JOIN IN AN UNPRECEDENTED STATEWIDE MOVEMENT TO CHANGE HEALTHCARE

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1 JOIN IN AN UNPRECEDENTED STATEWIDE MOVEMENT TO CHANGE HEALTHCARE PASBO S STATEWIDE DATA STRATEGY WITH INNOVU PASBO 62 ND ANNUAL CONFERENCE AND EXHIBITS, PITTSBURGH 1 DATA STRATEGY PLATFORM 2 1

2 WHAT ARE YOU DEALING WITH IN MANAGING BENEFITS? How to budget for annual benefits cost increases for the district/iu Whether to carve-out pharmacy from the medical carrier Whether to change carriers Whether (and how) to narrow the provider network Whether to contract with: A wellness and/or biometric company A health app or consumer pricing tool A specialty program for specialty medications, cancer navigation, diabetes management, behavioral counseling, etc. Whether my local hospitals and physicians provide high quality at a reasonable cost Employer Costs Employee Satisfaction 3 WHAT ARE YOU DEALING WITH IN YOUR WORKFORCE? Employee wages, benefits, and retirement account for, on average, 70% or more of your spend Minimizing the impact of benefits cost increases to employees and their families A multi-generational workforce Varying levels of employee engagement Union CBA contract(s) Switching benefits carriers Benefit eligibility and enrollment files are difficult to maintain Employer Costs Employee Satisfaction 4 2

3 WHY PARTICIPATE IN THE PASBO DATA STRATEGY? Are you responsible for employee benefit costs for your district? Do you contribute to employee benefits decisions being made each year? Do you make better decisions by understanding the data first? Would you like to be able to measure benefit costs on a monthly basis? Do you think the health and pharmaceutical decisions you will face in the future will get clearer and less costly? Would it be beneficial to have regional and statewide benchmarks for cost, quality, and population health? 5 WHY PARTICIPATE IN THE PASBO DATA STRATEGY? Claims data is your data if your district/iu is self-insured! You are the purchaser. Neither you nor your benefits advisor have not been able to get data from your carrier that is insightful and actionable. Your benefits advisor can help you even more with this data. Innovu has experts in medical, pharmacy, actuarial modeling, and risk analytics Innovu can correlate data between medical, pharmacy, dental, vision, biometric, workers comp, retirement, disability, absence management PASBO is supporting this data strategy to help you make decisions in your local market 6 3

4 PENNSYLVANIA S SCHOOL DISTRICTS AND INTERMEDIATE UNITS Innovu Database Includes: 200 PA Schools IU 13 ACSHIC 7 CAN YOU USE THIS DATA? A SAMPLER OF PHARMACY INSIGHTS 1. Price Hikes 2. Specialty Medications 3. Overdose/Fraud/Abuse 4

5 PRESCRIPTION PRICE HIKES The EpiPen is one of the most important life-saving medical innovations for people with severe food allergies. The price increased 400% since 2008, from $100 to $500. Fortune, Aug 2016 WPA Schools with 40,000 Members 9 INDUSTRY REACTION WPA Schools Allowed per Claim by Month Mylan Launches the First Generic for EpiPen (epinephrine injection, USP) Auto-Injector as an Authorized Generic $450 $400 $350 $300 $250 $200 $344 $381 $354 $416 $360 $388 $354 $305 $418 $310 $386 $295 $150 $100 CVS targets EpiPen with cheaper, generic version $50 $0 10 5

6 Average $ / Claim INSULIN PRICE INCREASE IMPACT NBC News reported a price increase in insulin since 2004 from $20 to $250 per vial. Innovu national benchmark shows 20 30% increase from 2013 to One Innovu client experienced a 55% 97% increase over 3 years. After years of price hikes, Eli Lilly and Novo Nordisk announce discounts on insulin for those without insurance. December 15, 2016 Pittsburgh Post Gazette $900 $800 $700 $600 $500 $400 $300 $200 WPA Schools with 40,000 Members Cost per Insulin Claim HUMALOG LANTUS LEVEMIR NOVOLOG $820 $714 $693 $608 $608 $558 $566 $513 $482 $494 $450 $423 $412 $362 $348 $318 $100 $ MANAGEMENT STRATEGIES Preferred formulary programs when alternatives are available Unique group purchasing discussions Power of the collective voice 12 6

