Sources of DoD Information
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Transcript of Sources of DoD Information
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Sources of DoD InformationSources of DoD Information
Libby Hearin, PharmD
Harsha Mistry, PharmD
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ObjectivesObjectives
• Describe sources of Uniform Formulary and clinical information that local MTF personnel can use for formulary decision making
• Focusing on the following tools:
– TRICARE pharmacy webpages
– PEC website
– RxNET
– Formulary search tool
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Knowing Our AudienceKnowing Our Audience
• Clinical background
• Years within the military system
• Participated in P&T Committee meetings
• Exposure to the Uniform Formulary and related resources
• Your favorite resource
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OverviewOverview
• Describe DoD Uniform Formulary (UF)– What is it?
• Answer DoD UF specific questions– Where do I find the answers?
• Prepare for local MTF formulary decisions– How can I prepare a presentation with pertinent
information?
• Stay current with new drugs and UF information
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DoD Uniform Formulary (UF)DoD Uniform Formulary (UF)
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DoD Uniform Formulary (UF)DoD Uniform Formulary (UF)TerminologyTerminology
• BCF vs. ECF– www.pec.ha.osd.mil
– BCF (basic core formulary)• list of medications required to be on formulary at all full-
service Military Treatment Facilities (MTFs)
– ECF (extended core formulary)• Therapeutic classes that are used to support more
specialized scopes of practice than those on the BCF.
• MTFs may choose whether or not to include an ECF therapeutic class on formulary.
– If an MTF chooses to have an ECF therapeutic class on formulary, it must have ALL ECF medications in that class on formulary.
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BCF and ECF InformationBCF and ECF InformationPEC websitePEC website
www.pec.ha.osd.milwww.pec.ha.osd.mil
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DoD UF and P&T CommitteeDoD UF and P&T CommitteeKey pointsKey points
• The DoD P&T Committee makes recommendations regarding the formulary status of medications on the BCF, ECF, and UF to the Director, TRICARE Management Activity (TMA).
• The Director, TMA, makes final decisions after considering comments from the Beneficiary Advisory Panel (BAP).
• The minutes are available approximately 2-3 months after the meeting.
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DoD P&T Committee Minute DoD P&T Committee Minute Websites Websites
• P&T Committee minutes & future meeting information
– www.pec.ha.osd.mil
– www.tricare.mil/pharmacy
• P&T Committee cumulative minutes
– www.dodrxnet.org
• BAP handouts
– www.tricare.mil/pharmacy/BAP/default.htm
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DoD UF DoD UF ScenariosScenarios
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ObjectivesObjectives
• Part 1: Understand the question
– Rumor or Truth?
• Part 2: Evaluate the question
– Related to UF or local formulary decisions
• Part 3: Answer the question
– PEC drug class written reviews
– Other evidence-based medicine reviews
– Other drug literature websites
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Part 1: Understand the QuestionPart 1: Understand the QuestionScenario 1Scenario 1
• Dr Snow asks the technician at the MTF pharmacy window:
Why can’t my patient get her pregabalin?
• Understand what the question is asking…– Does the medication have formulary restrictions?
– Are there supply or distribution issues ?
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Part 2: Evaluate the QuestionPart 2: Evaluate the QuestionDoes this medication have formulary restrictions?Does this medication have formulary restrictions?
Fast facts:
–TRICARE formulary search tool:
www.tricareformularysearch.org
–TRICARE Pharmacy pages
www.tricare.mil/pharmacy
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Part 2: Evaluate the QuestionPart 2: Evaluate the Questionwww.tricareformularysearch.orgwww.tricareformularysearch.org
pregabalin
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Part 2: Evaluate the QuestionPart 2: Evaluate the QuestionDoes this medication have formulary restrictions?Does this medication have formulary restrictions?
Effectivedate
pregabalin
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Part 3: Answer the QuestionPart 3: Answer the Question Why can’t my patient get pregabalin at the local MTF Why can’t my patient get pregabalin at the local MTF
pharmacy?pharmacy?
Short Answer:
– MTF pharmacies do not carry non-formulary medications, such as pregabalin.
Long Answer:
– MTF pharmacies do not carry non-formulary medications, but if the patient meets the medical necessity criteria, the patient may qualify to receive the medication at the MTF.
