Pharmacy P4P Program

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For any questions regarding Pharmacy P4P payments or reports please contact: PharmacyP4P@iehp.org

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Program Overview

The IEHP Pharmacy Pay-For-Performance (P4P) Program is set up to improve pharmacy services through the IEHP community pharmacy providers. This is considered one of the first large-scale Pharmacy P4P programs in United States. Our goal is to help validate the roles of community pharmacies in promoting healthcare quality and define a pharmacy payment model for outcome-based MTM services.

The Pharmacy P4P program is steered by a workgroup, comprised of community pharmacists, chains representatives, the Senior Director of IEHP Pharmaceutical Services, and the IEHP Chief Medical Officer.

For more information about previous IEHP Pharmacy P4P Program details, please click here for 2018 or click here for 2013-2017.

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Program Eligibility Criteria

In order to participate, pharmacies and pharmacists:

  • Must be a contracted IEHP Community Pharmacy Provider
  • Must be free of outstanding fraud, waste and abuse investigations
  • Must be located within San Bernardino and Riverside Counties
  • Must have an annual IEHP prescription volume of over 1,000 (500 in 6 months)
  • Shall be remain in business during the entire evaluation period
  • Should be credentialed by IEHP

If you are not a current provider, but would like to participate, please contact: PharmacyP4P@iehp.org

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P4P Program Timeline

Phase

Timeline

Phase I: Pharmacy P4P Launch

October 2013

Phase II: Pharmacy Home Program

July 4, 2016 - December 31, 2017

Phase III: Drug Utilization Review

January 2018 - December 2018

High Quality Pharmacy Network

January 2019 – December 2019

Bi-Annual Evaluation

Ongoing

____ Current stage

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Program Components

For 2019, the Pharmacy P4P Program will have three main components:

  • Drug Utilization Review (DUR): Therapeutic Duplication and High Dose
  • Medication Management Measures
  • Customer Satisfaction Survey

Please click here for provider communications sent out about the Pharmacy P4P Program.

Drug Utilization Review (DUR)

Drug Utilization Review (DUR) alerts provide patient safety information to pharmacists at point-of-sale (POS). These alerts include a range of safety-related issues to caution pharmacists that the medication may not be appropriate for the member. Pharmacists who actively review DUR alerts and intervene can mitigate the risk of adverse or medication-related events. 

DUR alerts and interventions based on High Dose Exceeding First DataBank (FDB) Maximum Recommended Dose and Therapeutic and Ingredient Duplication.

DUR Toolkit for Pharmacists:

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Chronic Disease Medication Management

The following Chronic Disease Medication Management Clinical Measures are endorsed by the National Committee for Quality Assurance (NCQA) and Pharmacy Quality Alliance (PQA). If you want to learn more about NCQA and PQA, please visit their websites at www.NCQA.org and www.pqaalliance.org.

Measurements

Description

Medication Therapy for Persons with Asthma- Absence of Controller Therapy

The percentage of patients with asthma during the measurement period who were dispensed more than 3 canisters of short acting beta2 agonist inhalers over a 90-day period and who did not receive controller therapy during the same 90-day period.

Medication Therapy for Persons with Asthma-Suboptimal Control

The percentage of patients with persistent asthma who were dispensed more than 3 canisters of a short-acting beta 2 agonist inhaler during the same 90-day period.

Medication Adherence for Cholesterol Medications

The percentage of patients 18 years and older who met the Proportion of Days Covered (PDC) during the measurement period for medications dispensed in therapeutic classes associated with the disease state.

Medication Adherence for Diabetes Medications

The percentage of patients 18 years and older who met the Proportion of Days Covered (PDC) during the measurement period for medications dispensed in therapeutic classes associated with the disease state.

High-Risk Medications

The percentage of patients 65 years and older who were dispensed a medication classified as high-risk.

Medication Adherence for Hypertension

The percentage of patients 18 years and older who met the Proportion of Days Covered (PDC) during the measurement period for medications dispensed in therapeutic classes associated with the disease state.

Statin Use in Persons with Diabetes

The percentage of patients ages 40-75 years who were dispensed a medication for diabetes that receive a statin medication.


Medication Management Toolkit for Pharmacists:

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Member Satisfaction

IEHP rewards pharmacies that engage members and create a member-centered experience. IEHP members are selected at random and surveys are conducted by a third-party vendor.

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Pharmacy Recognition

Recognition will be awarded to high performing pharmacies. These pharmacies will be allowed to promote their achievement to the community.

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For any questions regarding Pharmacy P4P payments or reports please contact: PharmacyP4P@iehp.org