joint federal pharmacy seminar · learning objectives. defense health agency pharmacy operations:...

Service Consultant’s Brief to Defense Health Agency

Col(r) David W. Bobb, RPh, MA, JD

Chief, Pharmacy Operations Division

Defense Health Agency

JOINT FEDERALPHARMACY SEMINARFEDERAL PHARMACY: SHARING THE VISION IN PHARMACY

Kevin W. Roberts, COL, MS

Director, USA MEDCOM Pharmacy Service Line

Pharmacy Consultant, USA Surgeon General

Target Audience: Pharmacists and Pharmacy Technicians

ACPE#: 0202-0000-19-207-L04-P/T

Activity Type: Knowledge-based

CPE Information

The American Pharmacist Association is accredited by the Accreditation Council for Pharmacy

Education as a provider of continuing pharmacy education.

David W. Bobb and Kevin W. Roberts declare no conflicts of interest, real or apparent, and no

financial interests in any company, product, or service mentioned in this program, including grants,

employment, gifts, stock holdings, and honoraria.

Disclosures

Identify readiness goals of the three Services.

Identify major strategic and operational initiatives of the Services and DHA.

Understand the roles and responsibilities of the Services and DHA within the

Military Health System.

Learning Objectives

Defense Health Agency PharmacyOperations: The Hard Part Begins…





“When you walk to the edge of all the light you have and take that first

step into the darkness of the unknown,

You must believe that one of two things will happen.

There will be something solid for you to stand upon or you will be

taught to fly.”

- Patrick Overton

Thank You for Your Time and Attention!

Self-Assessment Questions

1. DHA business markets will be fully operational by 1 October 2020.

A. True

B. False

2. A prescription drug monitoring program (PDMP):

➢ A. Supports access to the legitimate use of prescribed medications

➢ B. Facilitates identification, deterrence and prevention of drug abuse and

diversion

➢ C. Informs public health initiatives through outlining of use/abuse trends

➢ D. All the above


3. MTF pharmacies may provide Tier 3 medications to beneficiaries that are not

enrolled to the MTF for health care.

A. True

B. False

4. Air Force Pharmacy concerns includes all of the following accept:

A. DHA Tier 3 Policy

B. Technology

C. Pro Pay

D. Force Alignment and Manning


5. What four main areas, impacting Navy Pharmacy readiness, surfaced during

the readiness discussion and data collection

A. Manpower, data collection, critical care and supply operations

B. Manpower, training, critical care and supply operations

C. Training, data collection, resource management and critical care

D. Critical care, data collection, manpower and deployment


6. Which of the following are NOT part of Army Pharmacy’s readiness initiatives

A. Deployment Limiting Medication screening

B. Polypharmacy Review

C. Critical Care Short Course

D. Pharmacy Operations Course

E. PGY2 – Intensive Care Pharmacotherapy (AY21)

F. Reverse Distribution Credit Management

DHA and POD Changes

DHA Leadership Change➢ 3 September 2019 - Change of Responsibility Ceremony

➢ LTG Ronald Place is the new DHA Director

POD Leadership Changes➢ Bill Blanche retired

➢ Henry Gibbs will lead Purchased Care Branch

➢ Matt York will lead Informatics Branch

➢ Hiring new Industry Liaison

➢ New DHA POD leadership (December 2019)

Plan 3 version 6 Transition Roadmap - 638 pages

1.1.1. Describes the transition of MTFs to DHA ADC under the market construct

1.1.2. Describes the management structure through which the DHA assumes ADC

1.1.3. Establishes functions, proposed staffing, and org structure of Markets.

1.1.4. Establishes functions, proposed staffing, and organizational structure of the

Small Market and Stand-Alone MTF Organization (SSO) that will manage and

oversee both the Small Markets and the Stand-Alone MTFs that are not aligned to a

Market.

1.1.5. Establishes the functions, proposed staffing, and organizational structure of the

Defense Health Region (DHR) Europe (DHR-E) and DHR Indo-Pacific (DHR-IP) that

will manage and oversee OCONUS MTFs that are not aligned to Markets or the SSO.

1.1.6. Outlines the staffing of military and civilian personnel in the DHA at HQ,

Markets, and MTFs.

