Montana Department of Corrections Clinical Services Division - - PowerPoint PPT Presentation

Montana Department of Corrections

Clinical Services Division

Prescription Medication Costs

Connie Winner, Administrator

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DOC DOC Secur Secure Facilities cilities

• Clinical Services Division is responsible for oversight

and payment of all medical, dental, vision, and mental health services provided at DOC secure facilities

• Approximately 1900 individuals

Montana State Prison Montana Women’s Prison Riverside Pine Hills

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Con Contract acted ed Secur Secure Facilities cilities

• Clinical Services Division is responsible for
• versight and payment for all medical,

dental, vision, and mental health services provided at contracted secure facilities – regional prisons/jails and treatment facilities.

• Approximately 1400 individuals

Shelby Glendive Great Falls and Treatment Facilities

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Pre‐release centers

(approximately 800)

AND Probation/Parole

(approximately 10,000)

• The clinical services division IS NOT

responsible for oversight and payment for medical, dental, vision, and mental health services provided at Pre‐Release Centers or those individuals on probation or parole

• Many of these individuals are eligible for

medical coverage through Medicaid Expansion

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Minnesota Multi‐ state Contracting Alliance for Pharmacy (MMCAP) and Diamond Pharmacy

• DOC along with other state

agencies contract with MMCAP for the provision of medications

• This is a coalition of states formed

to maximize Rx costs and reduce administrative costs

• Medication costs are negotiated

through MMCAP

• Medications are ordered and

received from Diamond Pharmacy

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DOC PRESCRIPTION EXPENDITURES 2012 ‐ 2017

$2,497,206 $2,278,104 $2,237,029 $3,050,527 $3,245,819 $3,980,794 $384,551 $338,943 $327,402 $343,999 $329,530 $309,257 $0 $500,000 $1,000,000 $1,500,000 $2,000,000 $2,500,000 $3,000,000 $3,500,000 $4,000,000 $4,500,000 2012 2013 2014 2015 2016 2017 Pharmaceuticals Fill Fees

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Therapeutic Class Prescriptions

(1 month usage – July 2017)

ANALGESIC 944 14% ANTI‐INFECTIVE 215 3% ASTHMA 250 4% CARDIAC 1121 17% ANTIHYPERLIPIDEMIC 278 4% DIABETES 169 3% GASTROINTESTINAL 888 13% ENDOCRINE‐METAB 124 2% PSYCHOTROPIC 1419 21% SEIZURE 201 3% NUTRITIONAL 451 7% THYROID 103 2% DERMATOLOGICAL 172 3% OTHER 271 4% ANALGESIC ANTI‐INFECTIVE ASTHMA CARDIAC ANTIHYPERLIPIDEMIC DIABETES GASTROINTESTINAL ENDOCRINE‐METAB PSYCHOTROPIC SEIZURE NUTRITIONAL THYROID DERMATOLOGICAL OTHER

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Therapeutic Class Expenditures

1 month snapshot – July 2017

BIO‐IMMUNO $11,411.40 7% ANALGESIC $6,559.05 4% ANTI‐INFECTIVE $2,911.00 2% ASTHMA $25,492.10 16% CARDIAC $9,004.84 6% ANTIHYPERLIPIDEMIC $2,781.73 2% DIABETES $17,099.38 11% GASTROINTESTINAL $10,513.98 6% ANTINEOPLASTIC $3,209.05 2% HEPATITIS C $4,163.52 3% HIV $26,089.89 16% PSYCHOTROPIC $25,635.82 16% SEIZURE $2,681.16 2% NUTRITIONAL $3,974.09 2% DERMATOLOGICAL $3,790.26 2% OTHER $7,415.14 5% BIO‐IMMUNO ANALGESIC ANTI‐INFECTIVE ASTHMA CARDIAC ANTIHYPERLIPIDEMIC DIABETES GASTROINTESTINAL ANTINEOPLASTIC HEPATITIS C HIV PSYCHOTROPIC SEIZURE NUTRITIONAL DERMATOLOGICAL OTHER

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Top 10 Medications Cost Per Prescription and Total Paid

Medication Medical Condition Cost Per Rx Total Paid HUMIRA (2 INJECTIONS PER KIT) Rheumatoid Arthritis $4,399.64 $492,760.21 LANTUS Diabetes $1,127.43 $296,513.43 ENBREL Rheumatoid Arthritis $3,152.34 $223,816.29 EPCLUSA HepC $24,374.91 $219,374.19 COPAXONE MS $5,279.52 $174,224.04 HARVONI HepC $16,330.86 $163,308.60 DULERA Pulmonary $230.87 $126,746.93 TRUVADA HIV $1,477.92 $116,755.65 INVEGA SUST Psych $1,858.09 $100,336.67 LATUDA Psych $1,081.35 $81,101.13

