Trends in Medication Management. Jayson Gallant, B.Pharm, M.Sc Pharmacist, Health Benefit Management

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1 Trends in Medication Management Jayson Gallant, B.Pharm, M.Sc Pharmacist, Health Benefit Management

2 Agenda Drug Claims Trends Legislative / Public Plan Initiatives Biosimilars Pipeline Focus on Oncology 2

3 Drug Claims Trends

4 Top 10 Drug Classes by Adjudicated Amount Therapeutic Class Rank (by Adjudicated Amount) % Percent of Total Adjudicated Amount Immunomodulators (e.g. RA) % 11.0% Diabetes % 8.3% Depression % 6.0% Asthma % 5.5% Skin Disorders % 4.2% Blood Pressure % 4.5% Antibiotics/Anti-Infectives % 4.4% Ulcers % 4.1% Multiple Sclerosis % 3.1% ADD/Narcolepsy % 2.9% Share Of Total Adjudicated Amount 54.7% 54.0% 4

5 Top 15 Brand Single-Source by Adjudicated Amount Trade Name Disease Name % Percent of Adjudicated Amount Avg. Eligible Cost/ Claimant % Percent Change in Claimants over 2015 Remicade Rheumatoid Arthritis ,590 4 Humira Rheumatoid Arthritis , Enbrel Rheumatoid Arthritis ,020-3 Stelara Skin Disorders , Advair Asthma Symbicort Asthma Concerta ADD/Narcolepsy Coversyl Blood Pressure Harvoni Hepatitis , Vyvanse ADD/Narcolepsy Cymbalta Depression Xolair Asthma , Victoza Diabetes 1.1 1,875 4 Janumet Diabetes Abilify Mental Disorders Total 30.4 $1,

6 Legislative / Public Plan Initiatives

7 Multiple impactful trends Federal Bill S-201 on genetic discrimination. Medical marijuana coverage. A report from the Conference Board of Canada estimates savings of $1B for switching three categories of medication from prescription to over-the-counter (OTC). OHIP+ : New pharmacare program in Ontario providing 100 % coverage for all residents aged < 25 years old. Quebec Bill 81 allows for tendering processes for Basic Drug Plan listing of generic drugs. Similar to other provinces, Quebec will implement a blood glucose test strip limitation to its public plan (RAMQ). Operational changes to the Trillium Drug Program in Ontario allow for electronic claims transmission. Access to Hepatitis C drugs is expanding in BC and more drugs are funded in Ontario. 7

8 Quebec Bill 92 - Overview Wide scope: Investigation powers of the RAMQ, commercial practices related to prescription drugs, voluntary termination of pregnancy Transparency of pharmacy invoices Financial support from pharmaceutical manufacturers Private payer s preferred provider networks Delisting of drugs from the RAMQ List of Medications 8

9 September 15th 2017: pharmacy invoices will be more transparent For drugs listed on the RAMQ List of Medications only Drug Cost $23.71 Wholesaler s Mark-Up Dispensing Fee (including retail markup or other fees) $1.54 $8.96 9

10 Impacts of Bill 92 Plan members will be better equiped to seek pharmacies offering the best prices. Pharmacists may potentially lower their prices or limit their price increases. Invoices may become challenging to understand for plan members. Plan design impact will be highly dependent on claim submission by pharmacies. 10

11 No limits on limits! Proton Pump Inhibitors Quebec implemented new PPI limitations on May 3rd, day Supply allowed within a 365-day period Larger Supply allowed through exception codes Projected savings for the Quebec Public Plan (RAMQ): 14M$ on a 167M$ PPI expenditure Source: Usage optimal à long terme des inhibiteurs de la pompe à protons. May

12 Biosimilars Update

13 Five biosimilar drugs are currently available Biosimilar Reference Product Biosimilar Indications Product Availability OMNITROPE (somatropin) GENOTROPIN Growth Hormone Deficiency 2009 INFLECTRA (infliximab) REMICADE Rheumatoid Arthritis / Ankylosing Spondylitis Plaque Psoriasis / Psoriatic Arthritis Crohn Disease / Ulcerative Colitis * Not indicated for pediatric patients September 2014 BASAGLAR (glargine insulin) GRASTOFIL (filgrastim) LANTUS Type 1 / Type 2 Diabetes December 2015 NEUPOGEN Neutropenia March 2016 BRENZYS (etanercept) ENBREL Rheumatoid Arthritis / Ankylosing Spondylitis * Not indicated for Plaque Psoriasis / Psoriatic Arthritis ** Not indicated for pediatric patients September 2016 ERELZI (etanercept) ENBREL Rheumatoid Arthritis / Ankylosing Spondylitis Juvenile Idiopathic Arthritis (4-17 y.o.) * Not indicated for Plaque Psoriasis / Psoriatic Arthritis TBC 13

14 The impact of biosimilars remains limited in private drug plans According to the 2016 TELUS Health Book of Business, utilization and costs of three recently approved biosimilars represent : < 1 % of claimants for the chemical entity < 0,5 % of costs associated to the chemical entity INFLECTRA (infliximab) BASAGLAR (glargine insulin) GRASTOFIL (filgrastim) BRENZYS & ERELZI (etanercept) $ 0.37 % 0.25 % 0.41 % Claimants 0.84 % 0.61 % 0.99 % Too soon to tell New Claimants Only 3.75 % 2.5 % 1.2 % Too soon to tell TELUS Health Book of Business. Canada

15 Biosimilar Pipeline Update Reference Drug Indications Manufacturers (Biosimilar Name) Anticipated Approval Date AVASTIN (bevacizumab) Cancer (many indications) Pfizer (PF ) Health Canada is currently reviewing a submission for bevacizumab NEULASTA (pegfilgrastim) Neutropenia Mylan Health Canada is currently reviewing a submission for pegfilgrastim HUMIRA (adalimumab) Rhumatoid Arthritis / Inflammatory Diseases Amgen (ABP501) Also: Sandoz, BI et Merck Q1-Q LUCENTIS (ranibizumab) Macular Degeneration Pfenex (PF582) Also: Hospira, Novartis et Valeant Potentially 2018 HERCEPTIN (trastuzumab) Breast Cancer Celltrion (CT-P6) Also: Pfizer Potentially 2018 RITUXAN (rituximab) Lymphoma (RA phase 3) Sandoz (GP2013) Potentially late 2018 TELUS Health. Drug Pipeline Tracker. March

16 Pipeline Update

17 Pipeline Update Drug Indication Potential Impact Cost OCALIVA (obeticholic acid) Intercept A farnesoid X receptor agonist indicated for primary biliary cholangitis (approx. 10,000 patients in Canada): Approved by the FDA in May Health Canada approval is expected in the next few months. Off-label use potential for non alcoholic steatohepatitis (NASH) a much more prevalent condition (2 to 5 % of the general population). Cost expected to be $75,000 or more per year CGRP Inhibitors Many manufacturers Monoclonal antibodies (biologic drugs) targeting CGRP indicated for the prevention of chronic and episodic migraines. Global forecasts seem to indicate that approval will not be earlier than Highly anticipated new drug class targeting a highly prevalent medical condition (approx. 8% of Canadians). Expected cost between $9,000 to $20,000. EUCRISA (Crisaborole) Anacor / Pfizer Indicated for atopic dermatitis and potentially psoriasis Approved by the FDA for mild to moderate atopic dermatitis in December This is considerably more expensive that other therapies for atopic dermatitis such as topical steroids or immunomodulators. U.S. pricing has been set at $580 for a 60-gram tube TELUS. Health. Drug Pipeline Tracker. March

18 Thank You