1

PHARMOECONOMICS: ARE YOUR DRUG FILE PRICES

ACCURATE?

UTILIZING PHARMACY DATABASES TO IDENTIFY COST OPPORTUNITIES

Andrew Henriksen PBM/CMOP Pharmacoeconomic Data Manager

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Workshop Objectives

Learn tips to optimize local drug file setup

Introduction to methods used to validate data using available reports and tools

Learn how to access the Pharmacoeconomic SharePoint site and other available resources including future CDW reports and tools

3 Drug File Optimization

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How cost data gets entered into VISTA

Prime Vendor Invoices uploaded via the Drug Accountability application Data must be verified before being

accepted Quantity issues (dispense unit vs. order

unit, bottle size) Different dispense unit (gram vs. inhaler) Different NDC ordered

Items not purchased through prime vendor (omeprazole via repackaging provider) must be updated manually

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How costs gets into VISTA (and to PBM)

File 50: DRUG File Synonyms: Can have multiple NDC’s each

with their own price, quantity, dispense unit per order unit entered

Only one price at a time, assigns the most recent invoice price or last price change to all fills going forward (not tied to NDC)

Does not use CMOP prices for fills dispensed by CMOP, price assigned is current price in local drug file

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Example -Tiotropium 30 (Prime Vendor)

Mck Description Strength Form NDCPurchase Unit Manu-

facturer

Price Price SizeItem #

1771930 SPIRIVA HANDIHALER 30 18MCG CAP W/DEV00597-

0075-41$54.14 $1.8047 30

Prime Vendor uses capsule for unit price, the VA NationalDrug File (NDF) uses purchase price for dispense unit priceTIOTROPIUM 18MCG INHL CAP 30ORDER UNIT: BX// PRICE PER ORDER UNIT: 54.14// DISPENSE UNIT: PKG// DISPENSE UNITS PER ORDER UNIT: 30PRICE PER DISPENSE UNIT: 1.8047

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NDF data base-Tiotropium

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TIOTROPIUM 18MCG INHL CAP 30MESSAGE: DISPENSE PER BOX (NOT CAPSULES) to ALERT pharmacy

staffORDER UNIT: PK// PRICE PER ORDER UNIT: 54.14// DISPENSE UNIT: EA// DISPENSE UNITS PER ORDER UNIT: 30// 1PRICE PER DISPENSE UNIT: 1.8047 54.14*******************************************************************************This entry is marked for the following PHARMACY packages: D - Drug

AccountabilitySelect SYNONYM: // 30597007541INTENDED USE: DRUG ACCOUNTABILITY// NDC CODE: 00597-0075-41// ORDER UNIT: PK// PRICE PER ORDER UNIT: // <leave blank> DISPENSE UNITS PER ORDER UNIT: // 1 PRICE PER DISPENSE UNIT: // <leave blank>

Strategies to optimize file 50 setup

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Example - Ziprasidone

Mck Item # Description Strength Form NDC Purchase

PriceUnit Price

Manufacturer Size

1413988 GEODON CAP 20MG 60 20 MG CAPSULE 00049-3960-60 $397.54 $6.63 60

1380088 GEODON CAP 40MG 60 40 MG CAPSULE 00049-3970-60 $397.54 $6.63 60

1391838 GEODON CAP 60MG 60 60 MG CAPSULE 00049-3980-60 $482.45 $8.04 60

1394576 GEODON CAP 80MG 60 80 MG CAPSULE 00049-3990-60 $482.45 $8.04 60

Some products are essentially “flat priced” all strengths cost about the same

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Ziprasidone fills

va_productDay supply Qty

Qty/ day

Dose ordered schedule

Cost (as written)

Cost (if using higher capsule strength)

ZIPRASIDONE HCL 40MG CAP 30 120

4 80 BID $795 $398

ZIPRASIDONE HCL 40MG CAP 30 120

4 80 BID $795 $398

ZIPRASIDONE HCL 20MG CAP 30 180

6 60 QAM & QHS $1193 $482

ZIPRASIDONE HCL 20MG CAP 30 180

6 60 QAM & QHS $1193 $482Total: $3976 $1760

Savings: $2216

ZIPRASIDONE 20MG CAPStrength from National Drug File match => 20 MGStrength currently in the Drug File => 20 MG

Strength => 20 Unit => MGPOSSIBLE DOSAGES: DISPENSE UNITS PER DOSE: 1 DOSE: 20MG PACKAGE: IO DISPENSE UNITS PER DOSE: 2 DOSE: 40MG PACKAGE: IO

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Flat Priced Products

Dexlansoprazole: once daily dosing, low volume

Ziprasidone: BID dosing, big volume Aripiprazole: once daily dosing, big

volume Pregabalin: up to QID dosing, growing

volume Duloxetine: up to BID dosing, growing

volume Desvenlafaxine: once daily dosing, low

volume Others?

