PAS updated overview slide show 2000

1
An Overview
2
IHS Mission, Goal, and Foundation
In partnership with American
Indian and Alaska Native people

• Raise the health status of Indian people
• Ensure personal and public health services to
  Indian people
  
• Uphold Federal governments obligations to Indian
  people
  
• Honor and protect the inherent sovereign rights
  of tribes.
  

3
IHS Service Population
Area User Population
Indians served by the IHS
Indians not served by IHS
1.0 M
1.6 M
2.6 Million Indian People
4
155 Service Units in 12 Areas Located in 35
States
60 managed directly by IHS 95 tribally managed
5
Predominantly rural primary care system with
some urban locations
6
Indian Health Care Systems
Kyle Health Center, SD

• Hospitals 48
• Health Centers 231
• Health Stations 133
• Village Clinics 176
• Urban Clinics 34

Pine Ridge Hospital, SD
7
Service Units and FacilitiesOperated by IHS and
Tribes, October 1, 2001

• Tribes contract with IHS to provide services that
  IHS has traditionally
  
• performed.
• Title I - operated under Title I, P.L. 93-638
  Self-Determination Contracts.
  
• Tribes must get approval from IHS for
  significant program changes.
  
• Title V - operated under Title V, P.L. 106-260
  Tribal Self-Governance
  
• Amendment of 2000. Tribes may change
  services provided as the
  
• Tribe desires without prior IHS approval.
• Non-638 Contract a mechanism used by Alaska to
  fund tribally operated
  
• clinics not eligible for the Title I funding

8
Partnership with Tribal Governments

• The Indian Self-Determination Act of 1975 does
  not lessen any Federal treaty obligation, but
  provides an opportunity for Tribes to assume the
  responsibility of providing health care for their
  members.
• Tribes have historically assumed control of
  community health services first then expanded to
  medical care programs.
  
• Tribes now administer health care contracts and
  compacts with the IHS valued at over 1 billion.
  
• Today, Tribes directly operate 84 service units,
  13 hospitals, 158 health centers, 76 satellite
  health stations, and 170 Alaska village clinics.

9
Number of Service Units and FacilitiesOperated
by IHS and Tribes, October 1, 2001

• . Tribal
  .
  
• Non-638
• Type of Facility Total IHS Total I V
  Contract
  
• Service Units 155 63 92 -- -- --
• Hospitals 49 36 13 2 11 --
• Ambulatory Facilities 545 110 435 174 254 7
• Health Centers 231 59 172 108 64 --
• School Health Centers 5 2 3 2
  1 --
  
• Health Stations 133 49 84 55 29 --
• Alaska Village Clinics 176 -- 176 9 160
  7

10
IHS, Tribal and Urban Pharmacies

• ITUs operate 237 pharmacies in 29 states
• State Pharmacies State Pharmacies State Pharmacies
  
  
• AK 15 MI 7 NY 3
• AL 1 MN 7 OK 43
• AZ 23 MS 1 OR 7
• CA 18 MT 13 SC 1
• CO 2 NC 1 SD 12
• CT 1 ND 5 TX 2
• FL 1 NE 3 UT 1
• ID 3 NM 23 WA 12
• KS 5 NV 11 WI 11
• ME 3 WY 2

11
Directors Initiatives

• Behavioral Health
• Chronic Care
• Health Promotion/Disease Prevention

12
Behavioral Health

• Methamphetamine Reduction
• Suicide Prevention
• Behavioral Health - Management Information System
  and
  
• Child Protection
• Geared toward the implementation of
  strategies and techniques within the Indian
  Health Service on the Federal, Tribal, and Urban
  Health levels that integrate and adapt various
  types of mental health techniques, such as stages
  of change, social cognitive theory, preventive
  counseling and interviewing tools, toward the
  goal of improving the physical, mental, social
  and spiritual well-being of AI/AN people.

13
Chronic Care

• Chronic conditions such as diabetes,
  cardiovascular disease, asthma, renal disease,
  depression, and cancer have become increasingly
  prevalent in American Indian and Alaska Native
  communities and are placing growing demands on
  health care systems. Given the limited available
  resources, there is an urgent need for a
  strategic plan to address the treatment and
  prevention of chronic conditions in the Indian
  Health Service (IHS) health care system.

14
Health Promotion/Disease Prevention

• The main health challenges currently faced by
  American Indian and Alaska Native people are the
  increasing health conditions and chronic diseases
  that are related to lifestyles issues such as
  obesity, physical inactivity, poor diet,
  substance abuse, and injuries. To help meet these
  challenges, the Indian Health Service (IHS) has
  launched a Health Promotion and Disease
  Prevention (HP/DP) Initiative to develop a
  coordinated and systematic approach to enhance
  preventive health approaches at the local,
  regional, and national levels.
• This Initiative is aligned with the Presidents
  HealthierUS, HHS Steps to a HealthierUS, and
  Healthy People 2010

15
Medicare Prescription Drug Coverage

• Service to non-IHS beneficiaries
• Three levels of usage
• Patients who only use ITU facilities
• Patients who use ITU and private pharmacies
• Patients who do not have access to ITU
  facilities
  
• Formulary issues

16
Medicare Prescription Drug Coverage

• Enrollment in the Medicare Prescription Drug
  Benefit continues to grow in Indian Country.
  
