4/25/2018 NW Prescription Drug Consortium Health Policy & Analytics Health Policy & Analytics Office of Clinical Services Improvement Office of Clinical Services Improvement 2 History Outline I. Background on NW Drug Consortium 2003 2006 2007 2010 2013 OPDP was established – OPDP joined with the Moda selected to Consortium expands OPDP launches GPO II. NW Consortium service offerings: Oregon’s only prescription Washington Prescription administer the scope of services with program to include Traditional and Non- drug purchasing pool Drug Program (WPDP) to Consortium program new RFP to include • Group Pharmacy Benefits Management form the Northwest and expand Medicaid, Medicare, Traditional non-profit Prescription Drug participation GPO and 340B entities. Consortium to pool drug programs. Moda • NW Consortium Group “Value Proposition” purchasing and bring the selected to administer best price to participants program. III. Pharmacy Discount Card 2015 2016 2017 Through passage of OPDP extends current OPDP facilitates more Oregon House Bill 2638, agreement with Moda than $800 million in IV.Market expansion and NW Drug Consortium growth Medicaid received annual drug purchases through 2021. authorization to join OPDP. for over 1 million Any CCO can elect to use people in participating OPDP’s programs and groups and facilities contracts to better manage Health Policy & Analytics their program costs Health Policy & Analytics Office of Clinical Services Improvement Office of Clinical Services Improvement 3 Success Success Program enrollment by state (2016) More than a decade of continued and sustainable growth Health Policy & Analytics Health Policy & Analytics Office of Clinical Services Improvement Office of Clinical Services Improvement 5 6 1
4/25/2018 Major clients NW Consortium Services II. Group Pharmacy Benefits Management Health Policy & Analytics Health Policy & Analytics Office of Clinical Services Improvement Office of Clinical Services Improvement 7 8 Group Pharmacy Benefits Management How it works Participating programs • The pharmacy benefits management program was designed to meet the specific needs of clients (e.g., employer groups and government OPDP entities) and achieve the triple aim Oversee and administer program MODA Health - Contract Administrator Menu of program services Client / Member Billing and Reporting and Clinical services support reconciliation analytics MedImpact Administer Rebate After hours Process claims pharmacy administration support network Health Policy & Analytics Health Policy & Analytics Office of Clinical Services Improvement Office of Clinical Services Improvement 9 10 The Consortium is pulling together best-in-class group pharmacy management Autonomy expertise and experience with state purchasing power • Ability to design and manage own pharmacy program Flexibility • Option to use the pharmacy management resources available through OPDP • Select between broad and value pharmacy networks • Broad range of evidence-based clinical services Choice Program Contract • Innovative pharmacy programs (e.g., 340B, Discount Card, GPO, pharmacy Network and Claims charity care) Management Administrator Management • Purchasing power • Data analytics and • Ability to customize program to meet needs and goals • Prescription claim Customization • Ability to provide customized pharmacy analytics to support quality initiatives insights reporting • Consortium; pooled processing • High touch purchasing • Pharmacy network client/member support • Contract administration • Clinician consulting services on programs and initiatives Collaboration services administration • Coordination with OHA to improve pharmacy best practices with all CCOs • Eligibility verification and oversight • Billing and • Rebate administration reconciliation • Aggressive • After-hours member support • Quality metrics reporting guarantees • Broad range of Reporting • Cost and utilization reporting innovative clinical • Ad hoc and customized reporting options programs Health Policy & Analytics Office of Clinical Services Improvement 11 12 2
4/25/2018 Savings Experience • Aggressive discount guarantees • Fixed administration fees Pricing • Many fee items included free of charge • Alternative competitive contracting programs • Robust “value-based” pharmacy network with over 56,000pharmacies nationwide Access • All major pharmacies included, with one exception (Walgreens) • Critical Access Pharmacies • 100% pass-through agreement (including pharmacy costs and rebates) Transparency • 100% transparency on pharmacy discounts, rebates and administration fees • Downstream partners subject to the same transparency standards • Oregon-based mail order enabling faster delivery and guaranteed packaging integrity Convenience • Local specialty pharmacy with strong ties to prescriber community • Flat administration fee per paid transaction • Member access to specialty clinical pharmacist available 24/7 Predictability • Discount guarantees that improve over time • Detailed data analytics to track costs and savings • Access to clinical pharmacists • Treatment and medication support Guidance • Stringent performance guarantees that are measured and audited yearly • Access to patient care programs, including Drug Utilization Review (DUE) and Accuracy utilization management edits • Quarterly monitoring of Most Favored Nation status • Third-party payment annual audits and optional annual benefit audits • More than 22 performance guarantee measures • Quarterly reimbursement performance reports Assurance • Price competitiveness annual market checks • OPDP oversight to ensure contract amendments in rapidly changing market Health Policy & Analytics Health Policy & Analytics Office of Clinical Services Improvement Office of Clinical Services Improvement 13 14 � Excerpt from 2017 NW Drug Consortium Annual Market Report: Value Proposition 1. “Overall Consortium pricing was competitive; Autonomy Savings Experience 2. Market conditions could yield 0.5% or more savings if exclusive specialty pharmacy guarantees are improved; 3. Consider eliminating the effective rate guarantee over all specialty Customized Group Member drugs and obtaining drug-by-drug pricing; utilization management and + cost savings and member-centric + clinical programs cost containment service 4. Generic specialty drugs can be used to improve the overall effective discount, allowing for a reduction of the discount on the specialty brand drugs, the largest area of drug cost growth; and consider acquisition Flexibility Pricing Access cost plus fee pricing for specialty drugs.” Choice Transparency Convenience Predictability Customization Guidance Reporting Accuracy Assurance Health Policy & Analytics Health Policy & Analytics Office of Clinical Services Improvement Office of Clinical Services Improvement 15 16 Other Services Pharmacy Discount Card: opdp.org III. Pharmacy Discount Card Health Policy & Analytics Health Policy & Analytics Office of Clinical Services Improvement Office of Clinical Services Improvement 17 18 3
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