Pharmacy Management priorityhealth.com A little background Priority - - PowerPoint PPT Presentation

priorityhealth.com

Current Trends in Specialty Pharmacy Management

priorityhealth.com

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

priorityhealth.com

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

priorityhealth.com

Overall Unit Price Increase since 2007

36% 37% 22% 73% 79% 107% 56% 55% 28% 19% 0% 20% 40% 60% 80% 100% 120%

Humira Enbrel Cimzia Avonex Betaseron Copaxone Rebif Tysabri Remicade Norditropin

priorityhealth.com

Specialty Drug Management Strategies

Benefit Design

Formulary Management

Distribution Channel Patient Care

priorityhealth.com

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

priorityhealth.com

Specialty Drug Management Strategies

Benefit Design

Formulary Management

Distribution Channel Patient Care

priorityhealth.com

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

priorityhealth.com

Specialty Drug Management – Results

49% 47% 48% 28% 33% 37% 23% 20% 15% 0% 10% 20% 30% 40% 50% 60% 2008 2009 2010

Anti-TNF Market Share

ENBREL HUMIRA REMICADE

priorityhealth.com

Specialty Drug Management – Results

9% 71% 86% 89% 27% 9% 2% 1% 1% 4% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2008 2009 2010

Hyaluronic Acid Market Share

Euflexxa Hyalgan/supartz Orthovisc Synvisc/Synvisc-One

priorityhealth.com

Specialty Drug Management Strategies

Benefit Design

Formulary Management Distribution Channel Patient Care

priorityhealth.com

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

priorityhealth.com

Specialty Drug Management Strategies

Benefit Design

Formulary Management

Distribution Channel Patient Care

priorityhealth.com

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

priorityhealth.com

Specialty Drug Management – Patient Care

• Patient Assistance Programs

1st 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%

priorityhealth.com

Specialty Drug Management – Patient Care

• Medication Adherance

priorityhealth.com

Benefit Design

Formulary Management

Distribution Channel Patient Care

Current Trends in Specialty Pharmacy Management