• The IHS has signed Medicare Part D agreements
  with the 15 plans and patient benefit companies.
  We are now working on agreements with three more
  plans to meet specific regional needs.
• The IHS also continues to work with Part D plans
  to encourage them to develop tribal and urban
  program agreements with terms and conditions
  similar to those negotiated by the IHS.

17
Medicare Prescription Drug Coverage

• Medicare Part-D premiums continue to be an area
  of concern for the IHS and Tribes. While the IHS
  does not have statutory authority to pay premiums
  for Medicare Part D, there is no prohibition
  against a Tribe using tribal funds to pay for
  such costs.
• During the National Indian Health Board meeting
  in 2006, Phil Norrgard, Human Service Director
  for the Fond du Lac Tribe, spoke about how the
  Fond du Lac Tribe was able to increase
  collections by paying Medicare Part D premiums
  for tribal members. A copy of Mr. Norrgards NIHB
  presentation is available on the IHS website at
  www.pharmacyissues.ihs.gov under the Medicare
  and Medicaid section.

18
Indian Health ServicePharmaceutical Procurement
PT Committee Overview

• Presentation to the AMSUS Sustaining Members
• June 13, 2007
• Washington DC
• Rob Hayes, LCDR, USPHS
• Director, IHS National Supply Service Center
• Oklahoma City, OK

19
IHS National Supply Service Center

• Agencys Medical Supply and Pharmaceutical
  Distribution Management Program located in OKC,
  OK (formerly Ada, OK)
  
• 32 employees (22 administrative, 10 WH)
• Pharmaceutical Prime Vendor Coordinator for all
  IHS
  
• Utilize the VA PPV (McKesson)
• Work with the VA NAC to include IHS in National
  Contract Incentive Agreement solicitations and
  awards
  
• Negotiate and implement Agency specific
  agreements
  
• Evaluate Rx Expenditures to maximize cost
  avoidance potential
  
• FPESC
• Attend DoD VA PT meetings quarterly
• Coordinate Support IHS PT functions

20
Pharmaceutical Acquisition

• VA Pharmaceutical Prime Vendor
• - Federal Supply Schedule
• IHS and Tribal sites order medications at
  Federal Supply
  
• Schedule Pricing.
• - National Standardization Contracts
• - Blanket Purchase Agreements (Actos, Depakote
  ER)
  
• HRSA 340B Drug Pricing Program
• Tribes with compacts or contracts qualify as
  Federally Qualified Health
  
• Centers and after approval of HRSA are eligible
  to order medications
  
• at 340B pricing.

21
IHS Pharmaceutical Prime Vendor Expenditures
1999 97,762,435 ----------
2000 126,749,356 Increase 30
2001 141,392,971 Increase 12
2002 166,204,743 Increase 18
2003 186,118,054 Increase 12
2004 220,849,972 Increase 19
2005 234,629,344 Increase 6
2006 250,059,055 Increase 7
2007 Est 257,000,000 Increase 3
22
2006 PPV Spending Federal vs. Tribal
23
IHS Top 10 Drugs 2006
24
IHS Pharmaceutical Expenditures
25
IHS Pharmaceutical Expenditures
26
IHS PPV Facilities
27
IHS PPV Spending
28
National Core Formulary

• ITU Sites have their own local formularies.
• Aberdeen and Oklahoma City and Areas have area
  wide formularies to which sites can add
  additional medications.
  
• The IHS National Core Formulary is a listing of
  core medication that all IHS sites are expected
  to have available for use. The National Core
  Formulary.

29
IHS National Pharmacy Therapeutics Committee

• 12 voting members (one from each IHS Area)
• Chair (Appointed Physician)
• Vice Chair (Pharmacist)
• Consultants (Disease Specific, Procurement, etc)
• Meet Quarterly (2-4 face-to-face yearly)
• Manage Core Formulary
• Improve patient outcomes
• Promote portability

30
Integration of NPTC and NSSC

• Integrate Clinical evaluations, outcomes, and
  formulary decisions with Procurement program.
  
• Develop process similar to VA DoD
• Promote Formulary control to Fed Tribal
  Facilities
  

31
IHS Formulary Process

• Clinical Evaluation
• VA
• DoD
• IHS
• Procurement solicitation if needed
• Pharmacoeconomic Analysis
• Recommendation
• NPTC vote and formulary status

32
Agreement Opportunities With Industry

• VA Contracts
• VA BPAs
• BPAs
• TPAs

33
Contact Information

• RADM Robert E. Pittman
• Principal Pharmacy Consultant
• Phone [phone]
• robert.pittman_at_ihs.gov

• LCDR Rob Hayes
• Director, IHS-NSSC
• 888-948-1415
• Robert.hayes_at_ihs.gov
• www.nssc.ihs.gov
• www.nptc.ihs.gov up soon

34
Questions

• Thank You!