Specialty conditions overview

Transcription

1 Specialty conditions overview Prevalence and cost Click on the vials to learn more about these specialty conditions. 1. Approximate annual AWP cost per patient of top utilized drugs for UHC calendar year 2014/2015.

2 Growth hormone deficiency A condition in which there is inadequate secretion of growth hormone from the anterior pituitary gland. 40K 65K 4.19 both long and short term

3 Growth hormone deficiency A condition in which there is inadequate secretion of growth hormone from the anterior pituitary gland. Total drug cost by benefit Pharmacy only (100%) Medical + pharmacy Medical only 100% Multiple medications have the same active ingredient Top three medications * : Nutropin Saizen Genotropin 40K 65K 4.19 both long and short term Growth hormones are primarily used by children

4 Hemophilia A bleeding disorder that prevents the blood from clotting properly. 400K 750K 0.85 long term 2. Hemophilia Data & Statistics. Centers for Disease Control and Prevention. CDC, 26 Aug Web. 22 Sept. 2014

5 Hemophilia A bleeding disorder that prevents the blood from clotting properly. Total drug cost by benefit Pharmacy only (81%) Medical + pharmacy (5%) Medical only (14%) Severity varies: 60% have severe hemophilia 25% have mild hemophilia 15% have moderate hemophilia Top three medications * : Advate Kogenate Recombinate 400K 750K 0.85 long term Either on-demand (as needed) or preventive treatment 20,000 Americans affected 2 xx x x x 2. Hemophilia Data & Statistics. Centers for Disease Control and Prevention. CDC, 26 Aug Web. 22 Sept. 2014

6 Hepatitis C A chronic infection that can cause severe liver disease and is a common reason for needing a liver transplant. 95K 150K of drug therapy short term for UHC calendar year 2014/ Hepatitis C Fact Sheet. Centers for Disease Control and Prevention Department of Health & Human Services. June June 2, 2015.

7 Hepatitis C A chronic infection that can cause severe liver disease and is a common reason for needing a liver transplant. Total drug cost by benefit Pharmacy only (100%) Medical + pharmacy Medical only 100% Top three medications * : Harvoni Olysio Sovaldi A 12-week treatment of Harvoni costs approximately 94, K 150K of drug therapy ,000 Americans become infected each year 2 short term Treatment can range from 8 24 weeks 3.2 million Americans infected, most are unaware 2 for UHC calendar year 2014/ Hepatitis C Fact Sheet. Centers for Disease Control and Prevention Department of Health & Human Services. June June 2, 2015.

8 HIV Human immunodeficiency virus (HIV) attacks the cells of the immune system so that it can t fight off infections and disease. Advanced stages of HIV can lead to acquired immunodeficiency syndrome (AIDS). 30K 40K long-term 2. Accessed May, 2015.

9 HIV Human immunodeficiency virus (HIV) attacks the cells of the immune system so that it can t fight off infections and disease. Advanced stages of HIV can lead to acquired immunodeficiency syndrome (AIDS). Total drug cost by benefit Pharmacy only (100%) Medical + pharmacy Medical only 100% Single tablet regimens exist today; there are multiple options Top three medications * : Atripla Truvada Striblid 30K 40K long-term A combination of drugs is used for the best control. Almost all therapies are oral. There are some generics. 1.2 million Americans affected Accessed May, 2015.

10 Inflammatory conditions Inflammatory conditions include rheumatoid arthritis, Crohn s disease and psoriasis. They occur when the body attacks healthy tissue and cells, causing excessive and painful inflammation. 40K 65K long term 2. Questions and Answers About Rheumatic Diseases. National Institute of Arthritis and Musculoskeletal and Skin Diseases, Apr Web. 23 Jul 2014.