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Follow-Up Questions: Follow-Up Questions: What are the formulary alternatives What are the formulary alternatives
Fast Facts–TRICARE formulary search tool:
www.tricareformularysearch.org
• RxNET: Formulary Management document
–www.dodrxnet.org
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Formulary alternativesFormulary alternativeswww.tricareformularysearch.orgwww.tricareformularysearch.org
pregabalin
Formularyalternatives
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Formulary alternativesFormulary alternativeswww.dodrxnet.orgwww.dodrxnet.org
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Formulary alternativesFormulary alternativeswww.dodrxnet.orgwww.dodrxnet.org
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What are the medical necessity criteria What are the medical necessity criteria for pregabalin?for pregabalin?
Medical necessity criteria and forms
• RxNET: Word version
– www.dodrxnet.org
• TRICARE pharmacy pages: PDF version
– www.tricare.mil/pharmacy
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Medical necessity criteria and formsMedical necessity criteria and formswww.dodrxnet.orgwww.dodrxnet.org
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Medical Necessity Criteria and FormsMedical Necessity Criteria and Formswww.tricare.mil/pharmacywww.tricare.mil/pharmacy
Medical NecessityCriteria
Medical NecessityPDF form
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Follow-Up: Follow-Up: TMOP & Retail Network InformationTMOP & Retail Network Information
What if my patient wants to use TMOP or a network retail pharmacy?
• TRICARE formulary search tool:
– Drug availability information
– Copay ($3, $9, or $22)
– Generic equivalents
– Alternatives and their respective copays
– Restrictions: Quantity Limits (QL), Prior Authorizations (PAs)
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TMOP & Retail Network InformationTMOP & Retail Network Informationwww.tricareformularysearch.orgwww.tricareformularysearch.org
RetailMailOrder
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Part 1: Understand the QuestionPart 1: Understand the QuestionScenario 2Scenario 2
Your P&T Chair asks you:
What are we going to do with atorvastatin?
• Understand what the question is asking:
– What is atorvastatin’s UF status?
– Is atorvastatin a BCF agent?
– What formulary options do local MTFs have in regarding atorvastatin?
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Part 2: Evaluate the QuestionPart 2: Evaluate the Question
• What was the final UF decision for the statin drug class?– P&T minutes
• TRICARE Pharmacy pages
• RxNET
– Formulary Management Document• RxNET
• Which products are local MTFs required to carry?– BCF/ECF status
• Formulary Management Document: RxNET
• Complete BCF/ECF listing with changes: PEC website
• Do local MTFs have additional guidance?– Formulary Management Document: RxNET
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Part 3: Answer the QuestionPart 3: Answer the Question What are we going to do with atorvastatin?What are we going to do with atorvastatin?
• Atorvastatin is Formulary Brand (Tier 2) on the UF
• BCF agents
– Simvastatin
– Pravastatin
– Niacin extended release
• Atorvastatin is NOT a BCF agent
• Local MTFs can make local formulary decisions for atorvastatin
• Bottom Line: Our local MTF P&T Committee needs to make this decision
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How to prepare for a local MTF How to prepare for a local MTF P&T meetingP&T meeting
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How to prepare for a local MTF P&T meetingHow to prepare for a local MTF P&T meeting Pieces of the puzzlePieces of the puzzle
• Know your topic
– Drug class or a new drug
• Cite reputable literature sources
– Evidence based medicine (EBM) reviews
• Package the right information
– Know your audience
• Present a recommendation summary
– What is the bottom line?
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How to prepare for a local MTF P&T meetingHow to prepare for a local MTF P&T meeting Know your topicKnow your topic
• Has the DoD P&T committee reviewed the drug class?
