THE IMPLEMENTATION OF THE TRICARE PHARMACY HOME DELIVERY MAIL PROGRAM (HDMP) AT A MILITARY TREATMENT FACILITY

CPT Obinna O. Alu, PharmD, MBA, OIC, WBAMC Supply & Support Pharmacy; Ricardo Cisneros, CPhT, Pharmacy Informatics Technician

INTRODUCTION METHODS RESULTS

CONCLUSIONS

RESULTS

BACKGROUND

In June of 2015, the WBAMC Department of Pharmacy

implemented a new Home Delivery Mail Pharmacy (HDMP)

service to enhance patient choice and convenience, fiscal

responsibility, and workload distribution that allows for the

most efficient use of Medical Treatment Facilities (MTF)

resources across a continuum of patient care. This presentation

will highlight general aspects of the mail order program, as well

as some descriptive analysis, statistics, and objective results that

had an impact on the overall pharmacy operation.

 

RESULTS

t-test Results for Difference Before vs After HDMP Implementation

Retail Rxs

b/ * There is a significant difference in the Mean Monthly AudioCare for Before versus After Implementation of HDMP with Lower Mean After

compared to Before.

Mail Order Rxsc/ * There is a significant difference in the Mean Monthly Rx Mail Order

for Before versus After Implementation of HDMP with Higher Mean After compared to Before.

DISCLAIMER: The views expressed in this poster are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the United States Government.

TRICARE beneficiaries have had access to a mail order

pharmacy benefit for well over 12 years. While available to all,

many beneficiaries were still unaware of this component of

their pharmacy benefit because up until 2014, the education

and marketing for the program within MTFs was almost

nonexistent. In April 2014, the Defense Health Agency (DHA)

awarded a comprehensive contract to a Pharmacy Benefit

Management (PBM) company to provide claims adjudication

services, as well as to expand the home delivery capabilities.

This was done through the creation of an electronic connection

between CHCS and the PBM to facilitate electronic transfers of

MTF prescriptions to the mail order pharmacy.

A multi-faceted marketing campaign throughout the installation

along with embedding HDMP advertising into each window

transaction was used to provide patients with information

about the program. Average window transaction time was

assessed to determine if the additional time required to embed

HDMP advertising is off-set by other metrics. Patient HDMP

enrollment was completed during the provider visit or at the

pharmacy (majority). The primary objectives were assessed

through monthly metrics, which include: workload (defined as

prescription and patient volume), total HDMP prescriptions

transferred, pharmacy wait-times, patient satisfaction scores,

and the impact on retail pharmacy expenditure in the local

catchment area. Monthly workload, patient wait times and

satisfaction were analyzed using a two-sample t-test for two

means and the Binomial test for one proportion before and

after Implementation of the program. Descriptive statistics

were conducted to assess unsuccessful HDMP transfers.

Based on the data, we see a decrease in MTF workload (rxs

& patient volume) and wait times along with an increase in

satisfaction scores and transaction times. Challenges

experienced include patient concerns regarding co-pays, the

number of local medications (80.8% of formulary, 41.2% of

non-formulary) available for TMOP and limited HDMP options

for controlled substances. Opportunities for expansion include

an auto-transfer feature through the patient refill phone line

and TriCare Online website.

a/ No significant difference in the Mean Monthly Retail Rx for Before versus After implementation of HDMP.

WBAMC Pharmacy Patient Satisfaction Scores (APLSS)

* There is a significant difference in the Mean Satisfaction Score Before versus After Implementation of HDMP with Higher Mean Score After (77.3% ± 3.3%)

compared to Before (73.9% ± 1.6%), p-value = 0.0076.

* There is a significant difference in the proportion of CHCS Total RXs, Before versus After Implementation of HDMP with Lower Proportion After (49.5%)

compared to Before (50.5%), p-value < 0.0001.

* There is a significant difference in the Proportions of Patients Before versus After Implementation of HDMP with Lower Proportion After (49.6%) compared

to Before (50.4%), p-value < 0.0001

FEB – JUL 2016Total: 24 Rejections

AudioCare Rx Refill

Monthly RxMean ± SD t-test

p-valueBefore HDMP After HDMP

Retail 14430 ± 811 14132 ± 627 0.3710*a

AudioCare 15924 ± 1106 15009 ± 555 0.0207*b

Mail Order 4807 ± 154 5617.± 491 0.0009 *c

Q-FlowJul14 - May15

Jul15 - May16

Jul14 - May15

Jul15 - May16

Jul14 - May15

Jul15 - May16

All Patients

Avg Service

Time

Avg Service

Time

Avg Waiting

Time

Avg Waiting

Time Patients PatientsMain Outpatient 0:06:47 0:12:49 0:17:49 0:12:53 114,158 113,488Freedom Crossing 0:04:43 0:07:20 0:14:31 0:09:43 129,593 123,605Mendoza 0:04:37 0:07:16 0:13:09 0:10:36 99,650 96,893SFMC 0:05:10 0:05:07 0:09:25 0:07:08 47,460 46,098East Bliss 0:04:11 0:04:55 0:02:44 0:04:46 17,484 17,927Rio Bravo 0:03:57 0:04:09 0:02:24 0:04:23 16,065 21,327McAfee 0:02:48 0:26:20 0:10:24 0:05:32 13,204 11,339

Average 0:04:36 0:09:42 0:10:04 0:07:52 62,516 61,525Main 3 average 0:05:22 0:09:08 0:15:10 0:11:04 114,467 111,329

weighted average 3 0:05:22 0:09:11 0:15:13 0:11:03 343,401 333,986

Main 3

Totalweighted average 0:05:10 0:08:46 0:13:28 0:09:54 437,614 430,677 Total