Are Specialty Pharmacy Drugs Worth the Cost? How Companies Can Make Them More Affordable.
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1 Are Specialty Pharmacy Drugs Worth the Cost? How Companies Can Make Them More Affordable.
2 BACKGROUND Your Host: Eric Bricker, MD Co-Founder & Chief Medical Officer - Compass Professional Health Services Internal Medicine Physician - Johns Hopkins trained; Published research on diabetes care quality and hospital-acquired infections Prior Hospital Finance Consultant - Provider billing and revenue projects Blog - Won Ragan s Healthcare Best Blog Honorable Mention in 2013 and 2015 (compassphs.com/blog)
3 COMPASS SNAPSHOT Healthcare Navigation Redefined HQ: Dallas, Texas Founded: 2005 Employees: 258 Clients: ~2,000 Fee Model: Subscription (PEPM) Implementation: < 2 months Total Member Solutions: 1.35 million Utilization: 25%+ (5x industry avg.)
4 IN GOOD COMPANY Thousands of Companies Trust Compass TRAVEL MEDIA & COMMUNICATIONS RESTAURANTS RETAIL TECHNOLOGY MANUFACTURING REAL ESTATE ENERGY PROFESSIONAL SERVICES GOVERNMENT & EDUCATION HEALTHCARE PROFESSIONAL SPORTS
5 THE COMPASS HEALTHCARE NAVIGATION SOLUTION Compass Navigator. HEALTH PRO CLOUD APP Technology When You Want It. HEALTH PRO CONSULTANTS Expertise When You Needed It.
6 Are Specialty Pharmacy Drugs Worth the Cost? How Companies Can Make Them More Affordable.
7 THE ISSUE Rising Prescription Medication Spend One of the most common challenges employee benefits professionals face is Prescription Medication Spend Employer groups spend nearly 20% of overall healthcare budget on prescriptions Costs have increased 15% to 30% in the past year
8 THE ISSUE High Drug Costs The cost for these medications range from hundreds to thousands of dollars per month and treat a relatively small number of diseases, including: Autoimmune diseases Hepatitis C Diabetes Multiple Sclerosis Cancer Other (Asthma, Blood Clots, Macular Degeneration)
9 SOLUTIONS Ways to Lower Your Specialty Pharmacy Spend
10 LOWERING SPECIALTY PHARMACY SPEND How to Address Rising Drug Costs There are a number of clinical and nonclinical strategies for treating these conditions that may be more cost effective. It s important to explore these options, so we can help those in need and be good stewards of healthcare dollars. Healthcare professionals need to find a delicate balance between containing the cost of prescription medications and maintaining quality of care.
11 LOWERING SPECIALTY PHARMACY SPEND Get a Second Opinion You may want a second opinion from an outside pharmacy consultant. These medications may have alternative and/or options for Step Therapy. Just like for any surgery, it makes sense to ask for a second opinion on your medication, too.
12 LOWERING SPECIALTY PHARMACY SPEND Step Therapy Step Therapy involves using a less expensive medication before using a more expensive medication For example: A person may step up to the next medication only if the initial less expensive medication is not effective or has adverse/intolerable side-effects Each person is different and there is no one-sizefits-all approach to prescriptions There are logical progressions people should follow to be good stewards of their own money and their employer s money without sacrificing quality of care
13 LOWERING SPECIALTY PHARMACY SPEND Step Therapy: Things to Consider If less expensive drug results in a lower quality of care, it should not a candidate for Step Therapy. The Step Therapy approaches for the medications I ll discuss don t sacrifice quality of care. These Possible Earlier Step Alternatives are NOT the only alternative medications and other drugs may be preferable. This is a starting point for discussion with your PBM or pharmacy consultant.
