MTF Prescription Restriction Program

1. MTF Prescription Restriction Program MTF Prescription Restriction program

2. MTF Prescription Restriction Process • MTF providers identify beneficiary who may have “drug seeking behavior” or high risk of harming self or others • Use Pharmacy Data Transaction Service (PDTS) to set restriction • The provider has the option to: • Restrict all meds to a specific pharmacy(s) and/or provider(s) • Restrict controlled meds to a specific provider or list of providers • Exclude controlled substances or specific non-controlled substance(s) at mail order or retail pharmacy • The restriction form is available on the PEC website: • http://pec.ha.osd.mil/Pharmacy_restriction.php

4. Medication Restriction Program • MTFcommunicates to the POC which restriction type to manage pharmacy benefit • Requires signature and coordination of the “Triad Team” comprised of the Provider, Nurse Case Manager, and the MTF Pharmacist • Coordination between Triad Team and POC when SM is on leave or transfers for care • Community-Based Pharmacy Restriction Program • AD Members assigned to CBWTU • Community-based Pharmacy Restriction Form • Specific retail network pharmacy • Specific network provider • For Restriction Removal or temporary lift: • Contact the POC at 1-866-275-4732 option 8 or send e-mail to: pdts.ameddcs@amedd.army.mil

5. Retail Medication Restriction Program (1-1-1) • Express Scripts, Inc. (ESI) identifies members quarterly • ESI sends data to Managed Care Support Contractor (MCSC) to examines medical & pharmacy claims to include / exclude in program • ESI generates letters to members to select pharmacy, provider & medical facility • Letters not returned in 60 days or undeliverable are set at 100% Prepayment on all control meds • Member returns letter with selections • ESI sends information to POC to enter selections in PDTS

6. PDTS: Lock-In Edit

7. How Will the Lock-in Edit Work? What is the Lock-in edit? • The MTF Lock-in edit is an overridable PDTS warning that is triggered by patient restrictions established through the Prescription Restriction Programs • For patients with restrictions established through Prescription Restriction Programs: – MTF: •PDTS will return a warning message to AHLTA and CHCS if an unauthorized provider and/or pharmacy attempts to prescribe/dispense a medication •Lock-in warnings at MTFs can be overridden by the provider and pharmacy – Retail and Mail Order pharmacies: •PDTS will continue to return rejections to the pharmacy and the prescription will not process •Lock-in rejections at retail and mail order pharmacies can not be overridden by the pharmacy

8. MTF Lock-in Edit: Scenario and messaging • Patient RESTRICTED to Prescriber A for controlled medications • Conflict: LOCKED-INOrdered Drug: Percocet (oxycodone/acetaminophen) Comments:Additional Information:PRESCRIBER/DRUG NOT AUTHORIZED FOR THIS BENEFICIARY. PHARMACY ONLY, FOR QUESTIONS CALL 1-866-275-4732 OR DSN (312) 471-8274 OPTION 8.[PRESS RETURN TO CONTINUE] • The TMA POC toll free and DSN numbers are listed in the warning if detailed information on the restriction is required (e.g. the approved provider, pharmacy, etc). • AHLTA: Providers are presented with clinical reasons for not overriding the warning and

9. Variations in the Warning Message

10. Reports: Availability and Descriptions • Violation Reports – restricted members from your site that are in violation of their restriction • Site Reports – members with active restrictions • **70 and M2 Rejections Reports – restricted members from your site that attempted to violate their restriction at mail order and/or retail pharmacies. • **DUR Warning Reports – RXs that are the result of your MTF overriding the MTF Lock-in PDTS warning. Note: All reports are generated by individual site only. **70 and M2 Rejections reports and DUR Warning Reports are future initiatives.

11. Example Violation report (Type I): (Restricted to a specific pharmacy or list of pharmacies and/or provider or list of providers for all medications)

12. Example Site report (Type I): (Restricted to a specific pharmacy or list of pharmacies and/or provider or list of providers for all medications)

13. How do I learn more about the MTF Lock-in or MTF Prescription Restriction Program? • Additional information on both topics is available at http://pec.ha.osd.mil/Pharmacy_restriction.php OR • Contact the TMA POC at: • 1-866-275-4732 or • DSN (312) 471-8274 OPTION 8 or • email pdts.ameddcs@amedd.army.mil

14. Questions