Specialty Pharmacy: Understanding the Market and Solution. Your Goals. Presented by Chris Brown November 2009

Transcription

1 Specialty Pharmacy: Understanding the Market and Solution Presented by Chris Brown November 2009 Your Goals What What is a Specialty is a specialty Medication? medication? Specialty drugs are injectable, infused, oral or inhaled drugs defined as having one or more of several key characteristics Requires frequent dosing adjustments and intensive clinical monitoring to decrease potential for drug toxicity and increase probability for beneficial treatment outcomes Need for intensive patient training and compliance assistance to facilitate therapeutic goals Limited or exclusive product availability and distribution Specialized product handling and/or administration requirements Cost in excess of $500 for a 30-days supply

2 What are Specialty Medications? Everything is more complex with Specialty Clinically complex and very expensive Manufacturing Research Legislation Special handling and distribution Complex administration and dosing regimens Side effects Complex monitoring and education March 2009 Examples of Common Specialty Medications Hepatitis C: Pegasys, Infergen, Peg Intron, Ribavarin Inflammatory Conditions (RA): Enbrel, Humira, Kineret Growth Deficiency: Genotropin, Humatrope, Nutropin RSV Prevention: Synagis Multiple Sclerosis: Avonex, Betaseron, Copaxone Oncology/Cancer: Aranesp, Promacta, Gleevec, Revlimid, Herceptin, Sandostatin, Hycamtin, Sutent, Hycamtin, Oral Tarceva, Intron, Tasigna, Neulasta, Temodar, Neupogen, Thalomid, Nexavar, Theracys, Ondansetron, Tykerb, Procrit, Xeloda, Zoladex A Closer Look at the Manufacturing Process 6

3 Specialty Is Outpacing the Benefit Specialty is Outpacing the Benefit 2008 Specialty = 21% 2012 Specialty = 25% $61 B $230 B $89 B $267 B Traditional pharmacy Specialty pharmacy Over 630 Biologics In Development in 2008 Pipeline & New Drugs are Key Growth Drivers New Drug Approvals Rose in 2008 Small Patient Base Driving High Expense Rare disease, acute complex, or multiple comorbidities $50,000 Chronic conditions and/or procedures $10,000 Well, acute conditions, or lowgrade chronic $1,000 Medical Care 41:1153, 2003

4 10 Oncology Spend Historical and Future $ (billions) +14% 44 years 6 years Source: Cancer Facts and Figures 2008, Atlanta GA; National Cancer Institute Cost of Cancer Care, 2004, National Cancer Institute SEER incidence million new cancer cases > 560,000 cancer deaths Second leading cause of death 2 559,888 (23.1%) deaths in 2006 Lifetime Probability of Developing Cancer 1 in 3 women & 1 in 2 men Survival rate for all cancer 1 68% over five years Costs of $219 billion in Cancer Quick Facts 1 American Cancer Society US Mortality Data 2006, National Center for Health Statistics, Centers for Disease Control and Prevention, NIH, Who Are Specialty Patients? Anemia Cancer Growth Deficiency Hemophilia Hepatitis Infertility Multiple Sclerosis Pulmonary HTN Rheumatoid Arthritis Many others

5 A Crash Course in Multiple Sclerosis (MS) MS is a neurological disease with no known cure Affects the brain and spinal cord damaging the myelin sheath Most common in younger women years of age Symptoms Usually, the disease is mild, but some people lose the ability to write, speak or walk Visual disturbances Muscles weakness Trouble with coordination and balance Sensations such as numbness, prickling, or "pins and needles" Thinking and memory problems Unknowns: etiology, course, cure? 13 MS from a Daughters Perspective I'm not sure what to do anymore! My ma has had MS for 8 years now Just over a year ago, she had a REALLY bad attack, and still isn't fully recovered. I know sometimes you don't always fully recover, and she keeps saying, I'm just waiting to feel normal. And as much as it breaks my heart, this might be her new normal. She has her good and bad days On her bad days she's BAD. I was laid off my job about the time she had the attack, so I've been basically her care taker. I drive her around when she can't. I take care of the house now. she's frustrated and I'm pretty sure she's depressed, though she says she's not.. I always say it's hard, and I feel stupid when I say it cuz I'm not the one with MS, but it's hard watching my mother be a completely different person than she used to be Oncology Consider someone you know Diagnosis/prognosis Treatment How was their life affected? What kind of support did they need? 15

6 The Value of Patient Management A Different Approach is Needed Retail Pharmacy Cross coordination between all departments Confidential deliveries at any location Proactive refill compliance, risk assessment, and inventory management Access to licensed clinicians 24 hours a day Targeted education, adherence coaching, and side effect management How to manage increasing Specialty trend Patient admission and benefit verification Initial clinical assessment Disease-specific clinical pathway Patient care coordination Ongoing clinical assessment and interventions The High Touch Model Provides the best care for our patients

7 Patient Care Model in Action Cross coordination between all departments to provide the patient with the best care Patient receives confidential deliveries at the location of their choice Proactive refill compliance, risk assessment, and inventory management Access to licensed clinicians 24 hours a day Targeted education, adherence coaching, and side effect management to improve clinical outcomes Coordination with physicians, as necessary, for high-risk or noncompliant patients Leverage Traditional PBM Tools Step 1 Channel Management CuraScript for all fills Limit courtesy fills Comprehensive Communications for all programs Step 2 Optimize Benefit Design 30 Days Supply Copays support formulary Prior Authorization DQM Step 3 Medical Benefit Management Strategies Medical Carve-out CareContinuum Much is Hidden Today Specialty Spend PMPY Spend Specialty in Medical** $ Specialty in Pharmacy* $98.77 Total Spend $ Medical 55% Pharmacy 45% % Specialty in Pharmacy 45% * Express Scripts Drug Trend Report **Source: MarketScan Commercial Database 21

8 Market Overview 22 Source: Journal of Managed Care Medicine; Vol. 10, Nu 2 Medical Benefit vs. Pharmacy Benefit Third Step Create Appropriate Strategies Outside of Pharmacy Benefit Care Continuum Fertility Physician Office Oncology Home Infusion Outpatient Clinic

9 Three Steps to Manage Specialty Trend Five Five Fast Fast Facts Facts FACT #1: Specialty medications treat chronic and complex conditions such as hepatitis C, multiple sclerosis and rheumatoid arthritis FACT #2: Specialty pharmacy is a rapidly growing and critical component of healthcare FACT #3: Specialty pharmacy patients receive a higher level of personal care, service and value FACT #4: Specialty pharmacy offers a wide range of services that are not available at retail or home-delivery pharmacies FACT #5: The marketplace continues to evolve learnings are applied to best bend the trend and provide optimal patient care Thank you Thank you! 2009 Proprietary and Confidential. CuraScript is an Express Scripts Company. 27