Do n Huffo rd, MD CMO We ste rn He a lth Adva nta g e T he Big g - - PowerPoint PPT Presentation

▶
do n huffo rd md cmo we ste rn he a lth adva nta g e
SMART_READER_LITE
LIVE PREVIEW

Do n Huffo rd, MD CMO We ste rn He a lth Adva nta g e T he Big g - - PowerPoint PPT Presentation

Sep 07, 2023 367 likes •611 views

Pha rma c e utic a l Costs Industr y Dr ive r s and Manage me nt T e c hnique s Do n Huffo rd, MD CMO We ste rn He a lth Adva nta g e T he Big g e r Pic ture I HI s T he T riple Aim I mpro ving the He a lth o f

slide-1
SLIDE 1

Pha rma c e utic a l Costs

Industr y Dr ive r s and Manage me nt T e c hnique s

Do n Huffo rd, MD CMO We ste rn He a lth Adva nta g e

slide-2
SLIDE 2

Da te 2 Pre se nta tio n T itle

T he Big g e r Pic ture

– I

HI ’ s “T he T riple Aim”

  • I

mpro ving the He a lth o f Po pula tio ns

  • I

mpro ving the Pa tie nt E xpe rie nc e

  • Re duc ing pe r Ca pita Co st

T he T riple Aim is a ‘ thre e le g g e d sto o l’ tha t ne e ds a ll thre e to sta nd. T he fe de ra l g o ve rnme nt a nd CMS fully suppo rt this c o nc e pt He a lthc a re is >17% o f the na tio ns GDP a nd g ro wing

slide-3
SLIDE 3

Da te 3 Pre se nta tio n T itle

Pha rma c e utic a ls T he Good, T he Ba d a nd T he Ug ly

  • T

he Go o d!

– T

he Pha rma I ndustry ha s c re a te d so me g re a t ne w me dic a tio ns to tre a t dise a se s tha t pre vio usly we re ha rd to tre a t.

  • T

he Ba d!

– Muc h re se a rc h ha s simply g o ne into

re dunda nt drug s o r drug s with minima l b e ne fit.

  • T

he Ug ly!

– T

he Pric ing o f Pha rma c e utic a ls is o utra g e o us with no e nd in sig ht.

slide-4
SLIDE 4

Da te 4 Pre se nta tio n T itle

Pha rma c e utic a l Costs Re la te d to Me dic a l Spe nd

  • Out-Pa tie nt Rx Co sts (tra ditio na l a nd

spe c ia lty) – 12% o f me dic a l spe nd.

  • I

n-pa tie nt a nd o ut pa tie nt infusio n Rx is imb e dde d in me dic a l c o sts (a ppro x. 11% o f me dic a l spe nd).

  • Ove ra ll Pha rma c e utic a ls a dd up to a b o ut

23% o f me dic a l spe nd (a nd g ro wing ).

slide-5
SLIDE 5

Da te 5 Pre se nta tio n T itle

Industry Se g me nts Ne t Profit

Source – Sood et al USC/ Schaeffer Center for Public Policy Research

slide-6
SLIDE 6

Da te 6 Pre se nta tio n T itle

F

  • rtune 500 Ma nufa c ture rs
slide-7
SLIDE 7

Da te 7 Pre se nta tio n T itle

R&D vs. Ma rke ting

slide-8
SLIDE 8

Da te 8 Pre se nta tio n T itle

Dire c t to Consume r Adve rtising and Pharmac e utic al Re ps to Physic ians’ Offic e s

slide-9
SLIDE 9

Da te 9 Pre se nta tio n T itle

Re se a rc h a nd De ve lopme nt is E xpe nsive

  • Did you know?
  • Ab o ut 50% o f R&D is funde d b y F

e de ra l Gra nts. (NI H, Sta te a nd L

  • c a l

Go ve rnme nts, Cha rita b le Org s. E tc .)

  • So va ldi wa s de ve lo pe d b y Pha rma sse t

who pla nne d o n ma rke ting fo r $30,000 fo r a 3 mo nth c o urse o f tre a tme nt.

  • Gile a d purc ha se d Pha rma sse t fo r $11

b illio n a nd ra ise d the pric e to $86,000 fo r a thre e mo nth c o urse o f tre a tme nt

slide-10
SLIDE 10

Da te 10 Pre se nta tio n T itle

Pric ing Ba se d on Corne ring the Ma rke t

slide-11
SLIDE 11

Da te 11 Pre se nta tio n T itle

Onc olog y Pric ing

slide-12
SLIDE 12

Da te 12 Pre se nta tio n T itle

F DA F a st T ra c k for Onc olog y Me dic a tions

  • JAMA I

nte rna l Me dic ine – No v. 2016

– Of 31 Me dic a tio ns re c e iving e a rly

a ppro va l fo r surro g a te ma rke rs, 18 ha ve no t sho w impro ve me nt in surviva l o r q ua lity o f life in po st ma rke ting studie s.

– T

he F DA ha s no t g o ne b a c k a nd re vie we d tho se indic a tio ns.