– Table of Uniform Formulary decisions: www.pec.ha.osd.mil/MTF/UF_Info.htm
– Future drug class evaluations: www.pec.ha.osd.mil/PT_Committee.htm
– RXnet: Formulary management documents www.dodrxnet.org
• If possible hold off on a decision if the DoD P&T committee will be reviewing the drug class in the near future
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How to prepare for a local MTF P&T meetingHow to prepare for a local MTF P&T meeting Cite reputable literature sources Cite reputable literature sources
• National EBM Resources– Oregon Evidence- based Practice Center Drug Effectiveness
Review Project (DERP)
• www.ohsu.edu/drugeffectiveness/reports/final.cfm
• Written reviews, (caveat: narrow focus)
– Veterans Affair PBM (VA-PBM)
• www.pbm.va.gov/default.aspx
• Written reviews, new drug monographs (caveat: unique patient population & bottom line)
– Cochrane Database (OVID)
– PEC written reviews @ RxNET
• www.dodrxnet.org/
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How to prepare for a local MTF P&T meetingHow to prepare for a local MTF P&T meeting Cite reputable literature sources Cite reputable literature sources
• International EBM resources
– UK: National Institute for Clinical Reviews (NICE)
• www.nice.org.uk
– UK: Trip database
• www.tripdatabase.com/index.html
– UK: Bandolier
• www.jr2.ox.ac.uk/bandolier
– Canada: Canadian Agency for Drugs and Technology in Health
• www.cadth.ca
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How to prepare for a local MTF P&T meetingHow to prepare for a local MTF P&T meeting Know your audience Know your audience
• Health professionals
– Pharmacology: therapeutic class, mechanism of action
– Efficacy measures: report meta-analyses, DB PC trials, head to head trials if available
– Safety: list common adverse events, special populations, potential drug-drug interactions, overall benefit vs risk ratio, and tolerability (drug discontinuation due to ADRs)
– Other issues: administration, availability, distribution & packaging, dosage forms, patents, etc.
– Conclusion
• Efficacy summary
• Safety summary
• Overall conclusion
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How to prepare for a local MTF P&T meetingHow to prepare for a local MTF P&T meeting Know your audience Know your audience
• Health Care Administrators
– Utilization of drugs
• Possible market shifts to other drugs
• Possible shifts to another point of service
• Supply mechanism
– Cost issues
• Current therapies vs. “new drug” (remember cost/day of therapy)
• Formulary restriction such as quantity limits, prior authorization, medical necessity issues
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How to prepare for a local MTF P&T meetingHow to prepare for a local MTF P&T meeting Recommendation summary Recommendation summary
• What is the bottom-line?
– Very difficult to determine at times
– Analyze clinical effectiveness in conjunction with cost effectiveness
– The system (MTF personnel) must be able to handle the decision
– Summarize ways to help the decision
• FAQ sheets
• Algorithms
• Pre-written order sheets
• Formulary management document
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How to Stay CurrentHow to Stay Currentwith Drug Informationwith Drug Information
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How to stay current:How to stay current:FDA websites at www.fda.gov.cderFDA websites at www.fda.gov.cder
Center for Drug Evaluation and Research
– Drugs @ FDA section
• Package insert, approval letter
• Detailed medical, chemistry, statistical reviews often available
– Generic drugs
• www.fda.gov/cder/ogd/approvals/
• www.fda.gov/cder/drug/shortages/default.htm
– Safety warnings
• www.fda.gov/medwatch
• Dear Doctor letters; reverse chronological listing of safety alerts; changes in package inserts related to safety issues
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How to stay current:How to stay current:Auto-updatesAuto-updates
Sign up for auto-updates for:
• DoD UF specific information:
– RxNET
www.dodrxnet.org
– DoD P&T minutes page www.tricare.mil/pharmacy
• Clinical information:
– New drug approvals www.fda.gov/cder/cdernew/listserv.html
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Where to find already prepared drug Where to find already prepared drug monographsmonographs
• VA PBM (Pharmacy Benefits Management)
– www.pbm.va.gov/default.aspx
– VA’s equivalent of the PEC
–Monographs, criteria for use are on-line
• AMCP dossier from individual companies
• Pharmacy Journals (AJHP, Pharmacotherapy)
• Still must critically analyze!
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Newly Approved Drugs –Newly Approved Drugs –Free Monthly Journals (peer-reviewed)Free Monthly Journals (peer-reviewed)
• Formulary Journal - (www.formularyjournal.com)– New drug monographs; class reviews, news alerts, drugs in the
pipeline
• P&T Journal (www.ptcommunity.com/ptjournal/journalview.cfm)– similar info as the Formulary Journal; health policy
• Hospital Pharmacy Journal (www.hospitalpharmacyjournal.com)– Inpatient focused; lots of JCAHO tips
– “Current FDA-related drug info”: Column on new drugs, drugs in the pipeline, drugs with new indications
• Free journals, but need to fill out card saying you are part of a P&T Committee
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Our Bottom Line is the Big PictureOur Bottom Line is the Big Picture
• Resources with pre-packaged information are available to help you with your local formulary decision-making process, daily questions, and personal growth
• Our goal is to keep you well-informed regarding UF decisions and current clinical information
• PEC Website
– www.pec.ha.osd.mil