Current Trends in Specialty Pharmacy Management
A little background Priority Health members fill about 25,000 prescriptions every day We spend over $1,250,000 a day on prescriptions Over 80% of all prescriptions are filled with generics, but Nearly 80% of our cost is for brand-name drugs The average brand name retail prescription is over $300! Just 1% of our members account for 25% of our drug costs Attributable to specialty medications
Top 20 Specialty Drugs by Spend Drug Name Use Allowed Amt/Rx ADVATE HEMOPHELIA $23,189 INCIVIK HEPATITIS C $14,517 SABRIL SEIZURES $7,450 SPRYCEL CML (ORAL CHEMO) $7,399 REVLIMID MULTIPLE MYELOMA (ORAL CHEMO) $7,370 GLEEVEC CML (ORAL CHEMO) $6,485 TOBI CYSTIC FIBROSIS $5,471 XYREM NARCOLEPSY $4,813 GILENYA MULTIPLE SCLEROSIS $4,201 COPAXONE MULTIPLE SCLEROSIS $4,131 AVONEX MULTIPLE SCLEROSIS $3,859 REBIF MULTIPLE SCLEROSIS $3,616 TEMODAR BRAIN TUMOR (ORAL CHEMO) $3,380 BETASERON MULTIPLE SCLEROSIS $3,329 PULMOZYME CYSTIC FIBROSIS $2,756 NORDITROPIN GROWTH HORMONE $2,611 HUMIRA RHEUMATOID ARTHRITIS/CHROHN S $2,090 ENBREL RHEUMATOID ARTHRITIS $2,070 CIMZIA RHEUMATOID ARTHRITIS $1,939 FORTEO OSTEOPOROSIS $1,051
Overall Unit Price Increase since 2007 120% 107% 100% 80% 73% 79% 60% 56% 55% 40% 36% 37% 20% 22% 28% 19% 0% Humira Enbrel Cimzia Avonex Betaseron Copaxone Rebif Tysabri Remicade Norditropin
Specialty Drug Management Strategies Benefit Design Formulary Management Distribution Channel Patient Care
Specialty Drug Management Benefit Design Generic Preferred Brand Non Preferred Brand Specialty Preferred Specialty Non Preferred Historical Benefit Design $10 $40 $40 $40 $40 Current Benefit Design $10 $40 $80 20% coinsurance $100 max/rx 20% coinsurance $200 max/rx
Specialty Drug Management Strategies Benefit Design Formulary Management Distribution Channel Patient Care
Specialty Drug Management Formulary Management Preferred/Non-preferred drug classes TNF inhibitors MS injectables Pegylated interferons Hyaluronic acids Step therapy Coupled with preferred/non-preferred strategy Enbrel/Humira before Simponi Utilized within a preferred class Copaxone/Rebif before Gilenya Tied to medical benefit Enbrel/Humira before Remicade Rebate opportunities Leverage benefit design and formulary management
Specialty Drug Management Results 60% Anti-TNF Market Share 50% 49% 47% 48% 40% 37% 30% 28% 33% ENBREL HUMIRA 23% REMICADE 20% 20% 15% 10% 0% 2008 2009 2010
Specialty Drug Management Results 100% 90% 89% Hyaluronic Acid Market Share 86% 80% 70% 71% 60% 50% 40% Euflexxa Hyalgan/supartz Orthovisc Synvisc/Synvisc-One 30% 27% 20% 10% 9% 9% 2% 1% 1% 0% 2008 2009 2010 4%
Specialty Drug Management Strategies Benefit Design Formulary Management Distribution Channel Patient Care
Specialty Drug Management Distribution Specialty Pharmacy vs. Open Network Specialty pharmacy accreditation Often delivers most aggressive pricing Streamlines end-to-end medical management administration Improves provider experience Provides framework for consistent data reporting back to the health plan
Specialty Drug Management Strategies Benefit Design Formulary Management Distribution Channel Patient Care
Specialty Drug Management Patient Care Case Management Integration of specialty pharmacy and health plan activity Initial and ongoing health assessments Health Assessment Questionnaire II (HAQ II) RA and other rheumatic diseases Psoriasis Quality of Life (PQOL) Patient Health Questionnaire (PHQ-2 and PHQ-9) Multiple sclerosis and Hepatitis C Harvey Bradshaw Index (HBI) Crohn s disease
Specialty Drug Management Patient Care Patient Assistance Programs 1 st Qtr 2013 CoPay Assistance Patients Avg Assistance/ Patient January $343,600 1,243 $276.42 Feburary $153,873 1,066 $144.34 March $141,741 1,149 $123.36 Total $639,214 3,458 $184.85 % with CoPay Assist Specialty Patients Serviced 1Q 2013 7,166 48.26%
Specialty Drug Management Patient Care Medication Adherance
Current Trends in Specialty Pharmacy Management Benefit Design Formulary Management Distribution Channel Patient Care