Plan 3 version 6 Transition Roadmap – Objective I

1 May 2019 – 31 Dec 2019

➢DHA ADC of CONUS MTFs – starts 1 Oct 19

➢ADC executed through DS relationship with Service IMOs

➢ tIMO certifies 4 markets from 5+3

➢Build DHA capacity and capability to support 4 initial markets

➢Strategic pause in market standup to allow DHA HQ to mature

➢OCONUS support continues

Plan 3 version 6 Transition Roadmap – Objective II

1 Jan 2020 – 30 Sep 2020

➢DHA assumes responsibility of tIMO markets and certifies 17 additional

markets

➢Build DHA capability and capacity

➢Service IMOs divest CONUS markets

➢SSs remain with Service IMOs

➢Overseas support continues

Plan 3 version 6 Transition Roadmap – Objective III

1 Jan 2020 – 30 Sep 2020

➢DHA certifies SSO and assumes responsibility of SSO

➢ Service IMOs divest CONUS SSs and realign personnel to SSO

➢RHC A/C end direct support

➢Overseas support continues

Plan 3 version 6 Transition Roadmap – Objective IV

1 Jan 2020 – 30 Sep 2021

➢Service IMOs divest OCONUS MTFs and realign personnel to DHRs

➢DHA certifies DHR-E and DHR-IP

➢Service IMOs end direct support

➢DHA HQ and FCs reach full operational capability and capacity

Plan 3 version 6 Transition Roadmap – POD

1 April 2019 – 30 Sep 2021

➢Six Senior pharmacist SMEs to service as Market pharmacists

➢Serve as pharmacy SMEs for market leadership

➢Conduit between MTF pharmacies and DHA POD

➢All will be uniformed pharmacists initially

➢Will be a resource for MTF pharmacies

➢Change in Pharmacy Working Group structure

➢MTF Advisory Board

➢Subject Interest Groups

Non-Formulary Memo DHA POD Memo 19-001

➢ Non-Formulary meds for those who are not enrolled to, or referred

from the MTF

➢ Not a new policy

➢ Restatement of current policy

➢ Does not mesh with the “Recapture” mantra

➢ No policy will cover every contingency

➢ Use professional judgment

➢ Expect more things like this as we move forward

MHS Prescription Drug Monitoring Program (PDMP)

An electronic database that collects prescription data on controlled

substances dispensed within the Military Health System. This includes all

opioid containing substances and drugs with a high abuse potential. The

data is available for access by authorized healthcare providers to assist

in:

➢ Supporting access to the legitimate use of prescribed medications

➢ Identifying and deterring or preventing drug abuse and diversion

➢ Facilitating and encouraging the identification, intervention with, and

treatment of persons addicted to prescription drugs

➢ Informing public health initiatives through outlining of use/abuse

trends

MHS Prescription Drug Monitoring Program (PDMP)

PDMP administered by TRICARE contractor, Express Scripts, Inc., and

subcontracted through Appriss Health

➢ Requires sharing agreements with other states/territories PDMPs

➢ Types of sharing (two-way or one-way/receive only). Some state

statutes/regulations do not permit sharing with DoD

➢ Role based authorization to access PDMP information

➢ Direct access available to MHS provider/pharmacy staff and

assigned delegates

➢ No law enforcement access permitted

➢Bi-directional sharing: 34

➢One-way sharing: 6

➢No sharing: 13

Current Sharing Status

11,688 161,599247,654

327,182 367,382440,841

847,997963,454 1,004,570

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19

Total Searches of the MHS PDMP by Month by Other States

MHS PDMP Searches Since Inception

MHS PDMP Searches Since Inception Through 30 Sep 2019

Service Consultants Update



Pharmacy Consultant, USA Surgeon General


Readiness Focus Areas - NAVY

There were four main areas impacting readiness, which surfaced during the readiness assessment conducted in early 2019. The four focus areas below reflect the voice of

readiness participants and are the areas that impact each of the three mission components.

M A N P O W E R (Man)

• Navy Pharmacy must provide deployment preparation support for the Fleet,

and be ready to deploy for combat, disaster relief, or humanitarian missions

at a moment’s notice.

• Augmented workloads due to personnel cuts, can compromise AD patient

care and AD member medical readiness.

• Cuts may also impede Navy Pharmacy personnel from obtaining

deployment-specific experience and training while balancing MTF duties.

S U P P LY O P E R AT I O N S (Equip)

• Navy Pharmacy is responsible for supplying and maintaining the pharmacy

while deployed, and ensuring AD members get their supplies prior to going

underway.

• Navy Pharmacy personnel do not possess the necessary supply and

logistics experience and skills to adequately support the needs of AD

members during deployment.

C R I T I C A L C A R E (Train)

• During deployment, Navy Pharmacy plays a crucial role in critical care

situations, especially regarding drug dosage and administration, alternative

therapy, and post-trauma monitoring.

• Navy pharmacists and technicians lack the appropriate trauma experience

and training to execute vital responsibilities as part of critical care teams.

T R A I N I N G (Train)

• Classroom and practical training, continued education and certifications, as

well as on-the-job experience must prepare Navy Pharmacy to provide

pharmacy services during deployment.

• Navy pharmacists and technicians are inconsistently trained and ill-

prepared to successfully deliver crucial pharmacy services while deployed.

Deloitte Navy Pharmacy (2019). Navy Pharmacy Readiness Assessment.

