Towards a New Model of Delivery of Care What can we do Different to Provide Better Delivery of Care? Algis Jovaisas, MD,FRCPC Division of Rheumatology University of Ottawa
Current Modelsurrent Private solo / group practise with /without own infusion center Academic sites - with/ without own infusion centre Patients may go to multiple different sites as their Meds change different Patient Support programs, contact person etc May be very different patient/physcian experiences s Meds or Staff change
Current frustrations 1. Change meds change support program access person, infusion site, 2. delay in access to change of Meds 3. Not all infusion sites, programs equal for many reasons 4.Fragmented Clinic Networks Patient,Rheum. Perspective 5.MTX teaching, TB testing, vaccinations, SC Injections( 30 % pts do not self-inject )
oone possible Strategy to Consider New national strategy of clinics 1. High standards of infusion location, access,administartion 2. one stop shopping for both patient and Physician from deciding on treatment option to access,paperwork,patient support,education that is independent of what Med is chosen, the same standard for all truly one simple route of access. 3. Provide pt. teaching, drug, disease, possible access to other AHP, MTX teaching, TB testing, Vaccination administration, drop in SC admin. As well as IV infusion 4. High degree of collaboration and work with Industry to streamline processes for all Provide a win win situation which is critical for success!
Physicians & SDMSHN Clinics Manufacturers 3 rd Party Payers & Gov.
The Market Global biologic spends: $200B by 2015
The Market Canada accounts for 2-3% of global pharmaceutical spends. Canadian Biological Market will be an est. $5.2B by 2015
Canadian Biologic Market Biologic Market 2015 forecast ($) Global 200,000,000,000 Canada (2.6% of Global) 5,200,000,000 IMS reported retail/hospitals (IMS 2012) 1,400,000,000 Unreported to IMS (Innomar, McKesson Specialty, SHN, Adjuvantz (BioScript)) 3,800,000,000
Capitalizing on market growth Growth is largely biotech and specialty
11 Administration Options for anti-tnfs in Canada SC Administration Adalimumab (Humira) 1 40 mg /every other week Golimumab (Simponi) 2 50 mg /monthly Etanercept (Enbrel) 3 50 mg /weekly Certolizumab (Cimzia) 4 400 mg weeks 0,2, and 4 followed by 200 mg /every other week IV Administration Infliximab (Remicade) 5 3 mg/kg at weeks 0, 2, and 6 then every 8 weeks thereafter Golimumab (Simponi) 6 2 mg/kg at Weeks 0 and 4, then every 8 weeks thereafter 1. HUMIRA Product Monograph. Abbott Laboratories, Limited. January, 2011. 2. SIMPONI Product Monograph. Janssen Inc. September, 2013. 3. ENBREL Product Monograph. Amgen Canada Inc. July 2012. 4. CIMZIA Product Monograph. UCB Canada Inc. July 2012. 5. REMICADE Product Monograph. Janssen Inc. September, 2013. 6. SIMPONI I.V. Product Monograph, Janssen Inc. November, 2013.
12 Reasons for Patients Preferences for SC and IV Routes of Administration Preference for SC Administration No need for traveling to the clinic No interference with daily life Personal ability to perform a SC injection Ease of use Perception of less aggressive treatment Preference for IV Administration Lower frequency of administration Perceived safety of clinic/hospital environment The reassuring effect of the presence of healthcare professional No need for drug preparation Anxiety of injections Scarpato S et al. Rheumatology (Oxford) 2010;49(2):289-294.
Top 10 Biologics in Canada
Pricing Landscape: $20,000/patient Product Manufacturer Program Name Administration Est # of Active Patients Cost / year Enbrel Amgen Enliven Injection 12,000 $18,900 Humira Abbvie Progress Injection 20,000 $18,388 Orencia BMS ORP Infusion 3,500 $18,600 Actemra Roche Joint Effort Infusion 2,500 $18,000 Rituxan RA Roche Joint Effort Infusion 3,000 $28,000 Remicade Janssen BioAdvance Infusion 12.000 Avg. $25,000 Simponi Janssen BioAdvance Injection/infusion 1,500 17,364 Stelara Janssen BioAdvance Injection 2,500 TBD Xeljanz Pfizer Oral N/A TBD Cimzia UCB Injection 1000 $17,277 Kineret Injection TBD $18,600
Seamless: From enrolment to administration to program Program to Patient Enrolled Reimbursed Scheduled into clinic Cold Chain Maintained Clinic to patient Administered Trained Rescheduled to pharmacy Pharmacy to clinic Purchased from distributor Dispensed Compounded Delivered directly to clinic
Key Ingredients to manage patient care safely Need a one-stop-program to manage reimbursement, patient logistics and product (Shoppers CARE) Need a distribution center to manage national cold chain product (Hubs) Need specialty pharmacy capable to dispense and compound biologics Need partnered specialists to supervise product administration, act as advocates for the patient.
17 Example of Product Storage The shelf-life of DRUG ABC is 24 months Store DRUG ABC refrigerated at 2ºC to 8ºC (36ºF to 46ºF) Keep the product in original carton until time of use to protect from light Do not freeze / do not shake Once the solution has been diluted Store at room temperature / protect from light Complete infusion within 6 hours of preparation
Key Biologic Specialties Specialists Rheumatologists Gastroenterologists Oncologists Ophthalmologists Dermatologists
Shoppers Clinic Specialty Network Strategy:
OPTH MS Rheum Building External Referral GI ONC DERM Partnered physician advocacy Specialist supervision Promote biologic clinic referral process Quality and Safety One-stop-shop program Reimbursement Co-pay management Product management Patient scheduling Support all biologic molecules Shaping health outcomes Promote to local Rheum, GI, Neuro, Derm and eventually cancer centers
Proposed Ottawa Model Ready to go soon Several Potential Partnering rheumatologists 1.8 kms from referring hospitals. 5000 sq ft. Consulting, infusion/injection and full compounding. Build compounding as part of store.
Are we the crazy ones?