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Summary: drug file setup optimization

Use Drug Accountability package to lock in appropriate quantity dispense units per order unit

Utilize the drug message screen to guide pharmacy staff on how to complete orders

Consider provider Quick Orders to aid prescribing

Limit possible doses to 1 dose per strength on flat priced items (utilize tablet splitting where appropriate)

13 Questions?

14Validating Data: Available Reports and Tools

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Reports and Tools

High Cost RX report [PSO HI COST] CMOP Cost Reports

http://vaww.national.cmop.va.gov/CostReports/default.aspx

Prime Vendor Purchase reports

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High Cost RX report [PSO HI COST]

Run High Cost RX report [PSO HI COST] in VISTA Beginning Date: (APR 1, 2011) Ending Date: (APR 31, 2011) Dollar Limit : (0-9999): 30// 0 Capture all

fills DEVICE: HOME// ;255;999999 Send to file,

do not need to print out on paper

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High Cost RX report via Data Warehouse

Use CDWwork --(or, could use RDWwork or local data warehouse)

select distinct LEFT(DateText,7) as month, d.visn, b.sta3n, Facility, b.RxNumber

, b.LocalDrugNameWithDose, c.VAProductIdentifier as CMOPID

, c.DrugNameWithDose, c.DrugNameWithoutDose, A.DaysSupply

, UnitPrice, Qty, (UnitPrice*QtyNumeric)as Total_Cost

, RxStatus

from CDWwork.RxOut.RxOutpatFill a

inner join CDWwork.RxOut.RxOutpat b on a.RxOutpatIEN=b.RxOutpatIEN and a.sta3n=b.Sta3n

inner join CDWwork.Dim.NationalDrug c on a.NationalDrugIEN=c.NationalDrugIEN

inner join CDWwork.Dim.VistaSite d on a.Sta3n = d.Sta3n

inner join CDWwork.Dim.Date e on a.ReleaseDateTime=e.Date

where a.ReleaseDateTime >= dateadd(MONTH, -2, GETDATE()) AND A.Sta3n>0 AND D.Sta3n<999 and ((UnitPrice*QtyNumeric)>1000) and c.DrugNameWithoutDose not in ('imatinib‘, 'nilotinib', 'sorafenib', 'LENALIDOMIDE', 'SUNITINIB', 'ENTECAVIR', 'ERLOTINIB','PEGFILGRASTIM','DARUNAVIR‘) and (VISN =‘#') and a.Sta3n =‘###’

order by month desc, d.visn, b.sta3n, Facility, b.RxNumber, b.LocalDrugNameWithDose, c.DrugNameWithDose, c.DrugNameWithoutDose, Unitprice, Qty, (UnitPrice*QtyNumeric)

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NDF data base

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CMOP Cost Reports

CMOP-761 RX Cost Report (2/23/2011 12:00:00 AM Through 3/24/2011 11:59:59 PM)

New York (630)

CMOPID NDC VAPrintName UnitCost NumberRX QTY TotalCost

… … …. … … … …

XU838 AVK19641

DEPEND BELTED W/BUTTONS XTRA ABSORB $32.0200 16 34 $1,088.6800

XU845 AVK19840

DEPEND UNDERWEAR SUPER PLUS MEN SM/MED $50.0600 19 22 $1,101.3200

XU845 AVK19840

DEPEND UNDERWEAR SUPER PLUS MEN SM/MED $53.2800 11 16 $852.4800

XU846 AVK19758

DEPEND UNDERWEAR SUPER PLUS WMN SM/MED $50.0600 3 5 $250.3000

XU847 AVK19779DEPEND UNDERWEAR SUPER PLUS WMN XLG $53.2800 2 3 $159.8400

XU874 PRKBRB40ATTENDS REGULAR BRIEF X-LARGE $28.7600 6 10 $287.6000

… … … … … … …

Total Number Rx 20,292

Total Drug Cost $540,400.3546

Avg. Drug Cost per Rx $26.6312

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Quantity: 14 or 56? Or 16 or 64?

