Specialty pharmaceuticals

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Specialty pharmaceuticals - Description

Christina Hansen, . pharm.d. CHARACTERISTICS. Treat complex and rare disease states. RA, Cancer, Crohn’s, MS. More expensive . Distribution restrictions . Special handling requirements. Continuous monitoring. ID: 408313 Download Presentation

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Specialty pharmaceuticals




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Presentations text content in Specialty pharmaceuticals

Slide1

Specialty pharmaceuticals

Christina Hansen,

pharm.d

Slide2

CHARACTERISTICS

Treat complex and rare disease statesRA, Cancer, Crohn’s, MSMore expensive Distribution restrictions Special handling requirementsContinuous monitoring

Slide3

characteristics

Biologics or medications complex to manufactureROA – injectables, infusions, oralMore costlyRarely any low-cost generic equivalents

Slide4

background

<1% written prescriptions2013 - 27% of US total pharmacy spending2017 – estimated to be 50% (per Express Scripts)Specialty pharmaceuticals interest biopharmaceutical companies in the innovative and business perspective

Slide5

PCSK9 inhibitors

Praluent (alirocumab)

PCSK9 inhibitorPSCK9 is a protein that promotes degradation of LDLR receptors. Inhibits PCSK9 from binding to LDLR receptors on surface of liver cells – allows more LDL-C to bind and be cleared from liverSingle injection every 2 weeksApproved by FDA 07/2015Price: $1,120 every 28 days

Repatha (Evolocumab)

PCSK9

inihibitor

PSCK9 is a protein that promotes degradation of LDLR receptors. Inhibits PCSK9 from binding to LDLR receptors on surface of liver cells – allows more LDL-C to bind and be cleared from liver

Single injection given every 2 weeks or once monthly

Approved by FDA

08/2015

Price: $1300 per 28 days

Slide6

Hepatitis C Treatments

SOVALDI (sofosbuvir)

Treatment of Hepatitis CAttaches to RNA and prevents virus from replicatingTreatment duration- 12-24 weeks (depending on genotype diagnosed)Combination therapy – 1 pill dailyApproved by FDA 12/2013Price: $30,000/28 tablets

Harvoni (Ledipasvir/sofosbuvir)

Treatment of Hepatitis C – genotype 1

Targets

Hep

C virus to prevent replication

Treatment duration – 12 weeks

Single therapy – 1 pill daily

Approved by FDA 10/2014

Price: $38,000 per 28 tablets

Slide7

Impact of higher prices on patients

Patient Non-compliance – increased patient expense is associated with

Decreased rates of initiating medication therapy

Lower adherence rates

Increased patient discontinuation of therapy

Patient may or may not look for alternative – depending on disease state, may incur more physician visits, ER/hospital bills

Slide8

Specialty pharmacies

Typically owned by retail pharmacies or PBMs

May dispense medications

Biggest asset – patient support services on a per month basis

Compliance

Patience assistance

Tolerance of medication

Refill requests

Slide9

Tools for managing costs

Prior authorization/step therapy

Reference guidelines for treatment pathways

Physicians typically do not know how much medication costs!

Copayment/coinsurance

Incentivize patients to try preferred or generic alternatives with lower copays

Directed networks for physician and service care

Slide10

Intervention strategies

Change payment policies

“buy and bill” – physicians are paid a percentage of the cost of medication – incentivizing them to write for more expensive medications

Reimburse drug acquisition cost and flat fee (depends on therapeutic class) instead of a percentage

Reimbursement model could incentivize patients based on ROA and site of care

Self-injectable medicine available that is as effective and less expensive as one administered in physician office

Infusion or injection at physician clinic vs hospital setting

Utilization of specialty pharmacies adherence programs have the potential to improve outcomes and reduce costs

Slide11

Intervention Strategies

Financial incentive to those providers that use equally effective and more cost-effective therapy, if there is one

United

Healthcare piloting model reimbursing 100% drug acquisition cost to oncologist groups adhering to pathways for 85% of UHC patients

Exceptions for medical contraindications and clinical trial

enrollment

Wellpoint

, Inc., paying incentives to in-network oncologists for following the

clinical pathway

Promotes use of therapies that are best for patient – quality of care and best outcomes

Slide12

Value-based insurance design

15 years in the making with University of Michigan Center for Value-Based Insurance Design (V-BID) and National Pharmaceutical

Councel

(

NPC)

V-BID

makes high-value providers and the services they offer more accessible and discourages use of those that are of lower value, aligns patient out of pocket costs with value of services

Focus

on how smart you spend healthcare dollars vs dollar

amount

Cost-sharing ideas:

Modest cost-sharing on specialty medications for common chronic disease states

– encourage

compliace

Specialty meds showing benefit in a group of

patients,

decrease cost-sharing for those who may benefit

Failure on preferred medication (lower generic alternative

)

Differential cost sharing to incentivize patients to see better

providers

Slide13

Other avenues of cost-saving

YOUR EMPLOYEES HAVE MAJOR IMPACT ON HEALTHCARE DOLLARS SPENT!!

