BD Training
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Transcript of BD Training
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BD Training
Biologics & Specialty DrugsThe Road to Sustainability
Mark Rolnick
Director, Pharmaceutical Benefits
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Private Drug PlanCost Drivers
• Demographics• Mark-Ups and Fees• Coupon Cards• Lack of consumerism• Open formularies• Biologics & Specialty
$
$Source: Canadian Institute for Health Information, Drug Expenditures in Canada, 1985-2009
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• Specialty Drugs make up 14 of our top 50 DINs
• 42 drugs on the Prior Auth DIN List & others in top 50
= $203.5 Million in 2011 up from 170 million in 2010
(+20.4%)
• 15.2% of PDD spend in 2011 vs. 13.2% in 2010
• Treating just ~1% of plan members
(Source: 2011/2010 SLF Book of Business for All claims)
Background Stats
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Claimants over $25,000 in Spend
Source: Telus Health Solutions Data, March 2012
Unprecedented Growth
Source: Telus 2011 SLF All Claims Data report Telus PA DIN List (includes oral Cancer DINs)
Average Specialty Claim for drugs on the SLF
Prior Auth List = $2,340.80
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Sun Life’s Biologic Response Modifier Experience
• Top 3 biologics
• Distribution for utilization spans across age groups
–Reflective of multiple indications for these products
–Most common uses arthritis, gastrointestinal, psoriasis
DRUG NAME 2010 PAID AMOUNT 2011 PAID AMOUNT Growth #1 Remicade $40,265,975.64 $49,446,191.39 22.80%
#2 Humira $22,830,723.99 $29,109,898.38 27.50%#3 Enbrel $25,019,369.74 $26,781,645.93 7.04%
$88,116,069.37 $105,337,735.70 19.54%
(Source: 2011/2010 SLF Book of Business for All claims)
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Sun Life’s OncologyExperience
• Important Drugs
• Not a huge cost burden yet
• Growing incredibly quickly
Cancer Drugs 2010 PAID AMOUNT 2011 PAID AMOUNT Growth #1 Neulasta $7,058,323.15 $9,010,366.86 27.66%#2 Gleevec $5,760,711.53 $5,831,073.40 1.22%#3 Revlimid $3,504,050.32 $4,411,328.94 25.89%#4 Sutent $2,634,024.91 $3,185,328.66 20.93%
$18,957,109.91 $22,438,097.86 18.36%
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Source: Trusheim et al.: Do Biologics Differ from Small Molecules? Forum for Health Economics & Policy, Vol. 13 [2010], Iss. 1, Art. 4
Biologics Percentage of Global Therapeutic Pipeline
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8 in 10 agree“that rising costs will make it difficult to maintain Canada’s healthcare system” and that “Canadian healthcare faces a funding crisis”
7 in 10 agree“that rising costs and growing use of prescription drugs will make it difficult for employers to maintain their current drug coverage”
Awareness of Cost Pressures
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What’s Your Drug Plan Philosophy?
• Is the Drug Plan a cost or an investment?
• Is it a benefit to employees? • Or is it Health Insurance?• Can Wellness & Drug
programs work together to limit disability claims?
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Where does the Employers Responsibility begin and end?
Antibiotic for Acute chest infection? Cholesterol / Blood Pressure drugs prevent heart attack
in 15 years? Cancer drug that extends life by 3 mos? Biologic for Crohn’s, MS, Arthritis,
that helps keep members at work?
• Genetic testing shows, 25% chance at getting cancer in the next 10 years? Vaccine that costs $25,000 but prevents Alzheimer’s disease 30 years
from now?
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What is the Employee’s role?
• How can they help keep Costs down? • Do they even know that its an issue?• How can we engage
them more?• What education can we
provide them?
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What does the future hold in terms of specialty management?
• Negotiated reimbursement for high cost drugs where alternatives exist
• Risk Sharing arrangements for expensive therapies
• Maximums to avoid concerns of dose escalation
• Relying more on pharma company financial assistance
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What does the future hold in terms of specialty management?
•Prior Authorization with Re-authorization criteria to ensure member is getting best outcomes and is an appropriate candidate in the first place
•Preferred distribution network to gain efficiencies
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Maximize plan sponsor satisfaction through
plan design
Maximize planmember
satisfaction
Minimizeplan sponsor
costs
Creating Balance….
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