Mck Description Strength Form Purchase Unit Cust Cust Manufacturer Mfr Package SizeItem # Price Price Cntrct # Cntrct Type Size Name Multiplier

3238912 DEPEND U/W WMN X/AB XLG 16 CS4 $44.43 $2.78 16 KIMBERLY CLARK CORP 1.00

? DEPEND U/W WMN X/AB XLG 14 CS4 ? ? 14 KIMBERLY CLARK CORP 1.00

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Prime Vendor Reports

Purchase reports Penny prices Contract compliance Custom reports

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Purchase Reports

Selected Date Range:04/01/2010 to 04/15/2011

Cust#Customer Name EMost# NDC/UPC Item Description Invc/Cred # Invc/Cr Da Ordr Fill Net UOM

Unit Price

Ext. Price

727477

VA MED CTR-NORTHPORT MED 3238979 03600-0197-58

DEPEND U/W WMN S/AB S/M 18 CS4 7467106567 3/2/2011 1 1 1 CS $44.43 $44.43

727477

VA MED CTR-NORTHPORT MED 3238953 03600-0195-58

DEPEND UWEAR WMN S/M 20 CS4 7463190472 2/1/2011 1 1 1 CS $44.43 $44.43

SMO Pharmacy Management / Programs Access Reports & Analysis Create Report Canned Report Purchasing Detail Report Invoice Level Detail (choose the dates to search, customers account numbers and items to include)

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Purchase Reports

SMO Pharmacy Management / Programs Access Reports & Analysis Create Report Canned Report Purchasing Detail Report Invoice Level Detail (choose the dates to search, customers account numbers and items to include)

Cust# EMost# NDC/UPC Item DescriptionInvc/ Cred #

Invc/ Credit Date C Ordr Fill Ret Net UOM

Unit Price Ext. Price

679786 1383165 00078-0438-15 GLEEVEC TAB 400MG (SCORED) 3074652-44831 2/16/11 Y 1 1 0 1 EA $2,321 $2,321

679786 1383165 00078-0438-15 GLEEVEC TAB 400MG (SCORED) 3074671-64465 3/2/11 Y 2 2 0 2 EA $2,321 $4,642

679786 1383165 00078-0438-15 GLEEVEC TAB 400MG (SCORED) 3074717-58424 4/5/11 N 2 2 0 2 EA $4,570 $9,139

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Cost Change Report (Penny drugs) SMO Ordering / Inventory Reports

Contract Change Report

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Cost Change Report (Penny drugs)