14 TOP SELLING DRUGS DRIVING HEALTHCARE COSTS Humira # Worldwide Sales: $16 Billion Treats Rheumatoid Arthritis Possible Earlier Step Alternatives: Methotrexate, Hydroxychloroquine Treats Crohn s Disease and Ulcerative Colitis Possible Earlier Step Alternatives: Sulfasalazine, Mesalamine, Azathioprine
15 TOP SELLING DRUGS DRIVING HEALTHCARE COSTS Harvoni 2016 Worldwide Sales: $9 Billion #2 Treats (and cures) Hepatitis C # 2 Best to discuss treatment options with a specialist, per Mayo Clinic
16 TOP SELLING DRUGS DRIVING HEALTHCARE COSTS Enbrel # Worldwide Sales: $8.9 Billion Treats Rheumatoid Arthritis Possible Earlier Step Alternatives: Methotrexate, Hydroxychloroquine
17 TOP SELLING DRUGS DRIVING HEALTHCARE COSTS Rituxan 2016 Worldwide Sales: $8.6 Billion Treats certain types of Non-Hodgkin s Lymphoma Possible Step Alternatives: Other types of chemotherapy. Consult with physician Treats Chronic Lymphocytic Leukemia Possible Step Alternatives: Other types of chemotherapy. Consult with physician #2 # 4 Treats Rheumatoid Arthritis Possible Step Alternatives: Methotrexate, Hydroxychloroquine Treats Crohn s Disease & Ulcerative Colitis Possible Step Alternatives: Sulfasalazine, Mesalamine, Azathioprine
18 TOP SELLING DRUGS DRIVING HEALTHCARE COSTS Remicaid # Worldwide Sales: $7.8 Billion Treats Crohn s Disease and Ulcerative Colitis Possible Earlier Step Alternatives: Sulfasalazine, Mesalamine, Azathioprine
19 TOP SELLING DRUGS DRIVING HEALTHCARE COSTS Revlimid 2016 Worldwide Sales: $7 Billion Treats certain Multiple Myeloma Possible Earlier Step Alternatives: Other types of chemotherapy. Consult with physician #2 # 6
20 TOP SELLING DRUGS DRIVING HEALTHCARE COSTS Avastin # Worldwide Sales: $6.5 Billion Treats Metastatic Colon Cancer Possible Earlier Step Alternatives: Other types of chemotherapy. Consult with physician.
21 TOP SELLING DRUGS DRIVING HEALTHCARE COSTS Herceptin 2016 Worldwide Sales: $6.5 Billion Treats Breast Cancer (Human Epidermal Growth Factor Receptor 2 HER2 Positive) Possible Earlier Step Alternatives: Other types of chemotherapy. Consult with physician. #2 # 8
22 TOP SELLING DRUGS DRIVING HEALTHCARE COSTS Januvia # Worldwide Sales: $6.1 Billion Treats Type II Diabetes Possible Earlier Step Alternatives: Metformin, Glipizide, Glyburide
23 TOP SELLING DRUGS DRIVING HEALTHCARE COSTS Lantus 2016 Worldwide Sales: $6.0 Billion Treats Type I and II Diabetes Possible Earlier Step Alternatives: Many combinations of short, medium and longacting insulin exist. Consult with physician. # #2 10
24 TOP SELLING DRUGS DRIVING HEALTHCARE COSTS Prevnar # Worldwide Sales: $5.7 Billion Vaccine preventing only certain types of Pneumonia (not all types) Possible Earlier Step Alternatives: Potentially none
25 TOP SELLING DRUGS DRIVING HEALTHCARE COSTS Xarelto 2016 Worldwide Sales: $5.4 Billion Helps prevent blood clots in Atrial Fibrillation (A-Fib) Possible Earlier Step Alternatives: Warfarin (requires blood test monitoring), Pradaxa # #2 12
26 TOP SELLING DRUGS DRIVING HEALTHCARE COSTS Eylea # Worldwide Sales: $5 Billion Treats Wet Macular Degeneration Possible Earlier Step Alternatives: Avastin, Lucentis (also brand and potentially expensive)
27 TOP SELLING DRUGS DRIVING HEALTHCARE COSTS Lyrica 2016 Worldwide Sales: $5 Billion Treats Neuropathy/Neuropathic Pain Possible Earlier Step Alternatives: Gabapentin, Duloxetine, Capsaicin Cream # #2 14
28 TOP SELLING DRUGS DRIVING HEALTHCARE COSTS Neulasta # Worldwide Sales: $4.7 Billion Treats Low White Blood Cell Count (usually caused by chemotherapy) Possible Earlier Step Alternatives: Possibly none.
29 LOWERING SPECIALTY PHARMACY SPEND Key Takeaways 1) Specialty pharmacy costs continue to rise 2) One way to address these costs is through Step Therapy 3) Work with PBM and pharmacy consultant to explore effective options 4) Get a second opinion
30 COMPASS NAVIGATOR Complete Support Throughout Your Entire Journey Find Highly-Rated, Cost-Effective Providers Understand Health Benefits and Plans Coordinate Care Guide to the Right Programs at the Right Time Compare Costs for Procedures and Care Drive Lower Cost Rx Options Get Help with Medical Bills
31 Covers topics that matter to HR & benefits professionals: Employee health Health plan management Price transparency How to engage employees in their own health How to help employees effectively navigate the healthcare system Healthcare trends To receive a weekly with updated content, SUBSCRIBE here:
32 THANK YOU! To learn more about Compass Navigator please me at Follow Dr. Bricker at compassphs.com/blog
33 Eliminate the healthcare hassle and optimize your network with high quality, cost-effective care.
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