11 Inflammatory conditions Inflammatory conditions include rheumatoid arthritis, Crohn s disease and psoriasis. They occur when the body attacks healthy tissue and cells, causing excessive and painful inflammation. Total drug cost by benefit Pharmacy only (70%) Medical + pharmacy (3%) Medical only (27%) Top three medications * : Enbrel Humira Remicade 40K 65K The #1 pharmacy and #2 medical benefit specialty category * long term Most therapies are injections, some are now orals. 46 million Americans affected 2 2. Questions and Answers About Rheumatic Diseases. National Institute of Arthritis and Musculoskeletal and Skin Diseases, Apr Web. 23 Jul 2014.

12 Multiple sclerosis Multiple Sclerosis (MS) is a condition in which the immune system attacks the protective sheath (myelin) of the nerves. This disrupts the flow of information within the brain, and between the brain and body. 65K 75K long term 2. FAQs about MS. National MS Society. National Multiple Sclerosis Society, n.d. Web. 22 Jan

13 Multiple sclerosis A condition in which the immune system attacks the protective sheath (myelin) of the nerves. This disrupts the flow of information within the brain, and between the brain and body. Total drug cost by benefit Pharmacy only (88%) Medical + pharmacy (4%) Medical only (9%) Top three medications * : Copaxone Tecfidera Tysabri 65K 75K The #2 pharmacy and #5 medical benefit specialty category * long term Most therapies are injections, some are now orals. 2. FAQs about MS. National MS Society. National Multiple Sclerosis Society, n.d. Web. 22 Jan

14 Oncology Cancer is the general name for a group of more than 100 diseases which start when mutations damage cellular DNA. Freed from their natural life cycle, damaged cells can grow in an unrestricted way that can form tumors and spread. 2 50K 100K for UHC calendar year 2014/ American Cancer Society: What Is Cancer? Available at: cancer.org/cancer/cancerbasics/what-is-cancer. Accessed 02/10/ American Cancer Society. Cancer Facts & Figures National Cancer Institute. Questions and Answers: Annual Report to the Nation on the Status of Cancer, gov/newscenter/newsfromnci/2013

15 Oncology Cancer is the general name for a group of more than 100 diseases which start when mutations damage cellular DNA. Freed from their natural life cycle, damaged cells can grow in an unrestricted way that can form tumors and spread. 2 Total drug cost by benefit Pharmacy only (20%) Medical + pharmacy (20%) Medical only (60%) Top three medications * : Rituxan Avastin Herceptin 50K 100K+ Lifetime risk of cancer in US: 4 1 in 3 women 1 in 2 men More than 1.6 million Americans diagnosed in for UHC calendar year 2014/ American Cancer Society: What Is Cancer? Available at: cancer.org/cancer/cancerbasics/what-is-cancer. Accessed 02/10/ American Cancer Society. Cancer Facts & Figures National Cancer Institute. Questions and Answers: Annual Report to the Nation on the Status of Cancer, gov/newscenter/newsfromnci/2013

16 PAH Pulmonary arterial hypertension (PAH) causes stress on the heart due to increased blood pressure in the pulmonary arteries. 25K 100K 1.39 for UHC calendar year 2014/ Peacock AJ, Murphy NF, McMurray JJV, et al. An epidemiological study of pulmonary arterial hypertension. Eur Respir J 2007;30:104 9.

17 PAH Pulmonary arterial hypertension (PAH) causes stress on the heart due to increased blood pressure in the pulmonary arteries. Total drug cost by benefit Pharmacy only (65%) Medical + pharmacy (25%) Medical only (10%) Top three medications * : Letairis Tracleer Remodulin 25K 100K Most members start on oral medications but, depending on severity, switch to multiple medications including infusions and inhaled and oral treatments long term With no cure, treatment focuses on decreasing symptoms and improving quality of life affected per million 2 for UHC calendar year 2014/ Peacock AJ, Murphy NF, McMurray JJV, et al. An epidemiological study of pulmonary arterial hypertension. Eur Respir J 2007;30:104 9.