Item Number NDC Sell Description

Generic Dose Form

Proper Contract Price

Dose Strength Description Name Generic Name Supplier Account Name

Size Qty

Unit Code

Contract End Date

1265883 61314-0656-25CIPROFLOX O/S 0.3% FAL 2.5ML@ DROPS $0.01 0.30% CIPROFLOXACIN HCL

FALCON PHARMACEUTICALS @ 1 EACH 9/30/2011

1266089 61314-0656-05CIPROFLOX O/S 0.3% FAL 5ML@ DROPS $0.01 0.30% CIPROFLOXACIN HCL

FALCON PHARMACEUTICALS @ 1 EACH 9/30/2011

1430412 63304-0436-01FELODIP ER TAB 5MG RAN 100@

TAB SR 24H $0.01 5 MG FELODIPINE

RANBAXY PHARMACEUTICALS @ 100 TAB 1/14/2015

1432285 63304-0437-01FELODIP ER TAB 10MG RAN 100@

TAB SR 24H $0.01 10 MG FELODIPINE

RANBAXY PHARMACEUTICALS @ 100 TAB 1/14/2015

1630235 68220-0140-15CORTIFOAM 15GM

FOAM/ APPL $0.01 10%

HYDROCORTISONE ACETATE

MEDA PHARMACEUTICALS INC 1 EACH 1/14/2013

1723915 00085-1718-01POT CHL ER TB 20MEQ SCHE 1000

TAB ER PRT $0.01 20 MEQ

POTASSIUM CHLORIDE

SCHERING CORPORATION 1000 TAB 8/31/2011

1752245 50458-0591-60RISPERID TB 0.5MG PATR 60@ TABLET $0.01 0.5 MG RISPERIDONE

PATRIOT PHARMACEUTICALS @ 60 TAB 7/14/2013

1763101 50458-0594-10RISPERID TB 3MG UD PATR 100@ TABLET $0.01 3 MG RISPERIDONE

PATRIOT PHARMACEUTICALS @ 100 UNIT 7/14/2013

2139327 55566-5040-01

DESMOPR VL 4MCG/ML FER 10ML VIAL $0.01 4MCG/ML

DESMOPRESSIN ACETATE

FERRING PHARMACEUTICALS 1 EACH 1/31/2012

2142701 59630-0802-01TWINJECT 0.3MG AUTO INJECTOR

COMBO . PKG $0.01 0.3MG/0.3 EPINEPHRINE

SHIONOGI PHARMA INC 1 EACH 5/31/2011

2220515 00093-9433-01GLYBURIDE TAB D 2.5MG TEV 100 TABLET $0.01 2.5 MG GLYBURIDE

TEVA PHARMACEUTICALS 100 TAB 4/14/2013

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Contract Compliance

SMO Pharmacy Management / Programs Access Reports & Analysis Create Report Canned Report Savings Identification Contract Compliance/ Lost Savings (choose both Contract and Non-contract, display results as CSV)

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Contract Compliance

Item Item Description Inv. DatePurch Qty Supplier Name Purch Price

Max Lost Savings

Available Qty

CITALOPRAM HYDROBROMIDE Pkg Size: 100 Mfg Size: 100 CELEXA TAB 40MG 100

12/1/2010 1 FOREST PHARM/LABS $201.15

Alt Item Description Alt Supplier Name

BLU PHARMACEUTICALS LLC BLU PHARMACEUTICALS LLC $3.83 $197.32 14AUROBINDO PHARMA USA @

AUROBINDO PHARMA USA @ $3.91 $197.24 14

TORRENT PHARMA INC @ TORRENT PHARMA INC @ $6.18 $194.97 14

APOTEX CORPORATION APOTEX CORPORATION $9.04 $192.11 14CARACO PHARMACEUTICALS @

CARACO PHARMACEUTICALS @ $12.44 $188.71 14

GREENSTONE LIMITED @ GREENSTONE LIMITED @ $12.63 $188.52 14MYLAN PHARMACEUTICALS @

MYLAN PHARMACEUTICALS @ $12.75 $188.40 14

**Report does not tell you if alternate item was in stock that day; gives stock level of item you ordered not the alternatives. Also, may list alternatives that are not on FSS

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McKesson Custom Report:Template Using Reports & Analysis 6.6

• McKesson Connect Pharmacy Management/Programs Select Access Reports & Analysis Create report Custom report• Formatting:

• In the Field Selection, select the following parameters to invoice

level: account name, account #, invoice extended price,

invoice/credit #, invoice credit/date, invoiced price (dose)

invoiced price (pkg.), invoiced quantity, item description,

McKesson item #, NDC and package size• Results Display select all

Level 1 group by: Account numberLevel 2 group by: Item description

• Saving Report:• In save to my reports box name report and save

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Third Party: Update

Prior to March 18th,2011 maximum collection was $51/Rx

After March 18th-third party will pay the actual cost of the Rx plus an administration fee of $11.40

The actual cost billed to third party comes directly from your drug file Important: pricing in the drug file MUST be

accurate or you risk losing $$$$$

31 Questions?

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Link: http://vaww.national.cmop.va.gov/pre/PharmacoEconomic/default.aspx

You can request access from the page or send an email to me at Andrew.Henriksen@va.gov

Pharmacoeconomic SharePoint site and CDW

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Pharmacoeconomic SharePoint Site National Savings Opportunities Reports

Monthly Cost Review Top 25 (100) drugs by Total Cost Unmatched Items Individual drug analysis reports

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National Savings Opportunities

Selection Review of high cost and high volume areas with

significant variability in prescribing patterns Lack of evidence to support prescribing differences New contracts or Blanket Purchase Agreements (BPA)

that create incentives Areas of concern where community standard may not be

evidenced based Measures (ProClarity)

Outpatient pharmacy costs only Denominator is OP Pharmacy users only (Pharmacy

Unique) Numerator is based on VistA dispensing data Drug costs based on local drug file *

FY1999 FY2000 FY2001 FY2002 FY2003 FY2004 FY2005 FY2006 FY2007 FY2008 FY2009 FY2010

avg

599.32 631.65 654.57 663.83 704.44 774.34 794.2700000000

01

784.32 750.53 692.96 697.16 704.6800000000

01

min

455.94 460.73 499.92 507.27 547.14 615.68 638.97 669.83 666.14 627.94 624.25 615.11

max

655.66 701.3599999999

99

722.34 730.64 746.7800000000

01

827.49 864.42 834.56 779.12 715.71 723.2900000000

01

744.7900000000

01

range

199.72 240.63 222.42 223.37 199.64 211.81 225.45 164.73 112.98 87.77 99.04 129.68

