Broward Regional Health Planning Council, Inc. 200 Oakwood Lane, Suite 100 Hollywood, Florida 33020 T: (954) 561-9681 F: (954) 561-9685 Committed to delivering health and human services innovations at the national, state and local level through planning, direct services, evaluation and organizational capacity building. MEDICAL QI NETWORK Wednesday, April 25, 2012 at 2:00 P.M. Ryan White Part A Program Office AGENDA I. Call to Order II. Welcome/Introductions (5 Minutes) III. Review and Approve April 25, 2012 Agenda and February 22, 2012 Meeting Minutes (5 Minutes) IV. Cervical Screening QIP Development a. Cervical Screening Data Integrity Findings V. Operation H.O.P.E.F.U.L Discussion VI. NQC In+Care Retention Rates Summary (Handout A) a. Barriers and Challenges to Retention b. QIP Development VII. LPAC Directives a. Part A Drug Formulary (Handout B) b. Part A Formulary Changes 2011-2012 (Handout C) c. Part A Drug Utilization (Handout D) d. Recommended Additions to the Part A Formulary (Handout E) VIII. Old/New Business (5 Minutes) IX. Agenda Items for Next Meeting (5 Minutes) X. Adjournment Next Meeting Date: May 30, 2012 at 2:00 P.M.
Transcript
Broward Regional Health Planning Council, Inc. 200 Oakwood Lane, Suite 100 Hollywood, Florida 33020 T: (954) 561-9681 F: (954) 561-9685
Committed to delivering health and human services innovations at the national, state and local level through planning, direct services, evaluation and organizational capacity building.
MEDICAL QI NETWORK Wednesday, April 25, 2012 at 2:00 P.M.
Ryan White Part A Program Office
AGENDA
I. Call to Order
II. Welcome/Introductions (5 Minutes)
III. Review and Approve April 25, 2012 Agenda and February 22, 2012 Meeting Minutes (5 Minutes)
IV. Cervical Screening QIP Development a. Cervical Screening Data Integrity Findings
V. Operation H.O.P.E.F.U.L Discussion
VI. NQC In+Care Retention Rates Summary (Handout A)
a. Barriers and Challenges to Retention b. QIP Development
VII. LPAC Directives
a. Part A Drug Formulary (Handout B) b. Part A Formulary Changes 2011-2012 (Handout C) c. Part A Drug Utilization (Handout D) d. Recommended Additions to the Part A Formulary (Handout E)
VIII. Old/New Business (5 Minutes)
IX. Agenda Items for Next Meeting (5 Minutes) X. Adjournment
Next Meeting Date: May 30, 2012 at 2:00 P.M.
COMMUNITY PARTNERSHIPS DIVISION Health Care Services Section 115 S Andrews Avenue, Room A300 • Fort Lauderdale, Florida 33301 • 954-357-5390 • FAX 954-357-5897
Broward County Board of County Commissioners Sue Gunzburger • Dale V.C. Holness • Kristin Jacobs • Chip LaMarca • Ilene Lieberman • Stacy Ritter • John E. Rodstrom, Jr. •Barbara Sharief • Lois Wexler
www.broward.org•
) MEDICAL QI NETWORK
February 22, 2012 at 2:00 P.M. Ryan White Part A Program Office
MINUTES
MEMBERS PRESENT Dr. Kenneth Poon, BCFHC Dr. Michael Sension, NBHD Dr. Paula Eckardt, SBHD Dr. Robert Heglar, Care Resource GUESTS Angela Savage Ausline Paris David Waldron Dr. Jeffrey Beal, AETC Sean McIntosh
MEMBERS ABSENT Dr. Esther Schumann, AHF PART A GRANTEE Kim Strong Leonard Jones Shaundelyn Degraffenreidt CLINICAL QUALITY MANAGEMENT (CQM) SUPPORT STAFF Ariela Eshel Gladria Desa
I. Call to Order The Medical QI Network meeting was called to order at 2:23 P.M.
II. Welcome/Introductions
Members and guests were welcomed and introductions were made. III. Review and Approve February 22, 2012 Meeting Agenda and January 25, 2012 Meeting Minutes (5 Minutes)
The Network approved the agenda and minutes via consensus.
