Transcript Conference 2 - The Growing Impact of Biologics - M

Biologics & Specialty Drugs
The Road to Sustainability
Mark Rolnick
Director, Pharmaceutical Benefits
BD Training
Private Drug Plan
Cost Drivers
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Demographics
Mark-Ups and Fees
Coupon Cards
Lack of consumerism
Open formularies
Biologics & Specialty
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Source: Canadian Institute for Health Information, Drug Expenditures in Canada, 1985-2009
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Background Stats
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Specialty Drugs make up 14 of our top 50 DINs
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42 drugs on the Prior Auth DIN List & others in top 50
= $203.5 Million in 2011 up from 170 million in 2010
(+20.4%)
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15.2% of PDD spend in 2011 vs. 13.2% in 2010
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Treating just ~1% of plan members
(Source: 2011/2010 SLF Book of Business for All claims)
Unprecedented Growth
Claimants over $25,000 in Spend
Average Specialty Claim
for drugs on the SLF
Prior Auth List
= $2,340.80
Source: Telus 2011 SLF All Claims Data report
Telus PA DIN List (includes oral Cancer DINs)
Source: Telus Health Solutions Data, March 2012
Sun Life’s Biologic
Response Modifier Experience
• Top 3 biologics
DRUG NAME
#1 Remicade
#2 Humira
#3 Enbrel
2010 PAID AMOUNT 2011 PAID AMOUNT Growth
$40,265,975.64
$49,446,191.39
22.80%
$22,830,723.99
$29,109,898.38
27.50%
$25,019,369.74
$26,781,645.93
7.04%
$88,116,069.37
$105,337,735.70
19.54%
• Distribution for utilization spans across age groups
–Reflective of multiple indications for these products
–Most common uses arthritis, gastrointestinal, psoriasis
(Source: 2011/2010 SLF Book of Business for All claims)
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Sun Life’s Oncology
Experience
• Important Drugs
• Not a huge cost burden yet
• Growing incredibly quickly
Cancer Drugs
#1 Neulasta
#2 Gleevec
#3 Revlimid
#4 Sutent
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2010 PAID AMOUNT 2011 PAID AMOUNT
$7,058,323.15
$9,010,366.86
$5,760,711.53
$5,831,073.40
$3,504,050.32
$4,411,328.94
$2,634,024.91
$3,185,328.66
$18,957,109.91
$22,438,097.86
Growth
27.66%
1.22%
25.89%
20.93%
18.36%
Biologics Percentage of
Global Therapeutic Pipeline
Source: Trusheim et al.: Do Biologics Differ from Small Molecules? Forum for Health Economics & Policy, Vol. 13 [2010], Iss. 1, Art. 4
Awareness of
Cost Pressures
8 in 10 agree
“that rising costs will make it difficult
to maintain Canada’s healthcare
system” and that “Canadian
healthcare faces a funding crisis”
7 in 10 agree
“that rising costs and growing use
of prescription drugs will make it
difficult for employers to maintain
their current drug coverage”
What’s Your Drug
Plan Philosophy?
• Is the Drug Plan a cost or an
investment?
• Is it a benefit to employees?
• Or is it Health Insurance?
• Can Wellness & Drug
programs work together to
limit disability claims?
Where does the Employers
Responsibility begin and end?
 Antibiotic for Acute chest infection?
 Cholesterol / Blood Pressure drugs
prevent heart attack in 15 years?
 Cancer drug that extends life by 3 mos?
 Biologic for Crohn’s, MS, Arthritis,
that helps keep members at work?
• Genetic testing shows, 25% chance at getting cancer in the
next 10 years?
 Vaccine that costs $25,000 but prevents Alzheimer’s
disease 30 years from now?
What is the
Employee’s role?
• How can they help keep Costs down?
• Do they even know that its an issue?
• How can we engage
them more?
• What education can
provide them?
we
What does the future hold in
terms of specialty management?
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Negotiated reimbursement for high
cost drugs where alternatives exist
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Risk Sharing arrangements for
expensive therapies
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Maximums to avoid concerns of
dose escalation
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Relying more on pharma company
financial assistance
What does the future hold in
terms of specialty management?
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Prior Authorization with Reauthorization criteria to ensure
member is getting best outcomes
and is an appropriate candidate
in the first place
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Preferred distribution network to
gain efficiencies
Creating Balance….
Maximize plan sponsor
satisfaction through
plan design
Maximize plan
member
satisfaction
Minimize
plan sponsor
costs
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