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TOP 10 EXPENSIVE PATIENTS

WITH HEP C

• Makes up 32% of Prescription

Costs

WITHOUT HEP C

• Makes up 17% of Prescription

Costs

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3664.2119 855.9006 169.8597 109.3453 77.5048 69.9304 69.792 67.6177 66.9807 60.5974

5 Year Drug Inflation Rate by Fluctuation Percentage ‐ Top 10 Medications

Doxycycline Hyc 100mg Cap carBAMazepine 200mg Tab Levemir 100 Units/ml Vial Levemir 100 Units/ml Vial Enbrel 50mg/ml Syringe Lantus (insulin Glargin) Lantus (insulin Glargin) Humira Pen 40mg/0.8 Kit Enbrel Sureclick 50mg/ml Xifaxan 550mg Tablet

Percent Increase in Top 20 Medications (All Brand Name) Medication % AAC Fluctuation Doxycycline Hyc 100mg Cap 3664.2119 carBAMazepine 200mg Tab 855.9006 Levemir 100 Units/ml Vial 169.8597 Levemir 100 Units/ml Vial 109.3453 Enbrel 50mg/ml Syringe 77.5048 Lantus (insulin Glargin) 69.9304 Lantus (insulin Glargin) 69.792 Humira Pen 40mg/0.8 Kit 67.6177 Enbrel Sureclick 50mg/ml 66.9807 Xifaxan 550mg Tablet 60.5974 Humira 40mg/0.8ml Syringe 60.4574 Latuda 80mg Tablet 51.3266 Invega Sust 234/1.5 Inj 39.9667 Atrovent HFA Inhaler 28.3906 Dulera 200‐5mcg Aer 22.8071 Risperdal Cons 50mg Kit 21.4832 Dulera 100‐5mcg Aer 21.3464 Complera Tablet 19.4887 Truvada 200‐300mg Tablet 18.3001 Atripla 600‐200‐300mg Tab 13.852

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‐97.1855 ‐83.5011 ‐81.8391 ‐68.6274 ‐63.5225 ‐51.4156 ‐48.372 ‐44.893 ‐41.9852 ‐40.9862

5 Year Drug Inflation Rate by Fluctuation Percentage ‐ Bottom 10 Medications

Escitalopram 10mg Tablet Acyclovir 200mg Capsule Meloxicam 7.5mg Tab Enoxaparin 80mg/0.8ml Inj Tolterodine 1mg Tablet Vancomycin 125mg Capsule Tramadol 200mg ER Tab Enoxaparin 100mg/ml Inj Desmopressin 0.01% Spray Alvesco 80mcg Inhaler

Percent Decrease in Bottom 20 Medications (All Generic) Medication % AAC Fluctuation Escitalopram 10mg Tablet ‐97.1855 Acyclovir 200mg Capsule ‐83.5011 Meloxicam 7.5mg Tab ‐81.8391 Enoxaparin 80mg/0.8ml Inj ‐68.6274 Tolterodine 1mg Tablet ‐63.5225 Vancomycin 125mg Capsule ‐51.4156 Tramadol 200mg ER Tab ‐48.372 Enoxaparin 100mg/ml Inj ‐44.893 Desmopressin 0.01% Spray ‐41.9852 Alvesco 80mcg Inhaler ‐40.9862 Alvesco 160mcg Inhaler ‐37.6276 Modafinil 100mg Tablet ‐32.2278 Abacavir 300mg Tablet ‐31.5482 Sprintec 0.25/0.035mg Tab ‐28.9315 Modafinil 200mg Tablet ‐27.8566 Haloperidol Dec 100mg/ml ‐26.6961 Ziprasidone 80mg Capsule ‐25.3087 Omeprazole 20mg Capsule ‐13.4372 Flunisolide 0.025% Nasal ‐12.4786 Ventolin HFA Inhaler ‐5.7137

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OVERALL INFLATION OF TOP 20 MEDICATIONS

• 33.5 % OVERALL INFLATION

RATE FOR 5 Year PERIOD

• BOTTOM 20 MEDICATIONS

BROUGHT DOWN OVERALL INFLATION RATE

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What are we doing to combat costs

• Created a pain management

committee to review all offenders on pain medications to ensure the current CDC guidelines are being followed

• Working with Mountain Pacific

Quality Health on pre‐authorization process for treatment of Hep C to ensure offenders are screened and meet criteria for treatment

• Working with hospitals/clinics to

provide out‐reach services for specialty needs (cardiology,

• rthopedics, nephrology)

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Ideas:

• Explore joining Louisiana’s Health

Secretary to encourage federal government involved in reducing the price of Hep C treatment

• Explore state‐owned pharmacy
• Collaborate with University of

Montana’s School of Pharmacy to create a state pharmacy?

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Ques Questions?

• ns?

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