scriptsourcing THE NEXT 5 YEARS OF RX COSTS AND HOW THEY WILL IMPACT YOUR BOTTOM LINE ScriptSourcing Prescription Advocacy Services

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1 scriptsourcing THE NEXT 5 YEARS OF RX COSTS AND HOW THEY WILL IMPACT YOUR BOTTOM LINE ScriptSourcing Prescription Advocacy Services Gary Becker, CEO Benefit Consultant, Risk Mitigation Expert, and Author

2 Medication Costs On average, Rx spend represents 25% of an employer s health care spend.

3 Medication Costs Rx s are the fastest growing cost impacting health care budgets.

4 Medication Costs How fast Brand Name prescription drugs are skyrocketing % increase % increase % increase more than 8x faster than the 1.5% general inflation rate.

5 Medication Costs How fast The average price for the 50 most popular Generic Drugs have increased 373% from 2010 to 2014 from $13.14 to $62.10.

6 Medication Costs Nexium 20 employees on Nexium in 2015 $53,800 Employer Cost: $41, employees on Nexium in 2020 $99,000 Employer Cost: $87,000 Assumptions: $50 rx copay & 13% name brand medication trend

7 Medication Costs New arrival medications that target Hepatitis C such as Sovaldi and Harvoni can cure most people infected with the virus, but at a cost of $1000 per pill nearly $100,000.

8 Medication Costs The price of Multiple Sclerosis drugs have skyrocketed in the past two decades, in some cases rising more than 700%. Currently, there are no MS drugs in the United States with a list price below $50,000 a year.

9 Medication Costs Multiple Sclerosis One employee on MS medication in 2015 Copaxone $66,106 Avonex $61,716 Gilenya $66,720 One employee on MS medication in 2020 Copaxone $121,635 Avonex $113,557 Gilenya $122,764 Assumption 13% name brand medication trend

10 Medication Costs 2015 Rx Costs Condition Medication Annual Cost Cholesterol Evolocumab $ 12,000 Rheumatoid Arthritis Enbrel $ 18,000 HIV Atripla $ 26,238 Inflammation Humira $ 35,308 Growth Deficiency Norditropin $ 61,153 Cancer Gleevac $109,439 Melanoma Cancer Keytruda $150,000 Arterial Hypertension Tyvaso $250,000 Hemophilia Kogenate FS $600,000

11 Medication Costs In 2012, 1% of the prescriptions written were for Specialty Drugs and represented 25% of all prescription drug spend. By 2020, Specialty Drugs are predicted to represent 50% of all prescription drug spend Employee Company with $3.2 mm rx spend 2015 Specialty Drug Spend $800k 2020 Specialty Drug Spend $2.9mm Assumption 13% name brand medication trend

12 Case Study / 1200 Employees Label Name NDC Days Supply Claim Cost Member Payment Plan Payment SOVALDI TAB 400MG $170, $ $170, HUMIRA PEN KIT 40MG/ $72, $ $72, REBIF INJ 44/ $66, $ $65, GILENYA CAP 0.5MG $65, $ $65, HUMIRA PEN KIT 40MG/ $38, $ $38, HUMIRA PEN KIT 40MG/ $36, $ $36, HUMIRA PEN KIT 40MG/ $28, $ $27, TOBI PODHALR CAP 28MG $21, $ $21, ATRIPLA TAB $20, $ $20, ZENPEP CAP 25000UNT $19, $ $19, AMPYRA TAB 10MG $16, $ $16, ZENPEP CAP 25000UNT $15, $ $15, ENBREL SRCLK INJ 50MG/ML $14, $ $14, RENVELA TAB 800MG $12, $ $12, ENOXAPARIN INJ 80/0.8ML $12, $60.00 $12, FARESTON TAB 60MG $12, $ $11, HUMIRA PEN KIT 40MG/ $12, $75.00 $11, PENTASA CAP 500MG CR $11, $ $11, TRUVADA TAB $11, $ $11, TRUVADA TAB $11, $ $11, $667,457

13 Medication Costs 25% of the medications prescribed are Name Brand and Specialty medications these medications currently represent 75% of prescription spend.

