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IHS Pharmacies using VA CMOP for Central Fill Mail-Out

IHS Pharmacies using VA CMOP for Central Fill Mail-Out. March 2012. Definitions. VA CMOP – Consolidated Mail Outpatient Pharmacy

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IHS Pharmacies using VA CMOP for Central Fill Mail-Out

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  1. IHS Pharmacies using VA CMOP for Central Fill Mail-Out

    March 2012
  2. Definitions VA CMOP – Consolidated Mail Outpatient Pharmacy Central Fill –prescription refill information is electronically transmitted from the local facility to the VA CMOP for filling, packaging and mailing; The patient’s interaction is always with the local facility. Host CMOP Facility – IHS uses the VA CMOP located in Leavenworth, Kansas.
  3. Mailing Prescriptions using VA CMOP IHS IHS site determines which drugs can be mailed. pharmacy sets date prescription can be filled (suspense date) Prescription refill processed by pharmacy VA CMOP Leavenworth Fills prescription within 48 hours PATIENT Enrolls in IHS facility mail-out program Requests prescription refill from IHS facility. Transmitted to VA CMOP If needed, patient can contact IHS pharmacy to check on status of mailed prescription Pharmacy can view fill/package information. - Pharmacy bill (RPMS POS) generated. Return prescription fill and package tracking information to IHS RPMS MAIL VENDOR (USPS, UPS, FedEx) delivers to patient’s address on file. Package tracked.
  4. Reasons for Considering Mailing Prescriptions Customer service – patients/tribe have requested service; reduces wait time in clinic (access to care). Improves Adherence/Compliance Reduces the number of Return to Stock prescriptions Expand delivery of direct patient care activities – Clinical Pharmacy programs. Decreases the amount of drug inventory on the shelf
  5. Adherence
  6. Timeline NDF patch released monthly – April 2008 Interagency agreement (IAA) for pilot signed – March 2010 CMOP software - Pharmacy Patch 1009 – January 2011 Suspense functionality – Pharmacy Patch 1010 – April 2011 Alpha Test Site – FY 2010 Rapid City – implemented CMOP transmissions June 14, 2010 Averaging 2,000 Rx/month Beta Test Sites – FY 2011 PIMC – FY2011 – connectivity established September 1, 2011. Claremore – FY2012 – connectivity established September 15, 2011; in production Jan 2012 Yakama FY2012 – connectivity established Sep 23, 2011; in production January 2012. Phase II – FY 2012 between 7-10 sites to implement in summer of FY2012
  7. Key Preparation – Best Practice CEO support of mail out program Consider site visit to local VA-CMOP CEO support of pharmacists’ clinical work/clinics. Local and Area IT support Pharmacy Preparation Drug file preparation (Pharmacy CAC) Maximize automation within pharmacy Plan for expansion of pharmacy activities
  8. Key Preparation – Pharmacy Good communication and support within pharmacy department Regular Staff meetings Involve all staff in preparation/new processes Site visit to local VA Automation and Drug File Maximize automation, i.e. ScriptPro, Parata Refill system (Interactive Voice Response - IVR) Drug file preparation – Pharmacy CAC Clinical Pharmacy programs expanding or in development; medical staff support. Develop a plan for expansion of pharmacy activities with transfer of workload. Implement local/internal mail-out program
  9. Patient Outreach Efforts to improve compliance by making it easier for patients to obtain medication refills. Implement local mail-out (small scale). Outreach to tribal communities. Enrollment in mailout program. Accurate mailing address (Patient Registration package or Outpatient Pharmacy package) Requesting refills in advance; Suspense function. Process changes using IVR
  10. RPMS/IT Preparation Infrastructure Station code – coordinate with Area IT/OIT RPMS Mailman set-up Use of suspense (manual) – Outpatient Pharmacy patch 8 Drug File – populate appropriate “warning label” field. Marking drugs for CMOP
  11. Rx Volume Using CMOP The VA processes approximately 75-80% of refills through CMOP. Tribal sites that have implemented mail-out are mailing from 50-75% of refills after 2-3 years. IHS sites process 10-30% of refills using IVR.
  12. Costs using VA CMOP Cost to fill and mail prescriptions using CMOP, including mailing costs is equal to or less than the cost for the site to fill. NSSC – provides quality assurance oversight, and coordinates additional IHS drugs stocked by CMOP and mapping.
  13. Visits A patient requests a refill via IVR which is reviewed by the pharmacist. The suspended prescription is transmitted on the appropriate day to VA CMOP for filling and mailing. This is considered a Pharmacy visit (39) with primary provider being the pharmacist. The pharmacy visit is billable.
  14. Finance Use IPAC to pay VA monthly. 30 day estimate of usage paid in advanced starting FY2013. CMOP invoices monthly September (end of Fiscal year), estimate of bill is provided and reconciled at the end of the FY. Access to VA SharePoint – cost reports
  15. Controlled Substances No CII’s or diversion drugs will be mailed, i.e. hydrocodone Chronic meds, IV & V’s (i.e. seizure) – it is a local decision whether to mail. CSM report being adjusted to identify CMOP drugs. If patient is “missing” mailed prescription, might need to change to window pick-up.
  16. Local Mail Sites will need to determine how they will process prescriptions that are: Returned by CMOP, i.e. not in stock; clarification/editing of prescription. Refill request for non-CMOP drug when others in the request are filled by the VA CMOP. Eg. Non-formulary drug is not stocked at CMOP and will be filled/mailed locally. Remaining drugs will be filled/mailed by CMOP. Local site will need the capacity to mail meds locally.