IV. Operation H.O.P.E.F.U.L. (Healthy Objectives for People Enjoying Full, Uninterrupted Lives with HIV/AIDS) Dr. Jeffrey Beal from AIDS Education and Training Center (AETC) gave a presentation on Operation H.O.P.E.F.U.L., a tool that assists health care providers begin a candid discussion with their patients/clients about choosing healthy objectives to fully enjoy uninterrupted lives, and to prevent the spread of HIV and other STDs. Sensitive subjects can be approached by asking open-ended questions in a non-judgmental manner. Teaching points and behavior change suggestions were included to guide the provider and patient/client into negotiating a contract for change. At each clinic visit, a card should be selected and discussed with the patient/client to offer continual reinforcement of healthy lifestyle behavior. Providers identified barriers including lack of time and incentives for clients. It was suggested that AETC provide material to play in waiting rooms. Providers were asked to pilot the project and report back on the usefulness of the cards in 120 days from the date of implementation (March 1, 2012). The cards were distributed to all interested providers during the meeting. Cards will also be provided to AHF by Grantee staff. Members discussed an increase in the number of clients with virologic failure resulting from barriers to accessing medications through the AIDS Drugs Assistance Program (ADAP) and Patient Assistance Programs (PAP). Dr. Beal noted that the State is under the impression that all medication needs are being met. Dr. Beal asked that any ADAP or PAP related barriers to accessing medications be reported to him. It was agreed that this information be sent to CQM support staff who will forward it to Dr. Beal’s attention.
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V. Cervical Screenings – Next Steps for QIP Development a. Recommendations for Cervical Screening Data Tracking
The Network reviewed recommendations for Cervical Screening Data Tracking. Data elements needed to develop the cervical screenings QIP were discussed. It was agreed that the next step will be a review of agencies’ cervical screening data in the EMR compared to the cervical screening data entered in Provide Enterprise (PE). Grantee and CQM staff will draft a letter to members to schedule individual face-to-face meetings during which EMR client level data and PE client level data for the calendar year 2011 will be compared. To allow time for the face-to-face meetings, the March medical meeting will be cancelled.
VI. NQC In+Care Campaign Measures
a. Retention Rates Summary b. Challenges and Barriers to Retention
VII. Resource Sharing
None.
VIII. Old/New Business a. Health Literacy Site Visit Summary b. Recommendations for Formulary Additions
IX. Agenda Items for Next Meeting Next Meeting Date: April 25, 2012 at 2:00 P.M. X. Adjournment
Consent Item #1 To “adjourn at 3:40 P.M.” Action: Passed Unanimously
NQC In+Care Retention Rates Third Period
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In+Care Campaign Retention Measures
Gap Measure Percentage of patients, regardless of age, with a diagnosis of HIV/AIDS who did not have a medical visit with a provider with prescribing privileges in the last 6 months of the measurement year. Medical Visit Frequency Percentage of patients, regardless of age, with a diagnosis of HIV/AIDS who had at least one medical visit with a provider with prescribing privileges in each 6-month period of the 24-month measurement period with a minimum of 60 days between medical visits. Patients Newly Enrolled in Medical Care Percentage of patients, regardless of age, with a diagnosis of HIV/AIDS who were newly enrolled with a medical provider with prescribing privileges who had a medical visit in each of the 4-month periods in the measurement year. Viral Load Suppression Percentage of patients, regardless of age, with a diagnosis of HIV/AIDS with a viral load less than 200 copies/mL at last viral load test during the measurement year. Data Submission Dates
*applies to the following measures: Gap Measure, Patients Newly Enrolled in Medical Care, and Viral Load Suppression ** applies to the Medical Visit Frequency measure
RYAN WHITE PART A PHARMACY FORMULARY - Updated 03/21/12TIER TWO
In order to access Tier Two, clients must be screened every six (6) months for the State AIDS Drugs Assistance Program (ADAP) eligibility and must be ineligible and meet the Ryan Part A eligibility
requirements prior to the use of this formulary.
