Magellan Rx. A smarter approach to pharmacy benefits management

Transcription

1 Magellan Rx A smarter approach to pharmacy benefits management Presented by: Cheri Caruso, VP of Sales, Magellan Rx Management Bryce Canfield, VP, Client Development, GoodRx

2 A unique vision of care We have a unique vision of better and more affordable care in the fast-growing, highly complex and high-cost areas of healthcare.

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4 Solving Pharmacy Challenges while Focused on the Whole Member Medical Data Biometric Data Pharmacy Data Lab Data Our solutions leverage integrated data to identify gaps in care, increase adherence and improve outcomes resulting in lower medical trend 4

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6 Pharmacy/PBM Trends Cost pressure has led to more restrictive formularies Trending strategies for high cost therapies (Hep C, PCSK9) Oncology cost management trends Orphan drug approvals Specialty Rx costs continue to rise Generic price inflation Specialty drug approvals continue to climb Introduction of Biosimilars 6

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8 8 Source: Specialty Pharmacy Solutions, LLC

9 Drug Categories Driving Trend Categories 2014 Total ($) 2020 Total ($) Change Oncology 30.6B 73.8B 241% Autoimmune 18.5B 28.8B 56% Hep C 12.5B 10.7B -15% Multiple Sclerosis 12.4B 13.5B 9% HIV 10.3B 13.6B 32% Hemophilia 3.3B 4.5B 37% IVIG 2.6B 3.3B 28% New cholesterol drugs: PCSK9s - 3.5B Cancer Indication 2014 Total ($) 2020 Total ($) Change Expected increase is $43.22 billion; $24.6 billion will come from pipeline drugs Non-small cell lung cancer (NSCLC) 3.1B 11.8B 381% Breast cancer 3.8B 10.3B 273% Non-Hodgkin lymphoma (NHL) 3.8B 7.6B 201% Multiple myeloma 4B 7.4B 185% Leukemia, chronic lymphocytic (CLL) 1.2B 4.9B 398% Melanoma 784M 4.4B 560% 9 Source: 2015, EvaluatePharma, Evaluate Ltd,

10 Magellan Rx Specialty Total Specialty Drug Management 10

11 11 *includes Post Service Claims Edit (PCSE) Program, Fee Schedule Program, Utilization Management Services, Quality Review Program, Specialty Distribution

12 Experts in Medical Pharmacy Management National Experience Cost Savings Quality of Care Over 12 years experience managing Medical Pharmacy Over 10 million lives managed under our Medical Pharmacy and oncology management programs Extensive experience with multiple national &regional health plans across the country Saving payers an average of $17M per million covered lives through comprehensive Medical Pharmacy programs Overall program savings of 12 20% Includes management of support drugs that make up 25 30% of total costs Remove barriers from physician selection of lower cost, clinically equivalent alternative agents Eliminate inappropriate usage Quality ensured with claims rules for maximum dose, eligible diagnosis and therapy duration Managing the most expensive and rapidly growing portion of the specialty spend with an integrated approach across both medical and pharmacy benefits. 12 Autoimmune Diseases Cancer Immunodeficiencies (IVIG) Multiple Sclerosis Osteoporosis Osteoarthritis Age-Related (wet) Macular Degeneration Inborn Errors of Metabolism & Rare Diseases Pulmonary Arterial Hypertension Hemophilia Alpha-1-antitrypsin deficiency Hereditary Angioedema Musculoskeletal Conditions Cystic Fibrosis Asthma Respiratory Syncytial Virus Prevention 12

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14 Magellan Rx Cares Clinical Care Management Disease States Managed Multiple Sclerosis Hepatitis C Hemophilia Oral Oncology Rheumatoid Arthritis Psoriasis Psoriatic Arthritis Human Immunodeficiency Virus Planned Disease State Expansion RSV prophylaxis Osteoporosis Transplant medications IV Oncology Pulmonary Arterial Hypertension Hereditary Angioedema An interactive, high touch, clinical coaching program helping patients manage their specialty therapies to drive adherence and improve outcomes. Following evidence based guidelines, highly trained nurses provide education and support to enhance patient understanding and appropriate use of medications, while motivating patients to set personal goals and monitoring for success. MPR is on average 5% higher for patients enrolled in Magellan Rx Cares than patients not enrolled and 11% higher than the national average Crohn s disease/ulcerative colitis Hypercholesterolemia (PCSK9) 14 *Medication Possession Ratio (MPR) = the amount of medication patient has on hand vs. the amount of medication they should have on hand at time of next dispense.

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16 Optimal Patient Engagement through Technology Customized video with information about the specific medication, dosage and how to administer Available right on your prescription to scan anytime you want more information on your medication Available in English and Spanish, videos provide comprehensive information on top-prescribed medications, including proper usage, expected benefits and potential side effects 16

17 17 On-demand access to additional prescription information and health/wellness resources

18 A unique vision of care We have a unique vision of better and more affordable care in the fast-growing, highly complex and high-cost areas of healthcare.

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