VA-IHS Consolidated Mail Outpatient Pharmacy Program (CMOP) CAPT Todd Warren VA-IHS National CMOP Coordinator

VA-IHS Consolidated Mail Outpatient Pharmacy Program (CMOP) CAPT Todd Warren VA-IHS National CMOP Coordinator

CMOP Business Model CMOP does not function like private sector mail out pharmacies

CMOP Business Model The Pharmacy which sends the prescription to CMOP has the primary responsibility for their beneficiaries care and uses CMOP only for prescription fulfillment. Beneficiary contacts local Pharmacy to request prescription refills and with any questions Beneficiaries care remains coordinated because prescription information is all in one place Pharmacy reimburses CMOP for the service provided. CMOP sends prescription fulfillment information electronically back to the Pharmacy.

Chelmsford Hines Leavenworth Murfreesboro Tucson Lancaster Charleston Each CMOP is accredited individually by TJC 4

The CMOP Prescription Filling Process in a Nutshell: Patient notifies their local IHS pharmacy they need a prescription refilled Refill requests are screened and processed in the IHS Pharmacy Computer Package by an IHS Pharmacist Prescription information is sent electronically to the VA Central Fill Center (CMOP) The CMOP fills the prescription and mails it directly to the patient s address Patients receives meds in 4-7 business days

Mailing Prescriptions using VA CMOP PATIENT -Enrolls in IHS facility mail-out program -Requests prescription refill from IHS facility. If needed, patient can contact IHS pharmacy to check on status of mailed prescription IHS -IHS site determines which drugs can be mailed. -pharmacy sets date prescription can be filled (suspense date) -Prescription refill processed by pharmacy -Pharmacy can view fill/package information. - Pharmacy bill (RPMS POS) generated. Transmitted to VA CMOP Cancel Back Rx Return prescription fill and package tracking information to IHS RPMS VA CMOP Leavenworth Screens & Fills the prescription within 48 hours MAIL VENDOR (USPS, UPS, FedEx) delivers to patient s address on file. Package tracked.

CMOP Pharmacist Verification 7

VA National CMOP Statistics: FY2016 Workload = 119.7 million prescriptions 470,000 prescriptions/work day 83.1 million parcels shipped 330,000 parcels/work day Expenditures = $3.4 billion CMOP fills 80% of all Outpatient Rx s filled by the VA

IHS CMOP Timeline June 2010 - alpha test site: Rapid City Sep 2011 - beta site: Phoenix Jan 2012 beta sites: Claremore & Yakama FY2012: 21 new IHS sites FY2013: 5 new IHS sites FY2014: 3 new IHS sites FY2015: 15 new IHS sites FY2016: 16 new IHS sites FY2017: 4 new IHS sites added so far FY2017: IAA signed allowing Tribal Participation

Current Status of CMOP 79 of 84 IHS sites (with a pharmacy) have been configured in RPMS to utilize CMOP Of these 79 sites 60 sites are currently in production with CMOP 15 sites have transmitted at least 1 test Rx, but have not yet entered into CMOP production 4 IHS sites have been configured for CMOP, but have not yet been tested Over 2.2 million IHS Rx s have been processed by CMOP so far

IHS CMOP Rx s by Fiscal Year FY2017-173,175 Rx s (1 st Qtr) FY2016-608,496 Rx s FY2015-481,472 Rx s FY2014-440,575 Rxs FY2013-350,699 Rxs FY2012-110,695 Rxs FY2011-23,959 Rxs FY2010-1,972 Rxs The 2 millionth IHS CMOP Rx was processed in September 2016

IHS CMOP Prescriptions by Month

CMOP Directly Impacts IHS Agency Priorities To renew and strengthen our partnership with Tribes To reform the IHS To improve the quality of care To improve access to care To make all our work accountable, transparent, fair and inclusive

Why CMOP? Reasons for Mailing Out Rx s Improves Adherence to Chronic Medication Therapy Customer Service & Patient Convenience Pharmacy care benefit often requested by patients Provides alternative to patients with transportation challenges Decreases patient s transportation costs Difficulty in synchronizing chronic prescription refills (more trips) Decreased waiting times for prescriptions Reduces congestion at the outpatient pharmacy dispensing area Reduces the number of Rx s which are never picked up

Advantages of CMOP Pharmaceutical Care Aspects Decreased Outpatient Rx workload at the Healthcare Facility Expanded delivery of direct patient care activities through Clinical Pharmacy programs. Expands pharmacists role in Improving Patient Outcomes Increased pharmacist time to perform more cognitive and clinical functions Participation on Multidisciplinary Clinic Teams Pre-visit medication review and screenings, by phone or in person Pharmacist run clinics (Anticoagulation, Asthma, Hyperlipidemia, Hypertension, Diabetes, etc.) Pharmacists assisting providers with medication refill requests Medication Reconciliation / Medication Profile Upkeep Provide patient education right in the clinic, while prescriptions are being processed