– Ave ra g e a nnua l c o sts fo r the se drug s

ra ng e fro m $80K to $160K

slide-13
SLIDE 13

Da te 13 Pre se nta tio n T itle

Va lue Ba se d Pric ing ?

slide-14
SLIDE 14

Da te 14 Pre se nta tio n T itle

Wha t is Va lue ?

  • Va lue ha s se ve ra l de finitio ns b ut it is a n

e q ua tio n whe n c o mpa ring the ra pie s.

  • Va lue = b e ne fit-a dve rse e ffe c ts/ pric e
  • Ho w Do We Pric e F

ixing Ro ads?

– Do We Add the Co st o f Auto Re pairs fro m

Po t Ho le s?

slide-15
SLIDE 15

Da te 15 Pre se nta tio n T itle

IT IT’S T TIM IME T E TO PLA O PLAY “T “THE PR E PRIC ICE IS IS NOT OT R RIG IGHT”

  • Anuso l Plus a dde d to 2.5% Hydro c o rtiso ne =

Wha t Pre sc riptio n Pric e ?

  • Ne xium a dde d to Na pro syn = Wha t

Pre sc riptio n Pric e ?

slide-16
SLIDE 16

Da te 16 Pre se nta tio n T itle

Wha t If You Combine T he se T wo Me dic a tions

+ $12 $6

slide-17
SLIDE 17

Da te 17 Pre se nta tio n T itle

Anusol HC

$1,763.00

slide-18
SLIDE 18

Da te 18 Pre se nta tio n T itle

Wha t If You Combine T he se T wo Me dic a tions?

+ $10 $18

slide-19
SLIDE 19

Da te 19 Pre se nta tio n T itle

Vimovo

$3,564.00

slide-20
SLIDE 20

Da te 20 Pre se nta tio n T itle

E ffe c t of Couponing

  • Why a re Pha rma c e utic a l Ma nufa c ture rs Giving

Co -Pa y Assista nc e (Co upo ns)?

– Re duc e s Co st to the Pa tie nt – Ye s – Ma ke s the Pa tie nt’ s Co st le ss fo r a mo re

e xpe nsive drug .

– Ma nufa c ture rs a dd c o st o f c o upo n into

pric ing .

  • 98.3% o f Rx c o st is c o ve re d b y He a lth Pla ns a nd

1.7% b y the Pa tie nt

  • E

limina te s ‘ tie ring ’ a s a me tho d to dire c t c o nsume rs to mo st c o st e ffe c tive me dic a tio ns.

slide-21
SLIDE 21

Da te 21 Pre se nta tio n T itle

E xa mple s of Coupons

Medication Ingredients Patient Cost with Coupon 30 Day supply cost OTC separate cost Vimovo Nexium/Naprosyn $0 $3,564 $17.10 Alcortin A Hydrocortisone Aloe Vera Iodoquinol $0 $7,968 OTC anti- fungal or Neosporin

LA Times – Dec. 2016

slide-22
SLIDE 22

Da te 22 Pre se nta tio n T itle

So Wha t is WHA T rying to Do?

  • He a lth Pla ns a re Cha rg e d with Pro viding

Va lue fo r the Pre mium Do lla rs a nd I mpro ving Qua lity o f Ca re

– I

mpro ve d Qua lity (T he rig ht c a re a t the rig ht time the first time if po ssib le )

– Re duc e Wa ste (E

limina te Ca re tha t do e s no t a dd va lue o r c ha ng e o utc o me )

– F

ind Mo st Co st E ffe c tive Ca re .

  • We K

no w Ca re is E xpe nsive

slide-23
SLIDE 23

Da te 23 Pre se nta tio n T itle

T e c hnique s to ma na g e c ost while providing qua lity c a re

  • T

ie re d fo rmula ry

– Co upo ning ha s a ne g a tive e ffe c t o n this te c hniq ue

  • Ste p T

he ra py

– Mo st c o st e ffe c tive me dic a tio ns trie d first

  • Pro vide r E

duc a tio n

– WHA wo rks with me dic a l g ro up pha rma c ists a nd

me dic a l dire c to rs

  • Prio r Autho riza tio n

– Re vie w to c rite ria to e nsure me dic a l ne c e ssity – Dire c t to mo st c o st e ffe c tive a lte rna tive

  • Co ntra c ting – PBM’ s o b ta in disc o unts
  • Co mplia nc e Pro g ra ms – to impro ve pa tie nt c o mplia nc e
slide-24
SLIDE 24

Da te 24 Pre se nta tio n T itle

Summa ry

  • T

he Pha rma c e utic a l I ndustry ha s do ne So me Ama zing T hing s.

  • But…….

– T

he “o ve r the to p” pro fit a nd the re dunda nc ie s a re a sto unding in the Rx ma nufa c turing industry.

– T

he ma in o b je c tive fo r us is re duc ing wa ste thro ug h c o st e ffe c tive se le c tio ns, re duc ing o ve r pre sc rib ing a nd impro ving pa tie nt c o mplia nc e .