September / October 2017
  Volume: 6   Issue: 5   
Visit our NEW website at www.nepho.org
for more information, including: calendars, health plan information, fee schedules and more
In This Issue
Pharmacy Performance / Cost Savings Ideas Update
P harmacy expenses through YTD June 2017 are trending about 5.2% vs. 2016 as compared to the CHIA (Center for Health Information Analysis) Massachusetts target goal of < 3.1%. Since about 20% of TME ( Total Medical Expenses, the actual amount of spend on hospital admissions, MD appointments, lab, radiology, pharmacy etc .) are medications, NEPHO continues to focus on opportunities to minimize these rising costs.      
 
Reduction of TME is a major focus for 2017/2018 for all NEPHO risk contracts. It should be noted currently about 44% of all pharmacy expenses are generated by OOPHO (out-of-PHO) prescribers, hence the importance of keeping patients within the NEPHO network.
 
We welcome any ideas or suggestions you have to reduce pharmacy TME!

Cost Savings Idea Program Follow-up
 
In 2016 and 2017 the NEPHO Board along with the Risk Sharing Committee implemented an incentive  program for specialty providers to reduce TME called "Cost Savings Ideas" program. Specialty providers were asked to submit "Cost Savings Ideas" focusing on the following areas:
  •  pharmacy costs
  •  laboratory testing
  •  imaging studies
Over 200 ideas were submitted by NEPHO specialists and the following pharmacy related ideas were accepted by the Risk Sharing Committee for 2017:
  • Increase utilization of generic topical corticosteroids, acne topicals and antipsoriatic medications (Dermatology)
  • Increase utilization of cost-effective ophthalmic drops and cost-effective retinal injectables for macular degeneration (Ophthalmology)
Through June 2017 there were savings   in areas such as topical corticosteroids, acne topicals and antipsoriatic agents written by NEPHO Dermatology specialists. Both topical corticosteroids and antispsoriatic agents increased in costs for those written by non-specialists and OOPHO providers.
Ophthalmic drops increased in costs for this time period vs. 2016 for all prescribers, but there was a noted decrease in costs for VEGF Inhibitor injectables. Final evaluation of the Cost Savings Ideas program will be evaluated and shared at the end of 2017.
 

    Drug Comparisons of Preferred / Non Preferred Agents
Check out some of the tools comparing preferred vs. non-preferred agents generated during discussions with both dermatology and ophthalmology specialty providers:

We welcome any ideas or suggestions you have to reduce pharmacy TME!  Send your thoughts and suggestions to:   
 
Pharmacy Cost Savings Idea - Viagra
Here is an example of a pharmacy cost savings idea that will have immediate impact on reduction of pharmacy expenses:
 
PDE-5 Inhibitor Class:  NEPHO  projected 2017 expenses ~ $388,000
Potential Annual Savings ~ $200,000 if 50% of some scripts paid as CASH 
  • No generics available for ED (Erectile dysfunction) meds: Viagra, Cialis , Levitra etc.  
  • Sildenafil 20 mg tablets (generic for Revatio 20mg for pulmonary hypertension(PH)) is available; Sildenafil is generic for Viagra but not available as 50 or 100 mg
  • Patient must pay CASH for savings to NEPHO; write paper script for sildenafil 20 mg #30 or #60 ~$1 per tablet; do not use Rx insurance (will require PA for PH and cost will be high)
  • Viagra by insurance = 4 tablets per month at cost of $20 - $50 (4 - 8 doses per month)
  • Sildenafil 20 mg #30 (2.5 - 5 tabs per dose = 6 - 12 doses for ~$30)
  • ONLY certain pharmacies will have at ~$ 1 cost per tablet (e.g. COSTCO)
  • Good Rx.com or Blink Health.com  coupons can be used with paper Rx at the website suggested pharmacy
For more information:
Call Carol Freedman at 978 236 1774,  carol.freedman@lahey.org     
OR Erin Vega at 978 236 1728,   
T2DM and JNC 8 Hypertension Algorithms
Statin Medication Adherence - Smart Phone apps
Medication adherence is generally defined as filling or taking medications 80% or more of the time during a treatment period. BCBS AQC contract quality measures for 2017 include a Statin Therapy for Patients with Diabetes measure.  This measure requires 78% of our patients patients 40 - 75 years of age to meet the target fill rate of 80% or more.

In an effort to assist with this measure, a letter is being sent to patients with diabetes and on statin medications on behalf of NEPHO providers.  General recommendations on the benefits of taking statins as directed and directions to upload medication reminder apps as below will be included in the letter.
Medisafe Medication Reminder                                                              
www.medisafe.com 
                                                  
This medicine reminder is a simple smartphone app that can help manage multiple medications and will send an email or text / audible reminder when the next dose is due. It also tracks your prescriptions and reminds you when it's time for a refill.

MyMedSchedule
    
This app includes  "My Health Tracker" and lets you record all your lab results and vital signs.  In addition,  you can r
eceive reminders to take your medications by text or email, print schedules that are easy to create, read and update.  
 
   
MMIT Formulary Smart Phone app
 
Your single source of reliable and current drug coverage and restriction information. MMIT Formulary Application "Need to know if that drug is covered? Are you a prescribing doc and want to select a preferred drug for your patient?" MMIT's formulary drug status information is updated nightly, ensuring you have the data points needed to guide prescribing decisions for your patients. Quickly understand how every health plan and PBM covers all FDA approved medications in your geography.

 
NEPHO Clinical Newsletter
Produced by Northeast Physician Hospital Organization
For more information contact: 
 
Carol Freedman, RPh, MAS, BCGP 
Clinical Pharmacist NEPHO 
978-236-1774
Louis Di Lillo M.D., Northeast PHO Medical Director 


Copyright © 2016. All Rights Reserved.