  17. Addresses Sites need to verify that the patient mailing address is current. Coordinate with departments (Patient Registration?) that update this information. Pharmacy can update mailing addresses via Outpatient Pharmacy package. Pharmacy can also enter temporary address.
  18. VA drugs versus IHS drugs VA CMOP Leavenworth has a larger selection of drug product and is able to fill most prescriptions. NSSC will coordinate with VA to add drugs to CMOP (i.e. national or high use by IHS sites). The NSSC is liaison with McKesson (regions) for CMOP implementation timeline.
  19. Temperature USP did an extensive review - mailing a range of products to the hottest parts of the US during the heat of summer and all products still met pharmacy standards.  CMOPs do use freezer packs for select products with overnight shipping on select products to protect the integrity of the products. the newest insulin products are all shipped in coolers List of refrigerated items on the national CMOP web: https://vaww.apps.cmop.va.gov/CMOPRefrigerated/Refrig.aspx In general, these items are mailed in cold storage packs. Formoterol is the only one on the list that only gets mailed in coolers seasonally (from June 15-Sept 15).
  20. https://vaww.apps.cmop.va.gov/CMOPRefrigerated/Refrig.aspx
  21. Training Sites will need to consider training programs for both pharmacists and technicians, especially if roles change. Pharmacists may need more training as clinical role expands. Develop needs assessment for pharmacy staff.
  22. Support Through the VA-IHS Partnership, national support is now available for CMOP implementation.
  23. Chapter 7 - Mailed Prescriptions d. Mailed Prescriptions Prescriptions may be mailed to patients provided that pharmacists meet the IHS Pharmacy Standards of Practice (Sections 3-7.3B and 3-7.3C). The facility’s policy will define patients eligible to receive prescription refill mail-out service, including restrictions on medications mailed and how the pharmacy will meet the IHS Pharmacy Standards of Practice. A pharmacy may elect to fill and mail from their local facility or use a central fill pharmacy to fill on behalf of the local facility pharmacy. Schedule II controlled substances will not be mailed. Facilities can determine locally if Schedule III through V controlled substances will be mailed, taking into consideration clinical necessity and potential for diversion, e.g., hydrocodone. Mailing prescription refills will be made available, as medically indicated, to persons of Indian descent belonging to the Indian community served by the local facilities and program and others eligible for services in accordance with 42 CFR 136.12. The pharmacist will review the medication refill requests for appropriateness of therapy and when appropriate will provide consultation to ensure patient understanding of their drug therapy. New or first time prescriptions are expected to be processed locally. In locations where a pharmacist is not physically available for medication counseling, resources such as telepharmacy or trained community health aids can be utilized.
  24. Incorporating POS Pharmacy Billing Suspense file (prescriptions) transmitted to CMOP RPMS CMOP Message returned to local IHS site includes NDC dispensed and Pkg ID (used to track in Parcelite) Prescription filled and mailed to patient. Prescription released; calls POS package for e-billing.
  25. Prescription Activity Log CMOP Event Log: Date/Time Rx Ref TRN-Order Stat Comments ====================================================== 09/01/11@1625 Orig 7-1 DISP NDC: 00603333932 Carrier: USPS Pkg ID: 1124429490
  26. Pharmacy Billing Documenting receipt of prescription, in lieu of signature log – USPS delivery CMOP web site – package tracking: https://vaww.apps.cmop.va.gov/
  27. Display System Setup
  28. View Transmission
  29. CMOP Not Dispensed Rx List Example of RPMS Mailman message returned after CMOP transmission: Subj: DEMO IHS HOSP CMOP Not Dispensed Rx List, [#777026] 05/25/11@18:45 From: POSTMASTER In 'IN' basket. Page 1 *New* ------------------------------------------------------------------------------- Not Dispensed Rx Report for the DEMO IHS HOSP Division. The following prescriptions were not dispensed by the vendor: Patient: SMITH, LISA SS#: 987-65-1234 Rx #: 34343434 (REF8) Qty: 30 Trans #: 522 Drug: LISINOPRIL 40MG TAB Transmitted under CMOP ID: L0045 Reason: MANUFACTURER'S BACKORDER
  30. Access to Web Site - Security Users will need access to a VA account in order to log on to the web sites. Access potentially needed for these three sites: http://vhacmnreporting.vha.med.va.gov/ - CMOP web site used for order look up , package tracking, and product look ups http://vaww.national.cmop.va.gov/CostReports/OTHER/Forms/AllItems.aspx- where monthly drug cost bills are posted for medical centers to pickup http://vhacmnreporting.vha.med.va.gov/PBMOnlineProductDatabase/  - online product look up web site for the PBM.
  31. CMOP Portal Options
  32. CMOP Products
  33. CMOP Portal
  34. PARCELite tracking
  35. Leavenworth
  36. Stats – Leavenworth
  37. VA CMOP manuals
  38. Mapping Products Insulin, inhalers and eye ointment Routine in Outpatient Pharmacy v7 p9 to prevent dispense unit from being over-ridden when marking a CMOP drug. NSSC to coordinate with VA CMOP Leavenworth Redundancy Will eventually need make sure mapping set up at other VA’s.
  39. IHS representation Monthly VISN-CMOP-DoD-IHS call, Tuesday, 2:00pm CT NSSC represents IHS on monthly calls.
  40. Training –https://vaww.apps.cmop.va.gov/CMOPNationalWebApplicationv2/
  41. Things that are working great: Patient Satisfaction Pharmacy Staff satisfaction Payment process with Finance and VA RPMS POS billing Reduces Return to Stock VA communication Weekly meetings, daily follow-up Mapping process
  42. For more information contact: CAPT Pamela Schweitzer VA-IHS National CMOP Coordinator E-mail: pam.schweitzer@ihs.gov Phone: 480-678-5803
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