Walgreens Enterprise Specialty Pharmacy

Transcription

1 Walgreens Enterprise Specialty Pharmacy Chris Creamer Senior Director, Specialty Operations August 17, 2017 Member of Walgreens Boots Alliance

2 Core objectives for today at a glance Discuss the Key Market Drivers for Specialty Explore Walgreens Enterprise Specialty Assets Examine a Differentiated Multi- Channel Option 2

3 Specialty Pharmacy Market Landscape

4 Specialty medication utilization and expenditures are rapidly growing Spending reached $121B 1 Approximately 50 percent of the total new drugs approved by the FDA specialty drugs currently in development 3 Potential 25 per year to be LDDs 4 Projected to account for 50 percent of U.S. drug spend 5 Expected 171 million chronically ill patients LDD=limited-distribution drug. Specialty pharmaceuticals 1. Aitken M. Medicines Use and Spending in the US: A Review of 2015 and Outlook to Parsippany, NJ: IMS Institute for Healthcare Informatics; April Chandanais R; for Diplomat Clinical Services. Specialty drug approvals: 2015 highlights and predictions. Published Health Research Institute. Medical cost trend: behind the numbers Published June Accessed August 30, Walgreen Co. Data on file; CVS Health. Specialty pipeline: blockbusters on the horizon. Insights Executive Briefing. 2016;5. 6. Robert Wood Johnson Foundation, Johns Hopkins Bloomberg School of Public Health. Chronic care: making the case for ongoing care. Robert Wood Johnson Foundation Web site. Published February Accessed August 31,

5 U.S. specialty drug spend is predicted to more than double between 2016 and $192.2B $192.2B $401.7B 109% increase from PwC Health Research Institute. Medical cost trend: behind the numbers Published June Accessed February 20,

6 What you spend to manage specialty patients goes far beyond your contractual drug cost Drug costs 1 Wasted drugs Poor adherence Wrong dose, wrong timing, costly formulation Comorbidities Site of care costs Additional doctor visits Adverse events Hospitalizations Transitions from hospital to home Breakdown in the continuity of care Emergency department visits 1. Midwest Business Group on Health. Cost drivers. Accessed February 20,

7 Increasingly competitive specialty marketplace Payor PBM Provider Wholesaler Retail Independent RightSourceR x 7

8 Walgreens Enterprise Specialty Assets

9 Walgreens enterprise specialty highlights Integrated model of centralized & community-based assets Serving over 1M+ unique patients annually LDD partner of choice for biopharma Committed to key specialty therapies Comprehensive 340B solution 9

10 All-inclusive U.S. footprint Walgreens g Non-24-hour stores g 24-hour stores g Retail healthcare clinics* g Health systems and medical office pharmacies g Local specialty pharmacies g Specialty central and mail * Retail clinic operated by a local health system or Walgreens. 10

11 Providing convenient access to medication and clinical support AllianceRx Walgreens Prime Specialized Pharmacies Local Specialty Central Specialty & Mail Specialty at Retail 11

12 Expanding the scope of our capabilities and benefits Increased Access Reduced Costs Improved Quality Central specialty pharmacy + mail services National pharmacy network Community specialty pharmacy and hospital-based pharmacy locations Specialized pharmacies in oncology, HIV, HepC, transplant, cystic fibrosis and infertility Competitive buying power Reduced total medical and pharmacy costs Innovation that is clinically and economically relevant Bottom line impact Deep and broad clinical specialty disease management programs and LDD product portfolio Technology platform to provide transparency, care and outcomes across channels URAC, ACHC accredited 12

13 Differentiated Multi-Channel Specialty Solution

14 A consistent clinical experience is delivered across the enterprise Central specialty Local specialty Patients A unique system of central and local solutions Expert specialty care services Walgreens Connected Care programs for improved outcomes Price parity across all settings Central specialty expertise Strong utilization management programs for cost control Robust analytics and reporting Tailored local specialty access Face-to-face interactions for specialty patient populations/conditions Comprehensive provider services 14

