CUTTING DRUG COSTS
Specialty drugs are used for patients undergoing intensive therapies for uncommon or rare diseases and these medications are typically more expensive than routine treatments. DHA enjoys federal pricing or better when drugs are dispensed to patients from pharmacies under the pharmacy benefit but some specialty drugs, like certain chemotherapies and treatments for rheumatoid arthritis, are regularly administered in a doctor’s office, infusion center or hospital inpatient setting. These expensive drugs are currently reimbursed under the purchased care medical benefit where DHA does not get federal pricing. Specialty medications are straining the budgets of the Military Health System (MHS) and TRICARE.
We partnered with consultants, including a representative of the Defense Health Agency (DHA), to review methods used to charge for the administration of specialty drugs with specific focus on the differences between two methods of reimbursement – white bagging and brown bagging; costs of the drugs and administration methods; and options for decreasing the costs, while ensuring that patients have access to the drugs. We delivered a report to the MHS detailing proposed policy options that could result in potential cost savings of 31-39% on specialty drug costs while preserving patient access to the life saving treatments.
With more servicewomen deploying to austere locations and combat environments, the MHS must address women’s health concerns. We developed a report with proposed policy options the MHS could consider that could positively impact readiness of the force by identifying barriers to accessing contraceptive medications or devices that might be used for various reasons, including contraception, menstrual suppression and/or treatment of gynecologic conditions.
We used a variety of methods to ascertain current rates of unintended pregnancy and contraception utilization among servicewomen. We conducted a focused review of current DoD policies, the American College of Obstetrics and Gynecology (ACOG) statements on Long Acting Reversible Contraceptives (LARCs) and menstrual suppression, relevant regulations, and scholarly articles. We also spoke with key MHS stakeholders, representatives of Service member advocacy groups, and senior leaders within the MHS.
THE STATE OF GME
In 2016, at the request of Assistant Secretary of Defense for Health Affairs, we developed a white paper that analyzed the current state of Graduate Medical Education (GME) in the Military Health System (MHS). In January 2018 the Director of the Defense Health Agency, requested that we analyze potential courses of action DHA and the services might consider to meet sections of the 2017 National Defense Authorization Act (NDAA) pertaining to strengthening oversight and coordination of Graduate Medical Education in the Military Health System.
To prepare this report, we employed a multi-pronged approach including broad data collection; review and analysis of relevant policies, interviews with selected MHS leaders and analytical input from civilian subject matter experts. We drafted a report detailing potential courses of action that could strengthen organization and oversight of military GME and assure that existing and future GME programs meet the needs of the Services in an effective and efficient manner.
DECIDE + BE READY
One of the challenges that serves as a barrier to health care is the gap in patient information. Initiating conversations concerning reproductive health can be awkward for some women which can obstruct their access to reproductive health care. Rates of contraceptive use among servicewomen vary, with the lowest contraceptive use and the highest rates of unintended pregnancy occurring among the enlisted ranks. Decision aids are especially useful to facilitate patient-practitioner conversations and shared decision making.
In an effort to promote service women’s knowledge of and access to women’s health services, DHH supported the development of the of the decision aid tool, “Decide + Be Ready”. The tool features a short survey the user can complete to assess reproductive health needs and treatment options that respect the user’s personal needs and values. The user can share the information captured in the app with their clinician which will inform the practitioner of the user’s needs and help initiate the discussion of options.