Donut Hole Analysis November 2014

Transcription

1 Medicare Part D Donut Hole Analysis November 2014

2 Symphony Health Solutions offers an array of Managed Markets Studies CONSULTING/ANALYTICAL STUDIES Managed Markets Landscape Dynamic Claims Lifecycle Data Primary/Final Payer Copay Card Monitoring Copay Card Optimization Segmentation Payer Prescriber Payer & Prescriber Leaky Bucket Analysis Medicare Part D Donut Hole Analysis ONLINE REPORTING TOOLS Market Profiler Access Investigator Dynamic Claims Lifecycle Analyzer Decision Flow ADDITIONAL SERVICES Ad-hoc Reports and data sets Data set subscriptions Executive Summaries Cloud Hosted Solutions

3 Medicare Part D Donut Hole Analysis leverages exclusive PayerSource data, providing best-inclass payer-focused data Exclusive Advantages Payer Visibility Price Sensitivity Brand Substitution Benefit Design Details Specialty/Mail Order Payer and MPD Patient Mix Contracting Analytics Physician Pull Through

4 Medicare Part D Donut Hole Analysis addresses key business questions related to product sales What percent of patient's enter into the Medicare donut hole and when? When do patient s tend to enter into the donut hole? Catastrophic coverage? How do patient s manage prescription therapy before and while within the donut hole? What do patients do with their prescriptions once they enter into the donut hole? What percent of patient's enter into catastrophic coverage, and when? How does the donut hole impact a brand s rebate spend? How do competitor brands react/perform when patients enter the donut hole?

5 PayerSource offers industry-leading coverage of Medicare Part D patients SHS has consistently added Medicare Part D patients year over year. SHS has not only added volume, but also increased the coverage percentage of total enrolled patients. In 2013, SHS captured 94% of enrolled patients. Patient Counts (in Millions) LIS-DUAL LIS-LTC LIS-NONDUAL STD MPD Patients Not Captured Through the Integrated Dataverse(IDV) Symphony Health Solutions maintains year over year linkage of patients, enabling tracking of patient behavior over time. Understand how the behavior between existing MPD and newly enrolled patients varies, signifying changes in the market dynamics. Total Medicare enrollment data from

6 Medicare Part D Analysis includes patient level insights to allow for accurate market assessment Patient level analysis identifies the mix of patients based on Medicare eligibility type (Standard Eligible, Dual Eligible, and Low Income Subsidy(LIS)) Also includes monthly analysis of where Standard Eligible patients are in the Medicare benefit cycle (receiving benefits, entering the coverage gap, exiting the coverage gap and entering the catastrophic coverage phase). 100% 90% 80% 70% % of Claims 60% 50% 40% 30% 20% 10% 0% Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Patient Count n=54,548 53,602 56,751 57,669 59,207 58,335 60,883 60,321 60,863 63,226 61,349 63,370 STD Catastrophic STD Coverage Gap STD Benefit Phase LIS - All Others LIS - Dual

7 Patient and Payer Level Insights within Medicare Part D Analysis support payer level analysis Provides market-specific information patient mix information, more specific than highlevel membership enrollment data. SHS analysis provides patient classifications for MPD which can be combined with the other payment types to fully understand the membership composition of your key accounts within each of your markets. ESI MEDICARE ENVISIONRX HEALTHFIRST WELLCARE MGMT GRP WELLPOINT CIGNA AETNA HUMANA UNITED CVS CAREMARK 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Commercial Mngd Medicaid LIS-DUAL LIS-LTC LIS-NONDUAL STD

8 Understanding the MPD patient mix is critical to optimizing pull through opportunities Dr. Davis and Dr. Garner have a similar payer mix with exactly the same MPD distribution Dr. Davis Chicago, IL 30% Commercial 10% Medicaid 60% MPD Traditional RX analysis would lead to similar pull through messages for Dr. Davis and Gartner With SHS patient level insights, messages can be targeted to doctors based on their specific MPD patient population Dr. Gartner Chicago, IL 30% Commercial 10% Medicaid 60% MPD 50% of Dr. Gartner s patients are subject to the Medicare part D Coverage Gap Standard Pts. 10% LIS Pts. 10% Dual Pts. 40% 90% of Dr. Davis Dual and LIS Payers have no restrictions for your Product Standard Pts. 50% LIS Pts. 8% Dual Pts. 2%

9 Medicare Part D Analytics DELIVERY OPTIONS PowerPoint Executive Summary Transactional Level Data Summarized Data FREQUENCY OPTIONS Monthly Quarterly Semi-Annual One Time Ad-Hoc OTHER OPTIONS National Medicare Level Geographical Cuts - State, CBSA, Territory or Physician Level MCO or Plan Level