SD 54.19376854443

2

55.64876605400

57

54.72026175184

35

52.42411063350

69

45.69085301291

32

46.76402819322

62

47.70725355151

66

39.21619090436

59

33.63193495842

82

27.63517117215

54

30.71066610898

08

35.96739740640

83

$50

$150

$250

$350

$450

$550

$650

$750

$850

$950

National Cost per Pharmacy Unique

Cost Avoidance Results

FY ’09 12 National initiatives $192 million cost avoidance (6.1% of outpatient

expenditures) Drug cost per patient ­ 0.61% compared to FY 08

FY ’10 26 National initiatives $120 million cost avoidance (3.6% of outpatient

expenditures) Drug cost per patient ­ 1.08% compared to FY 09

FY ’11 36 National initiatives Target $128 million cost avoidance (~3-4% of projected

outpatient expenditures) Savings through Q1: $14.8 million

Formulas

Most measures are cost per 30 day fill Cost per 30 day based on total costs for

drugs in market basket and number of 30 day fill equivalents

Market basket to include all relevant drugs in targeted area

Drugs costs used in calculations come from local drug file*

Results calculated quarterly by PBM

Definitions

Target – based on average of top 5 VISNs for majority of initiatives or national average where indicated. If there was an outlier, the top 2-6 networks were used.

Goal – network specific goal based on 75% of the difference between network baseline and the target (top 5 networks average)

Performance Measure

Dollar amount based on the national initiatives

Finance Committee satisfactory goal (green) is 50% of dollar amount based on the national initiatives (no longer reported though…)

National initiatives are not mandatory

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Monthly Cost Review

VISN Cost/Day30RX last 6 mo, 6mo average

VISN Cost/ Pharmacy Unique last 4 Qtrs, FY YTD

Site Cost/Day30RX last two months and change for previous month

Site Cost/ Day30RX last 6mo, 6mo average

Site and Complexity Group templates

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Top 25 (100) Drugs by Total Cost

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Unmatched Items

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Individual Drug Analysis Reports

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CDW, RDW, & VISN data marts

Cartoon depicting Regional Data Warehouse Visual Architecture

Regional Data WarehousingVisual Architecture

VISNData

Warehouse(s)

CorporateData

Warehouse

Facility 2VistA

Facility 1VistA

SourceSystems

Facility 3VistA

RegionalFeeder

DataWarehouse

RegionalData

Warehouse

RegionalVistA

Shadow

Shadow/Journal ReaderProcess

• Business key• Time stamp

NearReal Time

• SQL Server• Business key • Time stamp• OpCode (I/U/D)• Indexes: - VistAEditDate - Business Key

Daily

Daily

• SQL Server• Business key • Time stamp• OpCode (I/U/D)

• SQL Server• Business key • Time stamp• OpCode (I/U/D)

• SQL Server• Business key • Time stamp• OpCode (I/U/D)

• Cache Classes define data of interest• Cache Methods insert or update to ODS• Data includes Fact and Dimension data

• Incremental loads are based upon VistAEditDate timestamp

Daily

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Drug Cost Report

Depending on perspective, one can look at the difference between the average, median, and mode cost prices from the pharmacy site acquisition price

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Drug Cost Report Definitions Unit Price – The price the pharmacy paid for the med

National/Region/VISN/Station/PharmacySite

Average/Median/Mode

Prescriptions – Prescriptions

Quantity – Quantity

Difference – Difference Between Prices

Cost Impact = Difference * Quantity

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Average Vs Median Vs Mode

Average is sensitive to outliers (high and low)

Median – Pick the median price among the stations (not bad)

Mode – Pick the most common price among the stations (not bad)

Reports show all of them depending on the pharmacoeconomists mood and trust of the internal data within the VISN and/or her fellow neighbors

Region II Mode Report

Region II Median Report

51 Questions?

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How do I fix errors in my data?

Prescription Cost Update [PSO RXCOST UPDATE] back to the date of the price change for

each drug entry you are changing a price Date Range Recompile Data [PSO MGMT

RPT RANGE COMPILE] back > 1yr once all the prescription cost

updates have been run Monthly Rx Cost Compilation [PSO

COSTMONTH]

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How do I request a fix of data I already transmitted to PBM?

Send an email request to Mike Wrobel, Alan Celestino and me including the below information Product name Time period to correct Wrong price (from individual prescriptions) Correct price

http://vaww.national.cmop.va.gov/pre/PharmacoEconomic/Document%20Library5/1/PBM%20Data%20Correction%20submission.xlsx

54 Questions?