Ryan White Part A Formulary - Updated 3.21.12 3
HANDOUT B
ANTIRETROVIALS Other Side Effects/ConditionsNucleosides/Nucleotide (NRTIs) Depakote (Divalproex)Hivid (Zalcitabine) Geodon (Ziprasidone)
RYAN WHITE PART A PHARMACY FORMULARY - Updated 03/21/12
In order to access Tier Three clients must meet the Ryan Part A eligibility requirements and have a Patient Assistance Program (PAP) application completed for each medication.
TIER THREE
Ryan White Part A Formulary - Updated 3.21.12 4
HANDOUT B
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RYAN WHITE PART A FORMULARY CHANGES 2011-2012
1.10.11
To “Add TMP-SMX ds and Dapsone (for sulfa allergic individuals) to the Part A Formulary Tier 1 to provide for PCP prophylaxis/maintenance therapy for individuals pending ADAP enrollment.” Justification: For time sensitive OI interventions for medications that have no PAP To “remove Seroquel from the Part A Formulary Tier 1.” Justification: Simple PAP application for clients. Only 94 clients utilized last quarter, therefore possible to complete PAPs. Potential cost savings of $11,758.36 per quarter.
2.14.11 To “Remove Fluphenazine (Prolixin), Acetaminophen (Tylenol), Aspirin, Ibuprofen (Motrin), and Fentanyl (Duragesic) from Ryan White Part A Formulary Tier 1.”
Justification: Fluphenazine (Prolixin): No longer standard of care Acetaminophen (Tylenol), Asprin, Ibuprofen (Motrin): Over the counter medications, low cost for generic formulation. The dispensing fee is greater than cost of the medication. Fentanyl (Duragesic): PAP available and accessible
To “Add ‘Oral Only’ to Sumatriptan (Imitrex).” Justification: To clarify the formulary
3.24.11 - HIVPC To “Remove the expiration date of the Ryan White Part A Formulary Tier 3.” Justification: To provide temporary access to medications for clients in an emergency situation To “remove the following from Ryan White Part A Formulary Tier 3”:
Justification: PAP available and accessible To “Add Pneumovax (Pneumococcal) to Part A Tier 1 Formulary” Justification: Required for standard of care to be consistent with PHS Guidelines
4.11.11 To “Remove Vancomycin INJ (Vancocin), Streptomycin INJ, Tuberculin test (PPD, Aplisol), and Voriconazole (V-Fend) from Ryan White Part A Formulary Tier 1.” Justification: Vancomycin INJ (Vancocin): No utilization (PAP available), Streptomycin INJ: No utilization, Tuberculin test (PPD, Aplisol): No utilization; available from other sources, Voriconazole (V-Fend): No utilization (PAP available)
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6.13.11 To “Remove Heparin sod INJ (Heparin) from Ryan White Part A Formulary Tier 1.” Justification: No utilization FY 2010; alternative products exist. Lovenox is an alternative that has a PAP (at 250% FPL or below). Heparin sod INJ (Heparin) is a blood thinner in the Cardiac & Anti-Hypertensive category.
7.11.11 To “Remove Aripiprazole (Abilify) from Ryan White Part A Formulary Tier 1.” Justification: Previously removed from ADAP Formulary, PAP available To “Remove Quinine from Ryan White Part A Formulary Tier 1.” Justification: Under utilization, PAP available To “Remove Cyclopentolate (Cyclogyl) from Ryan White Part A Formulary Tier 1.”
