HCA Drug Spend and Utilization Medicaid and Uniform Medical Plan Prescription Drug Price and Purchasing Summit – Part 1 June 14, 2016 Donna L. Sullivan, PharmD, MS Chief Pharmacy Officer
Total Drug Spend CY 2015 Medicaid FFS a $155,684,155 Medicaid MCO $926,327,899 Uniform Medical Plan b $283,946,782 Total $1,365,958,836 a Net Federal and Supplemental Rebates = $111,484,999 b UMP Paid amount. Total drug costs = $324,541,426; Member Share $40,594,644 2
Top Traditional Drugs by Cost Drug Name Drug Class Medicaid MCO* Medicaid FFS UMP* Total Cost (Net Paid) Aripiprazole Antipsychotic $35,713,547 $1,843,570 ($1,707,383) $1,344,140 Lantus/Solostar Diabetes $39,970,722 $2,384,259 (-$309,842) $12,177,589 Ventolin HFA Asthma/COPD $18,648,814 $342,615 ($93,886) $288,544 Methylphenidate ER ADHD $13,717,322 $2,834,098 ($1,082,724) $1,310,365 Amphetamine + ADHD $12,436,224 $1,789,189 ($1,612,472) $1,357,749 Dextroamphetamine Suboxone Opiate Use Disorder $5,447,391 $1,960,737 ($1,235,974) $451,835 Vyvanse ADHD $4,829,663 $971,827 ($834,831) $790,415 Advair/Diskus Asthma/COPD $8,522,949 $3,353,673 (-$2,024) $3,214,322 Novolog/Flexpen/Mix/Penfill Diabetes $11,159,056 $963,769 ($339,418) $5,192,542 Levemir/Flextouch Diabetes $4,527,420 $675,368 (-$41,217) $2,951,721 *Does not include rebates 3
Top Traditional Drugs by Utilization Drug Name Drug Class Medicaid FFS UMP Claims (Cost) Claims (total cost/ net paid) Hydrocodone/Acetaminophen Opiate Analgesic 82,139 ($841,464/$777,613) 33,810 ($1,237,456) Amoxicillin Antibiotic 45,711 ($309,518/$301,825 17,883 ($126,558) Ibuprofen NSAID 44,827 ($258,593/$249,540) 0 ProAir Asthma/COPD 25,815 ($1,271,417/$24,895) 13,140 ($2,554) Oxycodone/Acetaminophen Opiate Analgesic 23,127 ($419,480/$400,963) 9,084 ($63,552) Levothyroxine Hypothyroid 14,140 ($111,779/$86,716) 221,654 ($2,254,598) Lisinopril Hypertension 13,675 ($73,352/$72,613) 193,212 ($368,433) Atorvastatin Hypercholesterolemia 9,294 ($82,958/$78,248) 160,119 ($827,548) Simvastatin Hypercholesterolemia 4,694 ($28,312/$27,974) 153,850 ($220,803) 4
Top Specialty Drugs by Cost Drug Name Drug Class Medicaid MCO* Medicaid FFS* UMP* Harvoni Hepatitis C $77,862,278 $67,508,172 $15,412,654 Sovaldi Hepatitis C $23,694,766 $19,738,978 $1,072,171 Daklinza Hepatitis C $1,244,714 $1,148,886 $317,080 Truvada HIV $17,206,399 $693,274 $1,622,678 Norditropin Growth Hormone $651,653 $352,916 $45,596 Humira Anti-inflammatory $22,031,987 $1,714,318 $16,811,000 Atripla HIV $9,845,475 $484,631 $1,476,464 Enbrel Anti-inflammatory $13,943,331 $1,612,380 $14,466,747 Copaxone MS $3,019,035 $260,531 $7,443,395 Tecfidera MS $7,096,889 $302,308 $6,048,722 Revlimid Oncology $1,645,974 $60,553 $4,905,377 *Does not include rebates 5
Management Strategies Barriers and Challenges • • Washington Preferred Drug List Medicaid Drug Rebate Program “Best Price” • Prior authorization • Unexpected price increases • Full review • New drugs with high cost • Expedited Authorization • Balanced Budget • Step Therapy • Cost shifting to members • Quantity Limits • Reimbursement Rates • AWP-16% • FUL • MAC • Specialty Pharmacy – Split Fills • Member Cost Share – PEB • Member Premiums - PEB
Questions? Donna L. Sullivan, PharmD, MS donna.sullivan@hca.wa.gov Tel: 360-791-8783 7
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