Virginia Medicaid Preferred Drug List Educational Outreach Efforts: Overview and Accomplishments Pre

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Virginia Medicaid Preferred Drug List
Educational Outreach EffortsOverview and
AccomplishmentsPresented toPDL Implementation
Advisory GroupMarch 16, 2004By Barbara J.
Dowd, R.Ph.First Health Services Corporation


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Presentation Outline

• Background on PDL Program
• Communication Plan
• PDL Implementation Advisory Group
• Educational Efforts
• Lessons Learned

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Virginia Medicaid PDL Why and How?

• Appropriations Act 2003 established the PDL with
  requirements for consumer and provider education
  both prior to implementation and ongoing as the
  program evolved.
• Public Input
• Beginning in March 2003, DMAS met with over 40
  stakeholder groups to solicit input on program
  design.
• DMAS established a web site for notices and
  information.
• DMAS has an e-mail address for comments.
• PT Committee Meetings are public meetings
  allowing attendance by the general public.
• Request for Proposal (RFP) resulted in a contract
  with First Health Services Corporations(FHSC) to
  implement and administer the program.

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RFP Requires FHSC to Implement PDL Educational
Outreach Program

• Development and implementation of broad-based
  educational effort for prescribers, pharmacy
  providers and affected enrollees
• Develop and, following State approval, provide
  program materials to providers, enrollees, local
  DSS, advocacy groups and other interested parties
  regarding PDL and PA program
• Design and implement targeted educational
  efforts, with State approval, to improve
  compliance and maximize effectiveness
• Monitor and report on outcomes of educational
  efforts
• Develop and make available web-based information
  for providers and enrollees to aid in program
  understanding and compliance

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Communication Plan

• Developed as a partnership between DMAS and FHSC
  with input from various stakeholders
• Weekly meetings/conference calls for key DMAS and
  FHSC colleagues
• Timelines established
• Educational materials, both written and for
  presentation, developed, reviewed, and modified
  for DMAS Executive Management submission and
  approval
• Presentation strategy designed and approved
• Key groups identified for contact and
  presentation scheduling

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PDL Implementation Advisory Group Plays Key Role
in Education and PA Process

• Established by DMAS to include representatives
  from pharmaceutical manufacturers, providers and
  advocates
• First meeting of this group was September 2003 to
  summarize pharmacy programs and PDL concept with
  proposed PA process and educational plan
• This Committee reviewed drafted written and
  presentation materials and the PA process as well
  as provided suggestions for the educational
  methods

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Educational Impact of PDL Implementation Advisory
Group

• Communication strategy revised to include sending
  information for newsletters to PDL IAG members
• Reminder postcard for providers
• Regional trainings established for pharmacy
  providers
• Clarification of the Appeals Process
• Process for review of new drugs approved by the
  FDA
• 72-hour supply of medication
• Tri-fold for enrollees when medications changed
  as result of PDL
• Members arranged training sessions for their
  colleagues and several participated in those
  sessions

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PDL Program Enhanced Default Prescriber ID
Eliminated

• Accurate evaluation of the PDL program is
  facilitated
• Prescription claims must be submitted with valid
  Prescriber Medicaid ID number
• Default numbers are available for use when
  Prescriber Medicaid ID number is unknown
• 23 (2 million) claims were being submitted with
  a specific default number
• Effective December 15, 2003, use of this number
  was discontinued
• DMAS proactively worked with high utilizers of
  the number
• Disruption to pharmacy providers operations has
  been minimal

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FHSC Call Center Contributes to Smooth Program
Implementation

• Separate telephone lines established for
  providers and enrollees were operational on
  November 17, 2003 for PDL program questions
• FHSC Call Centers were operational for pro-active
  PA requests on December 1, 2003
• PA requests can be initiated by letter, by fax or
  by telephone
• Call volume has been steady since early February
  after sharp increases through the month of
  January
• Length of calls has consistently been under 3.5
  minutes with the most recent data less than an
  average of 3 minutes
• Average speed to answer consistently less than 30
  seconds
• No abandonment activity in first three weeks of
  the program

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PDL Prior Authorization Statistics

• During the first two months of the PDL Program
• No physician has been denied a prior
  authorization
• Call center staff are handling calls efficiently
• No Medicaid enrollee has been denied access to
  their prescribed medications

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MailingsKey Component of Educational Outreach

• News Release in October 2003 for publication in
  December 2003
• Letters to State Agencies within Health and Human
  Resources Secretariat
• Department of Social Services notified via DSS
  Alert
• FHSC mailed enrollee materials on December 2,
  2003 formatted in both English and Spanish
• DMAS mailed provider materials on December 8,
  2003 to include Medicaid Memo, PA Request Form,
  Provider FAQ Sheet, Hard-edit Phase-In Schedule
  and PDL Quick List
• Reminder post card mailed the week of December
  21, 2003

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Web Sites

• DMAS web site updated with PDL implementation
  information on December 1, 2003
• Medicaid Memo
• PDL Quick List
• Hard-edit Phase-In Schedule
• PA Request Form
• PDL PA Criteria
• PDL PowerPoint Presentation
• PT Committee Information
• General Assembly Presentations
• FHSC web site maintained for DMAS with PDL
  information

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Training Presentations

• FHSC Education Manager trained DMAS staff from
  multiple departmental divisions and several FHSC
  clinical pharmacists to serve on training teams
• FHSC Education Manager trained DMAS help line
  colleagues on program details
• Presentations, given by a training team of at
  least one DMAS and one FHSC member, were
  scheduled around the State beginning in early
  December
• Program goals were presented
• Operational procedures were presented

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Educational Outreach Presentations Target Key
Groups

• Regional Training Sessions for Pharmacy Providers
• Richmond
• Tidewater
• Roanoke
• Northern Virginia
• Long-term Care Providers targeted by association
  presentations
• Presentations to Community Service Board
  representatives
• Presentations to major health systems reach
  prescribers, pharmacy providers, case managers
  and physician office administrators

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Telephone Contacts

• Top 150 prescribers utilizing non-preferred drugs
  for at least 25 of their Medicaid patients in
  last quarter 2003
• Particular focus to prescribers of Proton Pump
  Inhibitors (PPIs) and COX-2 Inhibitors
• Direct contact with prescribers or their agents
• Subsequent faxed provider profiles allow
  information on specific Medicaid enrollee
  utilizers for prescriber office use
• This effort intervened on 36,794 claims for
  non-preferred drugs utilized by 11,582 enrollees

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Conclusion

• PDL was implemented using soft-edits, messages at
  Point-of-Sale, on January 5, 2004.
• Hard-edits, denials of non-preferred drugs, were
  phased in weekly beginning on January 19, 2004
  through February 23, 2004.
• Educational effort was far reaching and
  successful.
• Smooth hard-edit implementation was achieved over
  a shorter than usual timeframe.
• FHSC has coordinated the Educational Outreach
  effort to include the input and hard work of many
  people from both DMAS and FHSC as well as key
  people from stakeholders including the members of
  this PDL Implementation Advisory Group.

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Lessons Learned

• Adherence to the past practice of mailing
  Medicaid Memos and related materials to chain
  drug store headquarters rather than to each
  individual pharmacy may be less efficient than
  desired.
• Recipient calls to the FHSC Provider Call Center
  resulted in direct telephone contact by FHSC, at
  DMAS request, to the 15 pharmacies related to
  these recipients.
• Action Plan In the future, DMAS to incur
  expense of additional mailing costs to ensure
  that all pharmacy providers are efficiently
  informed of pharmacy program implementations and
  modifications.