the e-prescribing system. Anecdotal feedback from users continues to be positive.

16. Medicaid Cost Per Member Per Month Impact of e-Prescribing – Number of Claims

17. Medicaid Cost Per Member Per Month Impact of e-Prescribing - Savings

18. Integrated Drug Data TechnologiesFor Florida Medicaid Service ProvidersKathy Mosbaugh, Exec Vice PresidentInformed Decisions, LLC

19. The History of Rx History ProDUR Possible with Point of Sale Claims in 1993 Pharmacies Got the Message / Physicians In the Dark Prescribers would help if they had the information No “Real time connection” was available Internet connections were rare in physician offices Medicaid Fiscal Agent Website with Rx History – 2000 Did not have DUR / Pharmacology information Unpredictable Access

20. Prescriber Needs at the Point of Care Reference to Florida Medicaid PDL Constantly updated clinical pharmacology information Reference to best practice guidelines Specific, up-to-date patient medication history Elimination of errors in the prescribing/dispensing process due to: Legibility issues Lost paper prescriptions Patient non-compliance Assignment of prescription claim to incorrect prescriber

21. Application of Health Information In 2002, Florida Legislature directed Agency to develop wireless handheld drug information application for prescribers to use at point of care The system was to provide: Continuously updated clinical pharmacology information for prescriber reference Reference to the Florida Medicaid PDL Individual Medicaid patient medication history Ongoing education and support for prescribers

22. Impacting Utilization Through Technology • The wireless handheld drug information application was developed with expectations of creating value-added services by: • Applying Patient Information • Improving Outcomes • Saving Money

23. Point of care clinical decision support Coupling Clinical Pharmacology with real time patient data Delivering data for use on a variety of platforms Received National awards eMPOWERx

24. Impacting the Delivery System Accurate medication history Coordination of care – identify duplications Record of therapeutic failure Formulary verification Avoid formulary disruption Therapeutic fulfillment Impact on silent disease Legible & complete prescriptions

25. Overall Impact for Florida Medicaid Savings calculations- prescription utilization and cost avoidance 5:1 Return on Investment 2006 PEW Report noted $50 million savings for Florida in previous two years AHCA currently reports $1.8 - $2 million in monthly savings $4 million in savings quarterly by avoiding severe drug interactions

26. Overall Impact for Florida Medicaid Savings realized by eliminating waste and reducing medication errors Minimize duplication of therapy - Inefficiencies of a disconnected system Minimize fraud and abuse - Real-time, proactive identification Reduce medication errors – Preventing severe drug interactions

27. Drug Interaction Alerts by Severity RankingJuly-September 2006 Overall Impact for Florida Medicaid

28. About the Program - Florida Launched (2003): 1000 high volume Medicaid providers Providee Medicaid PDL Providee 60-day patient specific Rx history Drug utilization reports (interaction reports, etc.) Expanded (2004): Expanded to 3000 total providers Provided 100-day patient specific Rx history Included electronic prescribing

29. About the Program - Florida Currently: Renewal of service for providers using PDAs Open online access for all Medicaid providers Increase ePrescribing eMPOWERx Office

30. CMS Acknowledgement

31. Independent Review

32. The eMPOWERx Programand the Provider

33. Proof is in the Pudding “…I also use it as a teaching tool to let patients know how computers can make our lives easier and teach them and myself about medication side effects.  Once they see the whole list of medications they are on, many of them realize they may be overmedicated by too many prescribing physicians.”  Dr. Pedro Carballo

34. Patient Specific Information 100 Day Medication History List

35. Duplications of Therapy Medication History List Identifies Duplicate Drugs

36. Duplications of Therapy Medication History List Identifies Duplicate Drugs

37. Duplications of Therapy Medication History List Identifies Duplicate Drugs

38. Duplications of Therapy Medication History List Identifies Duplicate Drugs

39. Identifying Doctor Shoppers Medication History List Identifies Doctor Shopping

40. Identifying Doctor Shoppers Medication History List Identifies Doctor Shopping

41. eMPOWERx Solution The eMPOWERx Solution

42. Benefits of eMPOWERx Solution Improve Adherence by… Refill Compliance Indicator Date of Last Fill

43. Benefits of eMPOWERx Solution Enhance Safety by… Automatic Clinical Reports Supported by Clinical Content

44. Benefits of eMPOWERx Solution Lower Drug Costs by… Comprehensive medication history providing information for more informed therapeutic decisions Therapeutic duplications flagged for further review

45. eMPOWERx Ideals Empower the provider Quality clinical decision support at the point of care Provide efficiency throughout the process Enhance patient safety Optimal information Point-of-care access Better outcomes Eliminate waste

46. Results of eMPOWERx Pilot Project Prescribers who use the PDA write fewer prescriptions on average Significantly lower cost per patient for prescriptions compared to non-PDA prescribers Florida providers have sent over 850,000 electronic prescriptions to date eMPOWERx users receive more than 5,000 drug interaction alerts each week; more than 1,000 of these are of high or very high severity Savings from avoided hospitalizations due to preventable drug interactions and reduced Rx cost is estimated at more than $16 million annually

47. Going Forward e-Prescribing options used for only 7% of eligible Rx’s Outreach to physicians and pharmacies is ongoing New technology and platforms experience a learning curve Medicaid wireless handheld users prescribe 10%-16% fewer Rxs than control group physicians Wireless handheld and desktop prescribing and reference access moves system toward total electronic records

48. CMS Transformation Grant GenRx Expansion Project Tad Davis, PharmD – AHCA Agency for Health Care Administration

49. Medicaid Transformation Grant • July 2006 CMS announces grant funding for projects to “Transform” healthcare • Emphasis on increasing generic drug utilization • Enhancing patient safety through the use of technology (e-prescribing, EMR … etc. ) • October 1, 2006 Florida Medicaid submits GenRx Expansion Proposal • January 25th, 2007 CMS Awards Florida Medicaid 2 year $ 1.73 million for GenRx Expansion Project

50. GenRx Vision • Promote e-prescribing via • Provide 10 day generic starter pak • Increase utilization of generic medications • Promote recruitment and retention of Medicaid Providers • Improve patient outcomes by having with more direct contact with clinical pharmacists