Justification: Non-utilization 10.10.11
To “Remove Alesse 28 from Ryan White Part A Formulary Tier 1.” Justification: Therapeutic duplication; other medications from the same drug class are available. To “Remove Estrogen/Medroxyprogest (Prempro, Premphase) from Ryan White Part A Formulary Tier 1.” Justification: No utilization To “Remove Gentamycin (Garamycin crm) from Ryan White Part A Formulary Tier 1.” Justification: Neosporin covers this To “Remove Hexachlorophene (Phisohex) from Ryan White Part A Formulary Tier 1.” Justification: No utilization To “Remove Insulin Humulin 70/30 from Ryan White Part A Formulary Tier 1.” Justification: Duplicate Insulin Analog (Humalog) Simplify Formulary, Cost Saving Measure To “Remove Ortho Novum 1/35 from Ryan White Part A Formulary Tier 1.” Justification: Therapeutic duplication; other medications from the same drug class are available. To “Remove Ortho Novum 1/50 from Ryan White Part A Formulary Tier 1.” Justification: Therapeutic duplication; other medications from the same drug class are available. To “Remove Ortho Novum 7/7/7 from Ryan White Part A Formulary Tier 1.” Justification: Therapeutic duplication; other medications from the same drug class are available. To “Remove OrthoCept 28 from Ryan White Part A Formulary Tier 1.” Justification: Therapeutic duplication; other medications from the same drug class are available. To “Remove Rosiglitazone (Avandia) from Ryan White Part A Formulary Tier 1.” Justification: Adverse effects, Contraindication To “Remove Tri Phasil 28 from Ryan White Part A Formulary Tier 1.” Justification: Therapeutic duplication; other medications from the same drug class are available. To “Keep Lo Ovral 28 (Monophasic), Ortho-Tricyclen 28 (Triphasic) and Micronor 28 (Progestin only) on Ryan White Part A Formulary Tier 1.” Justification: Reduce the Oral Contraceptives Category on the Formulary
Recommended Additions to the Ryan White Part A Formulary
Add Megace (Dr. Eckardt) Justification: Periactin fails to work sometimes
Megace is currently on Tier 3 of the Ryan White Formulary PAP available - Strativa Pharmaceuticals
Add Statins and Diabetes Medications (Dr. Eckardt)
Diabetes medications on current Ryan White Formulary: Insulin Analog (Humalog) Insulin NPH (Novolin) Insulin Regular (Novolin) Insulin Glaritine(Lantus) Actose (Pioglitazone) Insulin 70/30 (Novolin) – Removed October 2011
o Justification: Duplicate Insulin Analog (Humalog) Simplify Formulary, Cost Saving Measure
Rosiglitazone (Avandia) - Removed October 2011 o Justification: Adverse effects, Contraindication
Statins currently on Tier 3 of the Ryan White Formulary: Crestor (Rosuvastatin); Astrazeneca Pharmaceuticals and Xubex Pharmaceutical Lipitor (Atorvastatin); Pfizer Lopid (Gemfibrozil); RX Outreach and Xubex Pharmaceutical Pravachol (Pravastatin); RX Outreach and Xubex Pharmaceutical Tricor (Fenofibrate); Abbott
Consider the barriers to obtaining Ensure through Abbott PAP (Dr. Heglar)
Abbott recently tightened its income criteria for the Ensure PAP to 100% FPL There is a cap on medical nutritionals – no new applications accepted at this time "due to increased demands for
assistance" but providers are instructed to call to see if there is availability Some Medicaid/Medicare plans do not cover Ensure
Megace Strativa Pharmaceuticals Patient must not have any prescription coverage for through any Private, State or Federal Program - including Medicaid, Medicare & Medicare Part D; Medicare Part D patients must submit documentation of the medication not being covered. Patients with private insurance must attach a pharmacy printout or documentation of the medication not being covered. 200% FPL; Shipped to provider; Megace ES Oral Suspension: 30-day supply
Crestor Astrazeneca Pharmaceuticals AZ & Me Prescription Savings Program For People Without Insurance
Patients must meet qualifying income eligibility criteria; Patients must not receive prescription drug coverage through private insurance or government program or such as Medicare (Part A or B), Medicare Prescription Drug Program (Part D), Medicaid, VA or military benefits, State Assistance Program for medicines. Patient must be a US resident, green card holder or work visa holder; Patients who appear to be eligible for the PAP and also appear to be eligible for federal or state programs, the AstraZeneca PAP will provide one-on-one education and counseling to assist that patient through the application process for those programs; Income limit; Single - $35,000, Couple-$48,000; Shipped to provider or patient; 90 day supply
