HIV: The Great Debate On Clinical Approach Vs. Cost Considerations

Transcription

1 M E D I C A ID H E A L T H P L A N S O F AMERICA HIV: The Great Debate On Clinical Approach Vs. Cost Considerations Steve Miller, MD Chief Medical Officer October 2018

2 HIV IMPACT: 1.1M Americans affected 1 ~$20B annual Medicaid costs 2 1. Express Scripts 2017 Drug Trend Report. Express Scripts Centers for Disease Control and Prevention. HIV in the United States: at a glance. Last updated Aug. 6,

3 M O S T C O S T L Y T H E R A P Y C L A S S HIV contributes 16.8% of all pharmacy costs for Medicaid Medicaid HIV Spend PMPY $250 $200 $ % Trend between 2016 and 2017 Positive trend is due to unit cost. Utilization trend is negative. $100 $50 $ Source: Express Scripts 2017 Drug Trend Report 3

4 Prevalence of HIV treatment is steady Medicaid patients -1.4% treated for HIV per 10,000 members between 2015 and 2017 Excludes pre-exposure prophylaxis (PrEP) therapy

5 Medication nonadherence is a concern, especially among younger people Single-tablet HIV regimen Multi-tablet HIV regimen 5

6 HIV therapy innovation is better for patients, but more complex to manage HIV Medications By Therapy Type, Cost and Date of Introduction 6

7 HIV-related complications raise healthcare burden WITH COMPLICATIONS WITHOUT COMPLICATIONS TOTAL MEDICAL TOTAL PHARMACY TOTAL HEALTHCARE $38,779 $8,096 $36,807 $28,159 $75,586 $36,255 COMPLICATIONS DOUBLED HEALTHCARE COST FOR 7.7% OF PATIENTS IN

8 THE RIGHT REGIMEN LEADS TO HEALTHIER OUTCOMES Undetectable viral load Increased ability to fight infections Decreased risk of transmission to others Decreased resistance Longer, fuller life 8

9 Treating HIV is complicated Six classes of antiretroviral therapy. Each targets HIV in a different way. Most patients require at least three types of therapy from two of the six classes. STRICT ADHERENCE IS CRITICAL. But tracking multi-tablet regimens is a challenge 9

10 WE CAN DO A BETTER JOB OF MEASURING HIV ADHERENCE AND VALUE 10 10

11 Multi-tablet regimen is more prevalent in Medicaid than commercial populations PLAN TYPE THERAPY STATUS STR MTR Commercial Continuous 72.5% 27.5% New 70.4% 29.6% Medicaid Continuous 58.7% 41.3% New 62.7% 37.3% 95.4% OF MEDICAID PATIENTS BEING TREATED FOR HIV ARE NOT NEW TO TREATMENT 11

12 One example: Cost of single-tablet regimen Vs. multi-tablet regimen Patient 1: STR Patient 2: MTR $2,381 per month Odefsey (emtracitabine/rilpivirine/ tenofovir alafenamide) Descovy (emtracitabine/ tenofovir alafenamide) Edurant (rilpivirine) $1,485 per month $929 per month Total: $2,414 per month 12

13 Higher adherence makes single-tablet regimen a greater value for patients and plans Average per-patient HIV pharmacy plan cost, 2017 Single-tablet regimen Multi-tablet regimen 13

14 FUTURE HIV COSTS AND CASES CAN BE AVOIDED BY REDUCING TRANSMISSION 14

15 PrEP is steadily rising across plan types, but still is underutilized Patients using PrEP and Treatment PrEP Treatment 15

16 Total healthcare costs are 6.5x higher for people with HIV HIV TREATMENT PReP TREATMENT NO HIV TOTAL MEDICAL TOTAL PHARMACY TOTAL HEALTHCARE $10,122 $4,870 $4,649 $28,783 $13,594 $1,577 $38,905 $18,464 $6,226 NEARLY 30% OF COSTS FOR PEOPLE WITH HIV ARE RELATED TO COMORBIDITIES 16

17 COMMERCIAL MARKET More people on HIV therapy in the Southeast HIV Treatment Prevalence of Use (Number of patients per 10,000 members) 17

18 COMMERCIAL MARKET PrEP use doesn t align with areas of most risk HIV PrEP Prevalence of Use (Number of patients per 10,000 members) 18

19 Takeaways 1 Higher HIV medication costs are driving up Medicaid spend 2 Medication adherence is critical for avoiding viral resistance, poor patient health and higher downstream medical expense 3 Maximizing use of single-tablet and PrEP HIV therapies where clinically appropriate drives greater value in Medicaid plans and better health outcomes for patients FULL REPORT AVAILABLE SOON. Visit 19