14 PBM Industry There are 300 PBMs in the marketplace. 3 PBMs represent 76% of the market share. Express Scripts 33% CVS Caremark 26% Optum Catamaran 17%

15 PBM Industry Fortune 500 Rankings #12 CVS Caremark #20 Express Scripts Annualized Return to Investors CVS Caremark 15.9% Express Scripts 23.8% Total Return to Investors in 2013 CVS Caremark 50.3% Express Scripts 30.1%

16 Copay Assistance Sovaldi Medication Cost $84,000 Member OOP $ 3,000 Employer Cost $81,000 Copay Assistance Manufacturer gives member a $3000 coupon for OOP expenses Great solution for: Member Manufacturer PBM

17 Medication Non-Adherence Medication Non-Adherence in U.S. healthcare system Costs Up to $290 Billion Annually

18 Medication Non-Adherence The Functionally Un-Insured are growing at an Epidemic Rate and it s not by choice. Medication Non-Adherence is a Ticking Time Bomb

19 Medication Non-Adherence 20% of hospital and long term care facility admissions are related to medication nonadherence. The average cost of a 3-day hospital stay is about $30k.

20 Medication Non-Adherence 20% of an employer s population represent 80% of healthcare costs. 20% of an employer s population have at least 1 chronic condition and take 4 or more medications

21 Medication Non-Adherence 20% of first-time prescriptions are never filled 31% of prescriptions for chronic conditions are never filled (diabetes, high blood pressure)

22 Medication Non-Adherence IMPROVING PRESCRIPTION MEDICINE ADHERENCE IS KEY TO BETTER HEALTH CARE Researchers estimate that eliminating copayments for patients at medium to high risk of heart disease would improve adherence enough to avoid 90,000 hospitalizations and generate savings exceeding $1 billion.

23 Medication Non-Adherence Hidden Costs: Employees are not as productive Employees are absent more Increased disability claims Poor medical outcomes Rehiring costs $30,000

24 ScriptSourcing Risk Management Focus & Philosophy Assume Current Practice Assume, Assume, Assume Prevent Mitigate Transfer We Suggest Prevent, Mitigate, and Transfer

25 ScriptSourcing Risk Management Focus & Philosophy As a fiduciary of your health plan, why take risk that you do not need to? There are options that allow you to reduce risk reduce cost improve sustainability

26 ScriptSourcing Overspend Analysis Medication Cost Analysis 1200 Employees $3.2mm Rx spend Drug Overspend 2015 $1mm 2020 $1.8mm Assumption 13% name brand medication trend

27 ScriptSourcing Case Studies Example 1 Example 2 Hemophiliac Pulmonary Arterial Hypertension Kogenate SF Rx: $600k annual cost ScriptSourcing $540k annual savings Tyvaso Rx: $250k annual cost ScriptSourcing $184k annual savings

28 ScriptSourcing Prescription Advocacy We have developed a system in which Members receive medications for a $0 copay Employers realize 50-75% savings Medication non-adherence improves

29 ScriptSourcing Prescription Advocacy ScriptSourcing We source Name Brand and Specialty Meds We do not replace the PBM We do not charge administrative or set up fees

30 ScriptSourcing Prescription Advocacy ScriptSourcing Advocate Expertise Manufacturer Assistance Foundations Philanthropic Organizations Pharmacy Management Companies Private Rx Plans In most cases, medications are shipped directly one s home. In some cases, medications are shipped to the physician s office or pharmacy.

31 The Process is Simple Step 1: Member logs onto ScriptSourcing website and completes a short form to initiate prescription advocacy process Step 2: Advocate will contact member Step 3: Advocate will complete and submit all paperwork and obtain scripts from doctors and advise member when approved

32 ScriptSourcing Communications Together, we develop a communication strategy Customized employee announcements Face to face education Target mailings, s, texts Custom whiteboard videos Employee webinars Outbound calls

33 ScriptSourcing Implementation 1) Are you concerned about rising Rx costs? 2) Would you like to realize significant bottom line savings? 3) Provide us a Detailed Rx Report and we ll provide a Medication Savings Analysis.

34 ScriptSourcing s Simple 6 Step Process Analyze Detail RX Report Quantify Results Prepare Medication Cost Analysis Provide Prescription Advocacy Service Rx Formulary Consultation Develop Communication Strategy

35 scriptsourcing Ready to take the next step? 2014 Book Release Doing More With Less Featuring: Gary Becker Self-Insurance & Group Health Captives Seven Critical Strategies to "Bend the Healthcare Trend Gary Becker ScriptSourcing Owings Mills Boulevard, Suite 6A Owings Mills, MD 21117