Transcription
Lawley CaptiveMedicationManagementQ1/Q2 2019
Things I Want toReview Today Who We Are Ideal Therapy Program P&T Program Next Steps
CSS OverviewCompany Overview Founded in 2000 Located in Buffalo, NY Analyzed 40 million MTM members Specializing in Medication Therapy Management 45 Payers Medicare, Medicaid, Self-InsuredEmployers & ACOs Care ManagementClinical Call Center Population Health Quality Improvement
Client Partners
iDealTherapyOverview and Q1 Results
Engineered CareManagement Iterative gap confirmation and mediationAutomated data collectionStructured data collectionAutomated gap reconciliation
Decrease PharmacySpendTypeDementiaPain ensionRespiratoryOphthalmicOsteoporosisGastro IntestinalRheumatoid 89212401514141538178192817 2.21 3.37 2.92 3.21 3.01 2.12 3.22 4.21 4.15 2.27 1.76 2.92 1.21Total SavingsConversion Rate(90 Days) 0.00 4,549.50 3,679.20 4,044.60 4,063.50 572.40 2,318.40 6,441.30 2,988.00 3,881.70 316.80 2,102.40 1,851.30 36,809.1037%48%47%38%33%42%38%38%50%22%38%71%Note: First 5 months of 2019
Improve Care QualityIdentifiedEliminatedConversionRateDrug InteractionsDuplicate TherapyGeriatric (Beers)542954%332267%3267%Diabetic / Cholesterol7343%Diabetic / Renin8338%Quality Gap59
ality GapNote: New addition based on midyear meeting
OpioidsIdentifiedEliminatedConversionRateMorphine Equivalents 90 mg16531%Opioid w/ Gabapentin5240%Opioid w/ Benzodiazepine6117%Quality Gap8Note: New addition based on midyear meeting
P&TCommittee
P&T Charge Maintain pharmacy‐related medical policies that promote the safety, effectiveness, and affordability ofmedications. Review new drugs, drug classes, new clinical indications, therapeutic advantages, new chemicalentities, and new safety information. Review and update Pharmaceutical Management Policies and Procedures at least annually and as newpharmaceutical information becomes available. Share pharmacy-related policies with captive PBM’s Monitor PBM activity to assure adherence with captive related policies
New Drugs 2017 Approved Monographs (17)Tabled for additional review (5)Grandfathering for existing usersRetrospective review for appropriateness
Excluded Drug ListTherapeutic ClassExcluded MedicationsPreferred Agents and CommentsAnti-Infective Anomaly medication Exorbitant Pricing Readily availablealternativesAntifungalSporonox, Onmel, VfendAnti-MigraneSumavel DosproEffective 3/7/18NarcolepticsNuvigil, ProvigilNarcotic AntagonistsEvzioEffective 3/7/18Costly brand and multisource antifungals with less expensivegeneric alternativesCentral Nervous SystemSumatriptan injection KitDosepro is sumpatriptan in a proprietary injector priced at 1,200 each. Generic sumatriptan injection kits provide anequivalent product for 150.Costly brand narcoleptics with less expensive genericalternativesNaloxone syringe, Narcan Nasal SprayEvzio is naloxone injection in a proprietary injector priced at 4,900 (ea.). naloxone injection or narcan nasal sprayprovide equivalent products priced between 150-200 (ea)
What’s Next
DiabeticCostSpendTotal PopulationDiabeticsPercent 25024951817% 250-499339175% 500-999217157% 1000-19991321310% 2000-399944614% 40003913%
DiabeticAdherencePDCNo. of Diabetics0-49%Percent94%50-79%10746% 8011750%Note – Proportion Days Covered(PDC)
Re-evaluatingDiabetic CareA1C StatusTotal DiabeticsA1C ReceivedOut of Date 8 (Uncontrolled) 8 (Controlled)Will ObtainNo ResponseQ1 2018Number (%)Q1 2019Number (%)22223321 (9.5%)73 (32.8%)24 (10.8%)14 (6.3%)90 (40.6%)35 (15%)82 (35%)37 (16%)18 (8%)61 (26%)
Pharmacogenomics DepressionSchizophreniaPost – StrokeCholesterolBreast CancerOncology
Value PricingExample
Thank YouJames NotaroPresidentjnotaro@csshealth.com
equivalent product for 150. Narcoleptics Nuvigil, Provigil Costly brand narcoleptics with less expensive generic alternatives Narcotic Antagonists Evzio Effective 3/7/18 Naloxone syringe, Narcan Nasal Spray Evzio is naloxone injection in a proprietary injector priced at 4,900 (ea.). naloxone injection or narcan nasal spray
