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The Impact of Sole Provider Program (SPP) / Warrior in Transition (WT) CHCS Drug Entries

The Impact of Sole Provider Program (SPP) / Warrior in Transition (WT) CHCS Drug Entries. Global Guidance. We do not recommend using Sole Provider Program, Warrior in Transition, or any other “dummy” drug entries in CHCS

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The Impact of Sole Provider Program (SPP) / Warrior in Transition (WT) CHCS Drug Entries

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  1. The Impact of Sole Provider Program (SPP) / Warrior in Transition (WT) CHCS Drug Entries

  2. Global Guidance • We do not recommend using Sole Provider Program, Warrior in Transition, or any other “dummy” drug entries in CHCS • Rationale: Prescriptions for these “drugs” generate valid, legal prescriptions on PDTS patient profiles • We recommend utilizing the MTF Prescription Restriction Program which triggers MTF Lock-in warnings in CHCS/AHLTA when using SPP and/or WT entries

  3. Global Guidance • If you continue to “dummy” drug entries for prescriptions, we recommend setting up the drugs in a way that minimizes the impact of the associated valid prescription. • You can control the NDCs and costs that are reported for “dummy” drug entries and prescriptions.

  4. Minimizing the Impact of “Dummy” Drug Entries and Prescriptions • Objective: maintain the effectiveness of the drug entry and minimize the impact on PDTS patient, provider, and site profiles. • Solution: Multi-ingredient compound entry • Performs DUR checks and produces applicable drug class warnings for each component NDC; must ENABLE Drug Checks • Limitation: does not generate the DEA Overlap warning • Presents on PDTS/M2 with a Pseudo NDC; components (e.g. morphine) are not included in reports

  5. SPP/WTU Drug Entry: Why are they used? • Mechanism to warn providers and pharmacy staff at the point of order entry and dispensing that this patient is on a sole provider program and/or a WT • Mechanism to communicate the details of the situation, such as the PCM, secondary provider, contact number, risk status, and quantity limits

  6. Pharmacy Data Transaction Service (PDTS)/ MHS Mart (M2) • PDTS: • Contains prescription data from MTF’s, Mail Order Pharmacy, and retail network pharmacies • M2: • Contains medical and prescription information from MTFs and purchased care sector • Prescription information originates from PDTS

  7. What are PDTS and M2 used for? • Reporting: Utilization and cost reports generated from PDTS or M2 are used by local, service, and DoD level leadership • Monitoring prescribing and utilization trends • Projecting the impact of proposed changes • Patient Safety: • Safety edits that automatically review the patient’s profile for appropriate therapy • Identification of issues related to use of controlled substances

  8. What is the Impact on PDTS/M2? • ALL of these entries show up as valid prescriptions • NDCs, Drug Quantity, and Costs have the most meaningful impact on PDTS/M2

  9. Impact on decision-making:Real life examples • NDC: • Increased number of Rx’s for controlled substances, including cocaine and morphine, for active duty members • Example: identified during the preparation in response to a Congressional inquiry and media question • Cost/Quantity: • Rx costs are used in determining drug expenditures and data integrity issues • Example: $284,353.80/Rx for a SPP drug entry was identified by data integrity reports and review of expenditures for controlled substances • Provider/Pharmacy IDs: • Used to identify fraud, abuse, and prescribing trends • Example: X% of controlled substance prescriptions were written by Provider Y

  10. Example:Single ingredient drug entry

  11. Example:Single ingredient drug entry

  12. Example:Multi-ingredient drug entry Quantities equal to zero trigger the first NDC to be reported.

  13. Example:Multi-ingredient drug entry

  14. How do I trigger the pseudo NDC in CHCS? • Legal status: 0 • manufactured in pharmacy; compound • NDC and quantities • Must add 2-8 NDCs • Component quantities • Each NDC added must have a quantity greater than 0 • 0.001 (CHCS will not accept the leading 0) is the smallest quantity accepted

  15. Triggering the pseudo NDC:Add New Drug to Formulary

  16. How do I minimize the cost of the prescription? • Component quantities (ADN menu) • 0.001 (CHCS will not accept the leading 0) is the smallest quantity accepted • Local Cost = 0 • Cost Flag • Set to Local • Prescription Quantity • 0.01 (CHCS will not accept the leading 0) is the smallest quantity accepted

  17. Minimizing prescription costs:Formulary Maintenance

  18. Minimizing prescription costs:Formulary Maintenance

  19. Drug File Template Summary • Legal status: set up as a compound (0) • NDCs: must be more 2-8 NDCs • Quantities for each component: must be 1 or more (.001 recommended) • Local cost = $0 • Cost flag = Local • Prescription quantity = .01

  20. Additional Considerations:Formulary Management Fields • Formulary Status = FORMULARY • Inactive Date = populated or blank • Some SPP processes rely on the drug entry being visible and available to providers and others rely on it being available only to pharmacy staff • Comment = Reminder to determine RISK STATUS and QUANTITY LIMITS • Max quantity = .01 or 1 (something low) • Max days supply = 365

  21. Additional Considerations:Formulary Management Fields • Dispense complete container = YES, if you are using a default quantity of 1 or NO, if you are using .01 • Default Days Supply = 365 • Default Quantity = .01 or 1 (something low) • Default Sig = Reminder to perform a profile review • Continuable = YES, in case the patient is admitted and is transferred

  22. Additional Considerations:Formulary Management Fields

  23. Additional Considerations:Prescription Information • Sig = Sole provider and alternate name/contact info, in addition to risk status and quantity limits • Provider = Sole provider, pharmacist involved in the SPP process, default provider • Default providers: • MTF, OTHER (BM6666664): intended to be used for transfers of non-controlled substance prescriptions from one MTF to another MTF • OTC, SELF CARE (BO6666664): intended to be used for OTC preparations • Pros for using default provider: does not assign a valid prescription to a person; known default to exclude when tracking prescribing • Cons for using default provider: not intended use, does not meet the needs of processes relying on the provider field to indicate the sole provider

  24. Additional Considerations:Prescription Information

  25. Additional Considerations:Prescription Information • Non-compliance: • Some processes include marking the prescription as “non-compliant” • Keeps the prescription on the active CHCS/AHLTA profile • Reverses the prescription from PDTS

  26. Summary • Using a multi-ingredient compound set-up in CHCS will: • Generate DUR warnings identifying Sole Provider patients • Minimize the impact on reporting systems • To trigger the multi-ingredient logic, you must: • Legal status: set up as a compound (0) • NDCs: must be more 2-8 NDCs • Quantities for each component: must be 1 or more (.001 recommended) • To minimize the costs reported for these entries, you can: • Local cost = $0 • Cost flag = Local • Prescription quantity = .01

  27. Contact Info TMA POC 1-866-275-4732 DSN (312) 471-8274 Option 8 Libby Hearin Elizabeth.hearin@amedd.army.mil 210-295-2452

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