KEEP A HEALTHY EMPLOYEE HEALTHY!

Wellness Programs:

Offer gym memberships

Weight management plans

Smoking cessation

Healthy lifestyle

strategies

Slide14

Why is this important?

Loeppke

and colleagues in a 2009 analysis showed the cost to employers for employees off work due to illness is 2.3 times as much as the cost of medical and pharmacy spending combined

Well documented that cost-related non-compliance with certain disease states is associated with increased morbidity and mortality

Slide15

conclusions

Specialty medications will continue to be scrutinized by payers in the coming years due to their expensive nature, increased need for use and burgeoning pipeline.

11 new biologics have been approved by the FDA in

2015, and all new medications start out very expensive

Payers have to be aware of how high cost-sharing can impact adherence, health, productivity and financial well-being among patients that use specialty medications.

Knowledge of guidelines and pathways can aid in formulary

design

It isn’t always about how much you are spending, but the potential outcome and savings you may incur from that spending.

Slide16

References

Hagerman, J, et al. “Specialty pharmacy: A unique and growing industry”. Pharmacy Today. 1 Jul 2013.

http://www.pharmacist.com/specialty-pharmacy-unique-and-growing-industry

Spatz

, I, et al. “Health Policy Brief: Specialty Pharmaceuticals. Complex new drugs hold great promise for people with chronic and life-threatening conditions. The drugs are also a driver of spending growth”. Health Affairs. 25 Nov 2013.

http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=103

.

Johnson, K. “Current trends in specialty drug utilization and management Payer interventions in the shadow of a burgeoning pipeline”. 4 Jul 2013.

http://formularyjournal.modernmedicine.com/formulary-journal/content/tags/specialty-drugs/current-trends-specialty-drug-utilization-and-managem?page=full

Jacobs, M, et al. “Curbing the Costly Trend: Exploring the need for a Progressive Approach to the Management of Specialty Pharmaceuticals Under the Medical Benefit”. American Health and Drug Benefits. Jul/Aug 2012.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046456

/

.

Burns, J. “Here’s why specialty pharmaceuticals need value-based insurance design”. Association of Health Care Journalists. Jun 2014.

http://healthjournalism.org/blog/2014/06/heres-why-specialty-pharmaceuticals-need-value-based-insurance-design

/

.

Slide17

References

Barlas

, S. “Are Specialty Drug Prices Destroying Insurers and Hurting Consumers?”. P&T. Aug 2014.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4123806/

.

Duffant

, B, et al. “Overview of the Specialty Drug Trend. Succeeding in the Rapidly Changing U.S. Specialty Market”. IMS Health. 2013.

https://www.imshealth.com/deployedfiles/imshealth/Global/North%20America/United%20States/Managed%20Markets/5-29-14%20Specialty_Drug_Trend_Whitepaper_Hi-Res.pdf

.

University of Michigan Center for Value-Based Insurance Design. “Supporting Consumer Access to Specialty Medications through Value-Based Insurance Design”. 11 Oct 2014.

http://vbidcenter.org/june-2014-issue-brief/10897/

.

University of Michigan Center for Value-Based Insurance Design. “Specialty Pharmaceuticals and Value-Based Insurance Design”. Jul 2014.

http://vbidcenter.org/wp-content/uploads/2014/07/Specialty-Pharmaceuticals-one-pager.pdf

.

Fendrick

, A, et al. “Supporting Consumer Access to Specialty Medications Through Value-Based Insurance Design”. Oct 2014.

http://vbidcenter.org/wp-content/uploads/2014/10/vbid-specialty-medications-npc2014-final-web.pdf

.

Therapeutics Research Center. “New Drugs Approved by the FDA in 2015. Pharmacists Letter. 2015.

http://pharmacistsletter.therapeuticresearch.com/pl/NewDrugs.aspx?cs=&s=PL&pt=20

.

Slide18

References

https://www.acponline.org/clinical_information/guidelines/guidelines

/

http://www.guideline.gov

/

https://

www.repatha.com/

https://www.harvoni.com/

https://www.praluent.com/

https://www.sovaldi.com/

Slide19

Thank you

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