CMOP is Cost Effective VA Buying Power 1% Savings in Drug Cost is passed on to the Healthcare Facility CMOP Rx cost = (drug cost + non-drug cost) Non-Drug Costs of a CMOP prescription include: vial, Rx label, packaging for mail, actual postage, personnel, building overhead, and equipment capitalization. FY2015 non-drug cost per IHS Rx = $2.69 FY2016 non-drug cost per IHS Rx = $2.67 CMOP charges and fees are typically much less than your current local costs

Requirements for Tribal Participation in CMOP Use RPMS & meet Minimum Technical Requirements Sign Site-Specific Agreement with IHS NSSC NSSC New Customer Agreement The tribe must utilize Pharmaceutical Prime Vendor (PPV) Agree to PPV terms & conditions of use Agree to IHS Pharmaceutical Procurement Management Function (PPMF) Fee & Payment Intermediary Function (PIF) Fee NSSC CMOP Agreement (Addendum to customer Agreement) Agree to CMOP conditions of use Agree to CMOP applicable fees CMOP Drug costs CMOP Non-drug costs

Technical Requirements for Tribal Participation in CMOP EHR/RPMS current software and up-to-date with all Pharmacy Package versions/patches, and National Drug File patches. The facility is part of the IHS (D1) network RPMS Server s IP Address has been added to the VA-IHS Connectivity Tunnel Agreement RPMS Server s domain name ends with the suffix ihs.gov, nsn.gov, or tribe.gov. (This is not to be confused with the facility s main server domain name. The RPMS server domain name only affects RPMS Mailman.) RPMS Server has been configured and set-up to utilize CMOP by an IT Specialist familiar with RPMS Round trip connectivity with the VA is established and successful CMOP testing has been accomplished

Estimated Timeline for CMOP Implementation at Tribal Sites Sites which formerly used CMOP: March 2017 to June 2017 (if RPMS server parameters have not changed) Sites where the RPMS Server has already been configured to utilize CMOP: July 2017 to December 2017 (if RPMS server parameters have not changed) Sites where the RPMS Server has not yet been configured to utilize CMOP: October 2017 to September 2021(depending on order of the request)

CMOP Myths It takes longer to process an Rx for CMOP CMOP won t mail to a PO Box CMOP won t mail refrigerated items A site must have an IVR in place first Must be a high-volume site Must be locally mailing Rx s first CMOP will negatively impact Pharmacy POS Preparing the RPMS Drug File is difficult Pharmacists will have less contact with patients

CMOP Successes High Patient Satisfaction Pharmacy, Nursing, & Provider satisfaction Financial Reimbursement Process RPMS Pharmacy POS billing Product Oversight NSSC Ability to Track Mailed Packages Detailed Cost and Workload Reports from the VA sent to Facilities every month

Key Points The healthcare facility "owns" the Rx and the patient's prescription records, and all Rx fill data is maintained on the local Pharmacy s system, not the VA s. The VA cannot view the patient s medical record. The local pharmacy utilizes CMOP as a "central fill" pharmacy; the VA CMOP does not act like a retail mail-out pharmacy The VA CMOP is only filling and mailing an already processed prescription, and all other pharmaceutical care is being provided by the local pharmacy. It is the local pharmacist, not a VA pharmacist, who is contacted to have the Rx refilled, for any questions or advice about the Rx, and what to do in cases where the Rx has run out of refills, etc. Patients do not contact a VA pharmacist for anything, unless they happen to be actual beneficiaries of the VA health system as well. It is the local pharmacist who screens each prescription for: therapeutic duplications, drug-drug interactions, drug-disease interactions, etc., and not a VA pharmacist. It is the local pharmacy's name, address, and telephone number on all materials sent from the VA CMOP (prescription labels, all patient information leaflets, and mailing labels, including the return address). The VA CMOP is not named on any materials and it's contact information is not included on any labels or leaflets sent with a patient's prescriptions.

CMOP Resources: CAPT Todd Warren VA-IHS National CMOP Partnership Coordinator todd.warren@ihs.gov (605) 390-2371 LCDR James Cummings IHS National Service Supply Center CMOP Products Liaison james.cummings@ihs.gov Visit the VA-IHS CMOP Collaboration SharePoint Site: http://vhacollaboration.ihs.gov/ihscmop/default.aspx