7 MEDICARE SPECIALTY DRUG SPEND Pharmacy Types and their Average Annual Cost Specialty Medication High-cost prescription medications ($1,000 or more per month) used to treat complex, chronic conditions like cancer, rheumatoid arthritis, and multiple sclerosis. These medications require special handling and administration. Specialty $53,384 Brand Name $2,960 Generic $283 AARP Report: Retail Prescription Prices Increasing Six Times Faster Than Inflation Press Center, February 29, 2016, 13 In 2016, an Innovu client paid more than $26,000,00 in specialty medications. Specialty Drugs Paid through Medical Benefit Specialty Drugs Paid through Pharmacy Benefit Product Name Amount Paid Product Name Amount Paid Infliximab injection Rheumatoid Arthritis $1,400,693 Natalizumab injection Multiple Sclerosis $977,105 Bevacizumab injection Cancer $944,718 Injection, pegfilgrastim 6mg Cancer, low wbc $775,099 Gamunex-c/gammaked Eculizumab injection Auto-immune diseases, leukemia Paroxysmal Nocturnal Hemoglobinuria $660,253 $629,900 Rituximab injection Cancer $591,907 Imuglucerase injection Gaucher s disease $568,693 Trastuzumab injection Cancer $566,635 Omalizumab injection Asthma, Chronic Idiopathic Urticaria $456,860 Subtotal $7,571,862 Total $13,777,628 Humira Enbrel Rheumatoid Arthritis Crohn's, Plaque Psoriasis $4,215,848 Rheumatoid Arthritis Crohn's, Plaque Psoriasis $2,206,684 Tecfidera Multiple Sclerosis $1,232,820 Avonex Multiple Sclerosis $767,742 Norditropin Flexpro Growth Deficiencies $665,322 Copaxone Multiple Sclerosis $608,641 Gilenya Multiple Sclerosis $531,736 Neulasta Low white blood cells (wbc) $522,431 Avonex Pen Multiple Sclerosis $507,985 Sprycel Cancer $326,435 Subtotal $11,585,644 Total $13,762,

8 MANAGE SPECIALTY COSTS - Cost to administer Infliximab in an outpatient hospital can be 50% 70% more expensive than at a professional office. - Innovu data analytics can substantiate the savings. $8,000 $7,000 $6,000 $5,000 $4,000 $3,000 $2,000 $1,000 $- Infliximab Cost per Site of Care $7,362 $6,485 $4,427 $3,849 Outpatient Hospital Professional National Benchmark Innovu Client 15 MANAGEMENT STRATEGY Prior authorization programs Preferred formulary programs Days supply limits and benefit design provisions Narrower prescribing and/or dispensing network Mandatory administration location protocols site of care programs Specialized vendor (carve-out) 16 8

9 STATE OF EMERGENCY DEATH BY OVERDOSE Public health officials have called the current opioid epidemic the worst drug crisis in American history; it killed more than 33,000 people in Overdose deaths per 100,000 people Pennsylvania Coroner Data, Deaths by overdose were nearly equal to the number of deaths from car crashes. In 2015, for the first time, deaths from heroin alone surpassed gun homicides. Source: 17 DEBBIE S FAMILY EXAMPLE - Wisdom teeth removal January 13, Prescriptions for generic Ativan, 20 tablets and Oxycodone/APAP 30 tablets Nathan, age 17 Matthew, older 18 9

10 PA OPIOID CRISIS DRUGS OF CHOICE Percentage of opioids reported in deaths by overdose in Pennsylvania in 2015 Analysis of Drug-RelatedOverdose Deaths in Pennsylvania, CDC Guideline for Prescribing Opioids For Chronic Pain US States, 2016 High-risk prescribing practices have contributed to the overdose epidemic: High-dose prescribing Overlapping opioid and benzodiazepine prescriptions Extended-release/long-acting [ER/LA] opioids for acute pain) Source: 19 INNOVU CLIENT EXAMPLE High Risk Profile: 65 year old school employee with multiple opioids since December 2010 Drug Name Date of Claim Drug Quantity OXYCODONE HCL HYDROMORPHONE HCL METHADONE HCL OXYCODONE HCL METHADONE HCL HYDROMORPHONE HCL METHADONE HCL HYDROMORPHONE HCL OXYCODONE HCL OXYCODONE HCL HYDROMORPHONE HCL METHADONE HCL OXYCODONE HCL HYDROMORPHONE HCL METHADONE HCL METHADONE HCL OXYCODONE HCL HYDROMORPHONE HCL OXYCODONE HCL HYDROMORPHONE HCL METHADONE HCL HYDROMORPHONE HCL OXYCODONE TAB 30MG METHADONE HCL = 38,000 pills - Concurrent use of Benzodiazepine - Early refills each month - Non cancerous medical conditions Price of drug for overdoses jumps from $690 in 2014 to $4,500. Pittsburgh Post Gazette February 19,

11 MANAGEMENT STRATEGIES Work with PASBO and your Regional Health Care Consortiums to: Create a drug and alcohol use policy Evaluate employee resources (e.g., EAP, addiction services, access to quality treatment facilities and providers) Create structure to share data with vendor programs (medical, pharmacy, STD/LTD, workers compensation) Narrower dispensing network Comply with State Legislation: Safe Emergency Prescribing Act - limits ER to 7 days supply of Opioids effective Jan 2017; Prescribing Opioids to Minors effective 11/02/ EASE OF ACCESS TO OPIOIDS Prescription filled for Nathan was the same as Matt s below (not filled). Prescriptions after 11/02/2017: Prescriber must assess whether the minor has taken or is currently taking prescription drugs for treatment of a substance use disorder. Discuss with the minor and the minor s parent the risks of addiction and overdose associated with the controlled substance Obtain written consent for the prescription from the minor s parent and record on required form

12 LET INNOVU EMPOWER YOUR SCHOOL!