Astrazeneca Pharmaceuticals AZ & Me Prescription Savings Program For People With Medicare Part D
Patient must meet qualifying income criteria; Patient must be enrolled in Medicare Part D; Patient must have spent 3% of the annual household income on out-of-pocket prescription medicines within calendar year; Income limit; Single - $35,000, Couple-$48,000; Shipped to provider or patient; 90 day supply
age 2
Xubex Pharmaceutical Free Medication Program
This program is not based on need. Anyone can receive a free 30-day supply of medication with prescription; Shipped to patient; 90 day supply
Lipitor PFIZER, INC. Connection to Care
Patients must not have any prescription drug coverage; Patients must meet program income guidelines; Hardship Exceptions: Individuals who have prescription coverage for prescription medicines may still be eligible for assistance through Connection to Care if they are experiencing significant financial or medical hardship; 200% FPL; Shipped to provider; 90 day supply
PFIZER, INC. Lipitor $4 Co-Pay Card
This Card is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare or other federal or state healthcare programs, private insurance plans or other health or pharmacy benefit programs which reimburse you for the entire cost of your prescription drugs; Patient's out-of-pocket expense must be greater than $4 per prescription. If your out-of-pocket expenses for a 1-month supply (30 tablets) are $54 or less, you will pay $4 for a 1-month supply. If your out-of-pocket expenses for a 1-month supply (30 tablets) exceed $54, you qualify for up to $50 in savings for a 1-month supply. In either case, you can only qualify for up to $600 of savings per calendar year. After maximum of $600, you will pay usual monthly out-of-pocket costs; Patient takes the Co-Pay card to a participating pharmacy to receive discount
PFIZER, INC. Pfizer Pfriends
Pfizer Pfriends is a program that helps eligible patients without prescription coverage get savings on Pfizer medicines, regardless of their age, or income, through participating pharmacies. Enrolling in the program is free. You may be eligible if you have no prescription coverage, and reside in the US, Puerto Rico or the US Virgin Islands; The Pfizer Pfriends savings program is not health insurance. For a complete list of participating pharmacies please go to www.PfizerHelpfulAnswers.com or call the toll-free number 866-706-2400. There are no membership fees to participate in the Pfizer Pfriends program. Estimated savings range up to 15-36% and depend on such factors as the particular drug purchased, amount purchased, and the pharmacy where purchased; Pharmacy Card
Lopid RX Outreach An individual of any age can participate in the program, as long as the program's financial guidelines are met; 300% FPL; Shipped to provider or patient; 90 day supply
This program is for generic medications only; Shipped to provider or patient; Amount shipped is based on amount requested on application
Pravachol Rx Outreach An individual of any age can participate in the program, as long as the program's financial guidelines are met; 300% FPL; Shipped to either Provider or Patient-medications sent to wherever the patient requests it; 90 day supply
This program is for generic medications only; Shipped to provider or patient; Amount shipped is based on amount requested on application
Tricor ABBOTT Abbott Patient Assistance Foundation
The Abbott Patient Assistance Program is designed to help financially disadvantaged individuals receive a limited supply of Abbott pharmaceutical products at no cost; To be eligible for this program, patients must not have prescription drug coverage for the requested medication through an employer, other third party payer, Medicaid or any other state or federally-funded program, and must be financially disadvantaged based upon current Federal Poverty Guidelines adjusted for household size; Patients with prescription drug coverage, including enrollment in a Medicare Part D Prescription Drug Plan, who have difficulty accessing their Abbott medications may be eligible for assistance by obtaining a Pharmaceutical Assistance Program exception based on health-related expenditures and household income; Shipped to provider; 90 day supply
