Pharmacy System Improves Health Safety, Delivers Cost Benefits

When a prescription is filled within the U.S. Military Health System, an online system automatically checks the prescription against the patient’s medication history before the drug is dispensed. This process has avoided more than 171,000 potentially life-threatening drug interactions.

That’s just one benefit of the Pharmacy Data Transaction Service (PDTS), which CSC provided under contract for the U.S. Department of Defense (DoD). With more than 9 million eligible beneficiaries, the DoD healthcare program is one of the largest in the United States. In revamping the MHS electronic pharmacy prescription system, the DoD wanted a solution that would deliver higher quality health services at significantly lower costs. The DoD contracted with CSC to build a centralized data repository and establish a common patient medication profile for all beneficiaries.

PDTS brings together prescription data from all points of service in the MHS, including retail, mail and military treatment facility pharmacies. The DoD says the system has helped improve the quality of the MHS's TRICARE prescription services and enhanced patient safety by reducing the likelihood of adverse drug interactions and duplicate treatments.

In tackling this project, CSC tapped into its own federal program management experience; for pharmacy claims management expertise, CSC brought on board MedE America (which was later acquired by WebMD and is now known as Emdeon).

New Process Pays Off

In addition to increased patient safety, the PDTS is one of a number of measures being adopted by the DoD to reduce costs. Another of the DoD's primary healthcare goals was to establish a uniform and improved formulary, which is a comprehensive database of prescription drugs that are approved for use. This DoD uniform formulary process places prescription drugs into one of three cost-share tiers, based on relative clinical effectiveness and cost. CSC/Emdeon developed the necessary PDTS edits and co-pay structure that has been applied to these uniform formulary products. Additionally, the CSC/Emdeon team developed the Web-based DoD Formulary Search Tool that provides beneficiaries with insight into the exact formulary status of any prescribed medication, including its availability, cost to the beneficiary, and possible alternative medications.

This new focus on cost effectiveness has paid off. In April 2006, the DoD reported that in the first year since the agency began using the uniform formulary process to review and classify prescription drugs, some $500 million had been saved through improved formulary and contract management. The PDTS system is one of a number of measures implemented by the agency that has helped enhance quality and reduce costs. Other contributors included the pursuit of joint contracts between the DoD and the Department of Veteran Affairs and increased use of the agency's TRICARE mail order pharmacy program.

The MHS includes a worldwide network of 70 hospitals, more than 500 health clinics, and thousands of private sector partners. As the MHS continues to expand, the pharmacy service is designed to grow with it. "The whole PDTS system has grown tremendously," says Tom Sullivan, a director in CSC's DoD health affairs practice. "Today, CSC provides program management support and much of the information assurance support as well as daily interaction with our subcontractor, Emdeon, providing the real-time pharmacy transaction support and responding to changing PDTS requirements." In addition, the CSC/Emdeon team supports PDTS requirements in the areas of telecommunications, operations, maintenance, and information technology.

Sullivan says CSC's experience in health services in both the commercial and government sectors came into play during the development of the PDTS system. "The requirements for the PDTS on the government side are significantly more stringent than requirements on the commercial side," he says, citing the fact that DoD requirements go well beyond what is spelled out in HIPAA (Health Insurance Portability and Accountability) regulations. "We have people on our staff here at CSC with vast government experience as well as people with health services experience that are providing expertise in areas such as security and information assurance support."

Quality and innovation

In fine-tuning the PDTS, the DoD wanted a system that lets beneficiaries fill their prescriptions from multiple points of service, including retail pharmacies, mail order, and military treatment facilities. By enabling this, the PDTS has provided enormous benefits. For example, the agency and beneficiaries both save money when the TRICARE mail order pharmacy is used to purchase medications. In addition, the service has provided increased convenience to beneficiaries.

The PDTS also serves as a massive data warehouse that lets the DoD track patient usage and provider prescribing patterns throughout the MHS. This has helped the DoD better monitor possible fraud and abuse and perform functions such as tracking drug recalls. The data warehouse also provides historic information that is used to help develop enhanced pharmacy programs, policies and procedures.

The system has been recognized as one of the most successful government programs of its kind, receiving a number of plaudits. Among these, PDTS was a finalist for the President's Quality Award, the highest federal recognition given by the government for managerial excellence. In addition, PDTS was selected by Harvard University's John F. Kennedy School of Government as a semifinalist for the prestigious Innovations in American Government Award.

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