Navy Pharmacy Sub-Committees and Priority Projects

S U B - C O M M I T T E E G O A L

Manpower Optimization

Lead: CDR Alan Chronister

Develop and maintain an effective deployment structure, ensure safe and quality patient care at MTFs,

and support civilian transition into traditional Active Duty roles

Fleet Integration

Leads: LCDR Jason Galka, LCDR Kyleigh Hupfl, LT James Spence

Increase Fleet readiness and lethality by integrating direct pharmacy support in supply & logistics,

training, strategic planning, and clinical functions

Deployment Readiness

Lead: LCDR Garret HandEnsure a deployment ready community for all platforms to which pharmacy staff are assigned

Training

Lead: HM3 Michael RodriguezEnsure pharmacy staff are consistently trained to positively contribute to the team

During the Onsite in May 2019, participants brainstormed challenges crucial to Navy Pharmacy. These priorities were used as a foundation for each of the four (4)

subcommittees and two (2) priority projects.

P R I O R I T Y P R O J E C T G O A L

Knowledge, Skills, & Abilities (KSA) Team

Leads: LCDR Kellye Donovan, LT Kevin KeeleyEdit, approve, communicate, and sustain KSAs in line with BUMED and DHA

Market Tiger Team

Leads: CAPT Traci Hindman, CDR Angie Klinski

Execute gap analysis of emergent issues identified within DHA’s new market structure and communicate

with Pharmacy community

Force Alignment and Manning:

Remain aligned as previously

What will AF pharmacy look like in 5-10 years

Manning:

Overall manning most likely to continue at or near current level

Potential future boost for clinical pharmacy (PCMH)

Continued adjustments across system as workload changes at individual MTFs

How earned manpower is calculated

TBD how much reduction there will be in AD end-strength, if any

TBD how much AD reductions will be off-set by increases in civilian and contractor authorizations (back-fills)

AFMS Reorganization:

Expect little to no impact on AF pharmacies

Impact on command opportunities/what promotion boards look for: TBD

Q: Change in Beneficiary Eligibility? A: TBD

AF Pharmacy: One Big Rock – DHA Transition

TRICARE Tier-3 Policy

Not a new policy, more a reminder / increased emphasis

Should not affect refills, just new prescriptions

Technology:

Biggest impact of transition on technology is the new centralized acquisition process

Standardization

Economies of scale, even with big-ticket items (should speed technology improvements

at MTFs)

Future of Remote Verification?

Future DHAPIs

Pharmacy Ops (standardization across MHS)

Controlled Substances?

AF Pharmacy: One Big Rock – DHA Transition

ARMY PHARMCY - DEPLOYED SKILL SETS

Army ICTL (Individual Critical Task Lists)

Pharmacy - Joint Readiness Reporting Metric (R2M)

Medication Therapy Management (critical care, emergency med, acute/ambulatory

care)

Sterile Product Preparation

Controlled Substance Acquisition and Accountability

Inventory/Supply/Operational Management

ARMY PHARMACY - READINESS INITIATIVES

Polypharmacy (Cohort 1/Strategic Measure)

Deployment Limiting Medications

Proof of Concept

212th CSH, 44th MED BDE, WOMACK

Pharmacy Operations Course (modified)

Expeditionary

Joint

Critical Care Short Course

Awaiting Approval

12-days/BAMC

PGY2 Intensive Care Pharmacotherapy (AY 21)

Develop ASHP Accredited ICU Residency for MHS

MAP (12 Positions)—Engage “Medically Ready” Pharmacy Initiatives/maintain “Ready Medical” status

Deployment Limiting Medications

Polypharmacy


1. DHA business markets will be fully operational by 1 October 2020.

A. True

B. False

2. A prescription drug monitoring program (PDMP):

➢ A. Supports access to the legitimate use of prescribed medications

➢ B. Facilitates identification, deterrence and prevention of drug abuse and

diversion

➢ C. Informs public health initiatives through outlining of use/abuse trends

➢ D. All the above


3. MTF pharmacies may provide Tier 3 medications to beneficiaries that are not

enrolled to the MTF for health care.

A. True

B. False

4. Air Force Pharmacy concerns includes all of the following accept:

A. DHA Tier 3 Policy

B. Technology

C. Pro Pay

D. Force Alignment and Manning


5. What four main areas impacting Navy Pharmacy readiness surfaced during the readiness discussion and

data collection

A. Manpower, data collection, critical care and supply operations

B. Manpower, training, critical care and supply operations

C. Training, data collection, resource management and critical care

D. Critical care, data collection, manpower and deployment

6. Which of the following are NOT part of Army Pharmacy’s readiness initiatives

A. Deployment Limiting Medication screening

B. Polypharmacy Review

C. Critical Care Short Course

D. Pharmacy Operations Course

E. PGY2 – Intensive Care Pharmacotherapy (AY21)

F. Reverse Distribution Credit Management





Pharmacy Consultant to The Surgeon General


([email protected]/703-681-5959)

JOINT FEDERAL

PHARMACY SEMINARFEDERAL PHARMACY: SHARING THE VISION IN PHARMACY

mailto:[email protected]/703-681-5959

joint federal pharmacy seminar · learning objectives. defense health agency pharmacy operations:...

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