Prescription Drug Abuse Prevention Pokagon Band

Pokagon Band of
Potawatomi
Pokégnek Bodéwadmik
Pokagon Band Pharmacy Staff
Nate Sagarsee, PharmD – Pharmacy Manager
Tonya Griggs, CPhT
Lorraine Malone CPhT
Pokégnek Bodéwadmik · Pokagon
Band of Potawatomi
2
Objectives
• State the importance of relationship
building with your prescriber and
pharmacist team members
• Describe one way to trend prescriber
habits and how to look for outliers
Pokégnek Bodéwadmik · Pokagon
Band of Potawatomi
Engage Prescribers and Pharmacist in “The Fight”
CONTROL DISTRIBUTION
History
As the 1833 Treaty of Chicago established the conditions for the removal of the
Potawatomi westward, this small band of Potawatomi, under Leopold Pokagon‟s
leadership, negotiated the right to remain in their homeland.
In 1838 Pokagon purchased land for his village in Silver Creek Township near
Dowagiac, Michigan, and moved his people there. As the Indian Removal Act
played out, Potawatomi from northern Indiana and Michigan sought refuge at
Pokagon‟s village.
Pokégnek Bodéwadmik · Pokagon
Band of Potawatomi
The descendants of this group today are the Pokagon Band of Potawatomi.
At the end of 2010 the Band had more than 4,300 enrolled tribal
citizens.
The Pokagon Band
of Potawatomi is
the only federallyrecognized Indian
tribe in Indiana.
Pokégnek Bodéwadmik · Pokagon
Band of Potawatomi
The Pokagon homeland is identified now as the six
counties of LaPorte, St. Joseph, Elkhart, Starke,
Marshall and Kosciusko in northern Indiana and the
four counties of Berrien,
Cass,Van Buren and Allegan in
southwest Michigan.
Pokégnek Bodéwadmik · Pokagon
Band of Potawatomi
Eligibility for
Services
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Administered by our Contract Health Services Department (CHS)
Native American and Alaska Natives are served at the tribe
Non-Pokagon Band citizens are only eligible for services provided by
the clinic (Direct)
Prescriptions from “outside” providers are covered at our pharmacy
for Pokagon Band citizens through a referral system
“The tribe is the payer of last resort” – if we have the capability to bill
your insurance first, we will, and any limitations they have, we must
follow
All patients must apply for Medicaid unless they have private insurance
Pokégnek Bodéwadmik · Pokagon
Band of Potawatomi
Policies
• Approval Hierarchy
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Tribal Council
Health Board
Director of the Department of Health Services
Pharmacy and Therapeutics Committee
• Policies are written to allow us maximal control over controlled
substances
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Formulary
30 day maximum supplies
Refill payment based on day supply
Pain contracts and policies
Pokégnek Bodéwadmik · Pokagon
Band of Potawatomi
Policies
Let your policies and procedures act as a
foundation for your network prescriber
relationship
Pokégnek Bodéwadmik · Pokagon
Band of Potawatomi
Prescribers
• Providers educated on policies and
procedures
– Formulary
– Day supply limitations
– No early refill
• Fill out Tribal Pharmacy Application – agree
to follow the policies
• Appreciate our rules
• Utilize State Prescription Drug Monitoring Programs
Pokégnek Bodéwadmik · Pokagon
Band of Potawatomi
Prescribers
• Provide high quality care
• Participate with us
• Communication
– Provider to provider (e.g. referral
physician)
– Patient to provider
– Pharmacist to provider
Pokégnek Bodéwadmik · Pokagon
Band of Potawatomi
Pharmacy
• Internal/External same standard of care
• State Prescription Drug Monitoring
Programs
• Approval before dispensing, unless
emergency
• Bill insurance
• Communicate any concerns, clinical or
process
Pokégnek Bodéwadmik · Pokagon
Band of Potawatomi
Pharmacy
Have a relationship with whatever
pharmacy you choose to fill your
controlled substances
Pokégnek Bodéwadmik · Pokagon
Band of Potawatomi
Pharmacy
• Pharmacy and Insurance
• Pharmacy bills insurance before ever putting a pill in the bottle
• The insurance agrees to pay the pharmacy electronically before you
pick up your prescription!