15 Going beyond traditional central pharmacy to delivering complex care locally Specialty at Retail 8,000+ specialty-enabled retail pharmacies Centralized specialty support center Convenient access to specialty medications Specialized Pharmacies 800+ condition-specific specialized pharmacies (CF, HIV, HCV, oncology, transplant, infertility) Maintain specialty inventory Strategically located Local Specialty 280+ specialty pharmacies in local markets Face-to-face clinical and financial support Access to certain limited distribution drugs (LDDs) Enhanced relationships with local specialty physicians 15

16 Walgreens local specialty pharmacies provide care for members with complex conditions Start members on therapy quickly Work with members care teams to help determine the appropriate level of clinical and support services Members have face-to-face interactions with highly trained specialty pharmacists Pharmacists build relationships with members and referring providers Offer a single point of contact for members, providers and case management teams Provide high-touch, expert care for a variety of complex conditions Complement centralized services to help promote member adherence 16

17 Walgreens Specialty Pharmacy meets the needs of all key stakeholders, starting with the patient PATIENT PHYSICIAN PHARMA PAYER * Medication costs and access Quality of life Side effect management Disease progression Administrative burden Facilitate prior authorizations Buy and bill challenges Collect patient data Development costs Initiation of therapy Adherence Financial assistance Biosimilars Specialty trend Utilization management programs Patient adherence and satisfaction Clinical outcomes *MCO and employers 17

18 Rapid, direct access to the majority of LDDs, including several that are exclusive Ability to serve more patients OUR BROAD LDD ACCESS Higher patient satisfaction due to speed to therapy Manage spend with predictable rate structures due to less one-off contracting LDD safeguard process When patient brings LDD script to a retail pharmacy Our system notifies staff drug is LDD We transfer script to central or local specialty pharmacy We notify patient Patient receives LDD in a timely manner LDD=limited-distribution drugs 18

19 Nonadherence is costly Walgreens Connected Care programs are part of the solution Approximately 20% to 30% of prescriptions are never filled 1 50% Only about of prescribed doses are actually taken 1 IMPACT PER YEAR 1 Approximately 125,000 deaths 10% of hospitalizations Costs of between $100B to $289B 1. Viswanathan M, Golin CE, Jones CD, Ashok M, et al. Interventions to improve adherence to self-administered medication for chronic diseases in the United States: a systematic review. Ann Intern Med. 2012;157(11):

20 Walgreens Connected Care programs support patients clinical goals and minimize costs Walgreens Connected Care Chronic inflammatory diseases Cystic fibrosis Hepatitis C Bleeding disorders Transplant Multiple sclerosis Oncology Pulmonary hypertension Program benefits Reduce or delay disease progression 1 Improve patient adherence and outcomes Improve care team communication Decrease healthcare costs 1 Enhance patients quality of life and satisfaction This list is not inclusive of all programs available 1. William Trombatt, PharmD1,2, Pamela Koerner, BS, PharmD, BCPS, Zoie Craft, BA, Richard Miller, RPh, MBA, CSP, Khalid Kamal, MPharm, PhD. Retrospective Analysis of the Medication Utilization and Clinical Outcomes of Patients Treated with Various Regimens for Hepatitis C Infection. AMCP Poster Presentation

21 Walgreens Connected Care differentiated services deliver proven results supported by data 1-5 Proactive patient engagement Adverse event and adherence monitoring Counseling interventions Care team communications Increased adherence Improved outcomes 1. Kirkham H, Mclane D, Staskon F, DuChane J. Medication adherence among patients in a pharmacy-led clinical management program for cystic fibrosis. Pediatr Pulmonol. 2015;41: Fritz SH, Doerner PH, Miller RT, Craft Z. Therapeutic reponse of triple durg therapy in hepatitis C infection. Gastroenterol Pancreatol Liver Disord. 2014;1(1): Walgreens data on file; Trombatt WD, Koerner PH, Miller RT, et al. Retrospective analysis of the medication utilization and clinical outcomes of patients treated with various regimens for hepatitis C infection. J Pharm Pract. 2017;30(2): DuChane J, Clark B, Staskon F, Miller R, Love K, Duncan I. Walgreens Connected Care Multiple Sclerosis: impact of managed therapy on adherence to medications used to treat multiple sclerosis and related comorbid conditions. Intern J of MS Care. 2015;17:

22 Walgreens Connected Care Hepatitis C outcomes are strong Proven track record of patient support high adherence/low overall discontinuation rates Walgreens Connected Care Hepatitis C Enterprise-wide program Triple therapy support Outcomes published Sovaldi data: 94% adherence 1.4% discontinuation rate due to adverse events 2 Outcomes published 97.2% adherence SVR rates comparable to clinical trials Outcomes published Adherence rates >90% SVR rates comparable to clinical trials 1 Award-winning hepatitis C utilization and clinical outcomes poster 2016 NASP Annual Meeting Low discontinuation rates 3 SVR rate of 92% comparable to clinical trials 3 1. Fritz SH, Doerner PH, Miller RT, Craft Z. Therapeutic reponse of triple durg therapy in hepatitis C infection. Gastroenterol Pancreatol Liver Disord. 2014;1(1): Walgreens data on file; Trombatt WD, Koerner PH, Miller RT, et al. Retrospective analysis of the medication utilization and clinical outcomes of patients treated with various regimens for hepatitis C infection. J Pharm Pract. 2017;30(2):

23 Percentage of adherence Walgreens Connected Care Multiple Sclerosis program significantly increased adherence Mean adherence rates were significantly higher for patients participating for at least six months in the Walgreens Connected Care Multiple Sclerosis program Mean adherence rates for six months or longer 70% increase in overall adherence 80% 70% 60% 50% 31% increase 75.6% 40% 30% 20% 44.6% 10% 0% Nonparticipants Participants in CCMS program 1. DuChane J, Clark B, Staskon F, Miller R, Love K, Duncan I. Walgreens Connected Care Multiple Sclerosis: impact of managed therapy on adherence to medications used to treat multiple sclerosis and related comorbid conditions. Intern J of MS Care. 2015;17:

24 Enhanced clinical services may result in cost savings Our approach provides member-centric care and support Pharmacists with deep clinical knowledge of complex conditions and related medications consult with members Set treatment expectations Provide side effect counseling Offer support throughout therapy Reduce the risk of wasted drugs Analysis of Walgreens Oral Chemotherapy Cycle Management Program*, 1 The average direct savings per member from avoiding wastage were The average savings per member from reduced hospitalizations were $ 934 $ 452 *Actual savings will depend on specific circumstances, including plan design. Data sets reflect Walgreens Central Specialty patients. 1. Khandelwal N, Duncan I, Ahmed T, Rubinstein E, Pegus C. Oral chemotherapy program improves adherence and reduces medication wastage and hospital admissions. J Natl Compr Canc Netw. 2012;10(5):

25 Successful Dose Optimization: Jakafi From Jakafi 5mg, 2 tabs by mouth daily to Jakafi 10mg, 1 tab by mouth daily. Intervention Opportunity From Jakafi 5mg, 2 tabs by mouth daily to Jakafi 10mg, 1 tab by mouth daily. Actions Outbound call to MD office on March 30, April 1, and April 3 to suggest dose optimization of Jakafi. Nurse returned call on April 7. Patient not stable on dose. Intervention suggestion denied. Follow-up call to MD office on June 10, June 11, and June 12. New rx received June 18. Patient counseled on new strength and directions. Med shipped to patient. Outcomes Successful dose optimization intervention. Decreased pill burden for patient. Estimated savings to health plan: $8,721 per month, or $104,658 per 12 months 25

26 Manufacturer and foundational assistance programs Financial Assistance Makes a Difference: A patient was in sticker shock from the cost of a new cancer medication. Our care team was able to find a nonprofit foundation that offered funds to help pay for the medication based on the patient's diagnosis. The patient's monthly copay went from $2,846 to $10. We saved our patients $198M through copay assistance in

27 Our pharmacists put patients first Scott has found that many patients don t like to talk about side effects, so he provides face-to-face counseling Harish meets with transplant patients at their hospital bedside Shauna specializes in hepatitis C so she closely monitors her patients and makes sure to collaborate with patients physicians 27

28 Conclusion Specialty Industry Will Continue to Rapidly Grow Walgreens has a Differentiated Multi-channel Solution Does Your Specialty Network Design put the Patient First? 28

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