UBCM Conference. Joanne Jung, BScPharm Director, Pharmacy Services Mar 10, 2016

Transcription

1 UBCM Conference Joanne Jung, BScPharm Director, Pharmacy Services Mar 10, 2016

2 Agenda Drug Landscape Private drug plan trends Cost drivers Specialty Drugs Drug Trends Top Therapeutic Classes Drug Plan Solutions Generic pricing Prior authorization Preferred Pharmacy Network 2

3 Drug Landscape

4 National Private Drug Plan Trends 4

5 Top 10 Therapeutic Class (National Private Drug Plans) Therapeutic Class Share of Cost Change Yr over Yr 1 1 Rheumatoid arthritis, Psoriasis, Crohn s 21.8% 6.6% 2 2 Mental Health 14.9% 4.2% 3 3 Gastrointestinal 13.9% 0.3% 7 4 Infectious diseases 7.4% 30.0% 6 5 Diabetes 7.0% 11.4% 4 6 Hypertension 6.6% 0.3% 8 7 Lung conditions 5.2% 2.9% 5 8 Lipid lowering drugs 5.0% 9.8% 9 9 Neurological disorders 2.9% 8.0% Hormones 2.7% 0.3%

6 Cost Drivers in 2014 Generic Prices Stabilized 4 additional Pan-Canadian (18%) No further decrease in provincial pricing (20-25% in BC) High Cost Biologics / Specialty Drugs National: Almost 20% of total drug cost PBC: 13% of total drug cost Hepatitis C National Private Drug Plans Sovaldi = $67.3 million (2x total treatment cost in 2013) Harvoni = $6.3 million (Oct Dec 2014) Pharmacy Markups 6 6

7 Generic Drugs Single Source Brand Multi-Source Brand Same medicinal ingredients Same effect on the body Interchangeable by pharmacists Multiple manufacturers Innovator Brand Usually still under patent protection No generics available e.g. Cymbalta Brand drug for which patent has expired Generic versions are available e.g. Lipitor 7

8 Generic Price Changes (BC PharmaCare) Pan Canadian 18% pricing for top 6 drugs Each year: 4 drugs added % of brand 40% of brand 35% of brand 25% of brand 20% of brand SOURCE: BC Government, Ministry of Health

9 Specialty Drugs Expensive Usually >$10,000 per year per patient No standard price threshold Special Handling Most are made of proteins (biologics) Fragile Refrigeration Special Administration Usually given by injection Some drugs need to be administered in an infusion clinic

10 Specialty Drugs 25% National Private Pay Direct Drug Plan Database 20% Share of Total Drug Cost 15% 10% 5% Specialty Drugs Drugs that cost >$10K per claimant per year 0%

11 60% Specialty Drug by Disease State Share of Total Drug Cost National Private Pay Direct Drug Plan Database 50% 40% 30% 20% 10% RA/Crohn's/Psoriasis Multiple Sclerosis Cancer Hepatitis C Asthma 0%

12 PCSK9 Inhibitors The Next Blockbuster? Repatha launched late September 2015 Health Canada approved indication: Patients with high cholesterol despite maximum doses of traditional cholesterol lowering drugs (eg Lipitor ) Patients with an inherited condition causing excess cholesterol Effect on cardiovascular morbidity/mortality has NOT been determined Cost: over $7,000/ year * Administrations: by injection every 2 weeks (*compared to statins = <$150/year) 12

13 PCSK9 Inhibitors Potential Impact Almost 40% Canadian adults between 18 and 79 years have unhealthy cholesterol 1 If used according to Health Canada approved indications 105K claimants on maximum doses of statins* Genetic: 1:500 HeFH 1:1 million HoFH 13 *National Private Drug Plan Data Jan 2015-Sep 2015 ** Canadian Cardiovascular Society Position Statement on Familial Hypercholesterolemia.CdnJrlCardiology30(2014): STATS Canada: Cholesterol levels of adults, 2012 to 2013

14 Hepatitis C Viral infection that attacks the liver Complications are slow to progress and can take years Prevalence rate is about 1 % in Canada Higher incidence in men than women Canadian Liver Foundation recommends that those born between should be screened New Therapies: $50,000 to >$130,000 per treatment course Most listed with BC PharmaCare in 2015 (Special Authority) 14

15 Hepatitis C: Frequent Outcomes 15

16 Subsequent Entry Biologics (SEBs) Biologics produced once innovator version is no longer under patent protection (AKA biosimilars) Unlike generics, they are similar but NOT identical to the original brand Broad range of manufacturers of SEBs Both brand and generic companies Blockbuster monoclonal antibodies >$1 billion/year sales 7/10 top grossing drugs in 2013 were biologics Reference Brand % Savings SEB s in pipeline Humira 16 Remicade* 47% 9 Neupogen* 17% 54 Neulasta 15 Enbrel 21 Lantus Insulin* 15% 6 *SEB available in Canada 16

17 MOST ARE SPECIALTY DRUGS

18 18

19 Other Drugs in the Pipeline Mental Health Additional therapeutic effects (eg cognitive function, sleep, alcohol dependence) Botox being investigated as an antidepressant Diabetes Biopharmaceutical research companies are developing 180 drugs Once weekly treatments Immunotherapy to stimulate insulin secretion Oral insulin (results of study available in 2017) Artificial pancreas (closed loop) Cancer Immunotherapies targeted, fewer side effects, very robust pipeline >$100,000 per year

20 Drug Plan Solutions

21 All Drugs refers to: Drug Coverage Drugs that legally require a prescription Life-sustaining non-prescription drugs (eg insulin, Epi-pens, nitrosprays) All Drugs (most generous) Managed Formulary Provincial Formulary (most cost effective) ( PHARMACARE TIE-IN ) 21

22 Drug Plan Cost Management Solutions Generic / Low Cost Alternative Pricing Apply to BC PharmaCare for coverage for high cost drugs Prior Authorization for specialty drugs Drug markup limits Preferred Pharmacy Network 22

23 Generic Pricing Apoatorvastatin $0.18 Generic Pricing: $0.18 Jampatovastatin $0.18 Mylanatorvastatin $0.18 Lipitor $1.00 Tevaatorvastatin $0.18 Ranatorvastatin $0.18 Auroatorvastatin $

24 Optimize Integration with PharmaCare Select high cost drugs require member seek funding from BC PharmaCare before the plan pays ~ 70 drugs require the physician apply to BC PharmaCare for Special Authority approval PharmaCare decision (YES or NO) sent to PBC: Claim will pay If approved. PharmaCare covers most of the cost. Plan $4,000 PHC $11,000 $15,000

25 Prior Authorization Program for High Cost Drugs Protect the plan from escalating costs Limit markups No balance billing to member Coordinates with provincial funding Enforce provincial criteria where possible Monitor appropriateness of therapy Set criteria Health Canada approved indications 25

26 Mark-ups A percentage added by the pharmacy and wholesaler to the manufacturer s list price (MLP) Wholesale Markup Pharmacy Markup Plan Mark-up 26

27 Drug Markups by Chain 2015 Submitted Claims Data

28 Preferred Pharmacy Network

29 Driving Members to Shop In Network Education Communication Promotional Material Advertising Incentives Adjust coinsurance Waive co-pay Exclusivity No shopping outside the network 29

30 Over 3000 searches per month 1. Enter drug name/din 2. Select strength 3. Users see a list of pharmacies near them, the price of the drug 30

31 Plan Design Change Considerations Given multiple generations in the workforce, hard to please everyone Plan members will be impacted Impact all or just some members Impact on members perception of plan value Communication plan is critical 17

32 Questions 32