• Insurance company data is updated minute to minute
• They NEVER pay for the same medication twice without a good
reason
• DOHS prescriber writes for Norco #30 on 2/20/2013 for fall on the ice
• Pharmacy approves the fill and patient goes to contracted pharmacy to fill
the controlled medication
• Insurance denies with a message “RTS – duplicate therapy filled 2/9/2013 at
outside pharmacy – 22 day supply”
• The pharmacy can now do one of two things
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Refuse to fill the prescription until a reasonable date (good)
Inform the patient their insurance isn‟t covering their prescription and offer to
sell it to them for cash (bad)
• You want the pharmacy to communicate these rejections to you
Pokégnek Bodéwadmik · Pokagon
Band of Potawatomi
Pharmacy
• Insurance limitations
– Not every patient has insurance
– Patients can go to the pharmacy and not
present their insurance card
– Patients can pay out of pocket at any
pharmacy
• PDMP Limitation – not updated minute
to minute like insurance is
Pokégnek Bodéwadmik · Pokagon
Band of Potawatomi
When it comes to treating pain there is no easily defined wrong
MONITOR PRESCRIBER
HABITS
Monitor Prescriber
Habits
• What to look for
– Outliers
– Peer Comparisons
– Using high quantity of fast acting
• Look at both the big and small
– Specialties -> Individual doctors
– Drug schedules -> Individual Drugs
Pokégnek Bodéwadmik · Pokagon
Band of Potawatomi
Monitor Prescriber
Habits
• Data Collected
– Fill date
– Patient name
– Doctor name (and specialty)
– Drug
– Schedule classification (CII, CIII, CIV)
– Quantity
– Day supply
Pokégnek Bodéwadmik · Pokagon
Band of Potawatomi
CII prescribing by specialty
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PSYC and DOHS will have lower average qty due to treating ADHD
ORTHO dispensing lower average days supply
PAIN has a very high average qty compared to others
Lets filter by CII pain medications to compare PAIN to other specialties
Pokégnek Bodéwadmik · Pokagon
Band of Potawatomi
20
Comparison of CII Pain
Prescribing: DOHS to Specialist
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Pain specialist utilize nearly twice the quantity as other specialist
Pain specialist not using fentanyl patch
Pain specialist using three times daily Oxycontin and MSContin
Ortho using very short day supply (<10) with qty of ~50 pills (small sample size)
Pokégnek Bodéwadmik · Pokagon
Band of Potawatomi
21
CII prescribing with no fentanyl
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Quantity dispensed for 30 day supplies now appear more normalized
across the specialties
Many DOHS chronic pain patients have had recommendations from pain
specialist made to our DOHS physicians
Pokégnek Bodéwadmik · Pokagon
Band of Potawatomi
22
CIII prescribing Worthless vs
Valuable?
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Gastroenterology has a huge outlier! Ave Qty of 350 with a low day supply
and a low count of prescriptions – Vicotuss Syrup 500ml bottle
DOHS has a higher count of CIII prescriptions than other specialties –
expected due to more visits – lets compare our internal providers
Pokégnek Bodéwadmik · Pokagon
Band of Potawatomi
23
Internal Comparison of CIII
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„Prescriber 3‟ < „Prescriber 1‟ < „Prescriber 2‟ in QTY, number of prescriptions and day supply
„Prescriber 1‟ was showing a decrease in qty and day supply after September, since has returned
to baseline
„Prescriber 2‟ manages a majority of our chronic pain patients
Pokégnek Bodéwadmik · Pokagon
Band of Potawatomi
24
Develop a model that focuses not only on distribution but prescriber habits
TAKE AWAY
Pokegnek pene ga
edawat zhode
The Pokagon have always lived here
Mine wi gage-edawat
zhode
And will always live here
Pokégnek Bodéwadmik · Pokagon
Band of Potawatomi