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

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 RHEUMATOID ARTHRITIS/CHROHN’S HUMIRA $2,090 ENBREL RHEUMATOID ARTHRITIS $2,070 CIMZIA RHEUMATOID ARTHRITIS $1,939 FORTEO OSTEOPOROSIS $1,051 priorityhealth.com

Overall Unit Price Increase since 2007 120% 107% 100% 79% 80% 73% 60% 56% 55% 37% 40% 36% 28% 22% 19% 20% 0% Humira Enbrel Cimzia Avonex Betaseron Copaxone Rebif Tysabri Remicade Norditropin priorityhealth.com

Specialty Drug Management Strategies Benefit Formulary Management Design Patient Distribution Care Channel priorityhealth.com

Specialty Drug Management – Benefit Design Non Specialty Preferred Specialty Generic Preferred Non Brand Preferred Brand Preferred Historical Benefit $10 $40 $40 $40 $40 Design Current 20% 20% Benefit $10 $40 $80 coinsurance coinsurance Design $100 max/rx $200 max/rx priorityhealth.com

Specialty Drug Management Strategies Benefit Formulary Design Management Patient Distribution Care Channel 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 Anti-TNF Market Share 60% 49% 50% 48% 47% 40% 37% 33% ENBREL 30% 28% HUMIRA 23% REMICADE 20% 20% 15% 10% 0% 2008 2009 2010 priorityhealth.com

Specialty Drug Management – Results Hyaluronic Acid Market Share 100% 89% 90% 86% 80% 71% 70% 60% Euflexxa Hyalgan/supartz 50% Orthovisc 40% Synvisc/Synvisc-One 27% 30% 20% 9% 9% 10% 4% 2% 1% 1% 0% 2008 2009 2010 priorityhealth.com

Specialty Drug Management Strategies Benefit Formulary Design Management Distribution Patient Care Channel 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 Formulary Design Management Patient Distribution Care Channel 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 Avg Assistance/ 1 st Qtr 2013 CoPay Assistance Patients 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 48.26% Specialty Patients 7,166 Serviced 1Q 2013 priorityhealth.com

Specialty Drug Management – Patient Care • Medication Adherance priorityhealth.com

Current Trends in Specialty Pharmacy Management Benefit Formulary Design Management Patient Distribution Care Channel priorityhealth.com