Transcript Renowned and Independent Consultancy for Specialty

Renowned and Independent
Consultancy for Specialty /
Biologics & Pharmaceutical Benefit
Strategy Development
HR Specialty Products & Services Catalogue Executive Summary
A No Frills Distillation of Vendor’s Marketing Collateral
Thomas A Ference
President & CEO
Human Resources Mining & Distribution Co
Locating, Validating and Accelerating HR Innovation
Office: 219-662-0201
Cell: 630-240-2583
Fax: 219-661-0236
e-mail: [email protected]
Website: www.hrmdco.com
Specialty / Biologics & Pharmaceutical Benefit
Strategy Consultancy
• Specialty drugs for conditions like cancer, RA, MS or rare
diseases now account for up to 1/3 of the total drug spend and
8-10% of the total healthcare plan spend and both are growing
rapidly)
• Managing these spends remains difficult given the high unit
dollar amounts involved, cross-benefit impacts (i.e. both the
Rx plan and the healthcare plan) and the employer's
comparative inability to control such costs through traditional
benefit plan design approaches and/or relying on TPA/PBMs
for help.
• This retainer-based, independent consultancy has 30+ years of
integrated health benefits consulting experience and 10+ years
of concentration in the area of specialty Rx.
Strategy Consultancy Services Provided
• These strategies impact both the pharmacy and medical
benefits portions of the healthcare program and address the
changing dynamics of specialty RX products to help achieve
related business goals. Services include:
-Assisting employers in finding value in health care
-Providing deep understanding of risk exposure to drug,
diagnostic and device trends and their aggregate impact on total
cost of care or risk management to the plan sponsor
-Giving direction on exposures, vendor contracting, and
addressing trend in context of plan goals
-Coordinating to improve care quality across continuum
while reducing unnecessary utilization
Comparison of Per Month Rx Claims Cost for
Coverage by Setting of Care
*using an illustrative example of $2,500 per month for Rheumatoid Arthritis (RA)
Self Inject/home
MD office (independent)
SC, IM
SC, IM, IV
$2,500-$4,000
$4-$10,000
SC, IM, IV
On-site work clinic
$4-9,000
SC, IM, IV
Hospital outpatient
$8-10,000
SC, IM, IV
Emergency Room
$8-10,000+
Glossary: SC = subcutaneous, IM = intramuscular, IV = intravenous
Complexity and Confusion Surrounds the Issue of Specialty
Pharmacy Including Where Covered Under Plan along with
Plan Parity
Top 5 Specialty Drug Categories – 2012 National Data
Under Pharmacy Benefit
Under Medical Benefit
Under Both Pharmacy &
Medical Benefit
Multiple sclerosis, Oral & Inj
Rheumatoid Arthritis & Crohns, IV
Various cancers
Rheumatoid Arthritis & Crohns, Inj
Immune globulin, IV & Inj
Hereditary Angioedema
Oncology, Oral
Multiple sclerosis, IV
Lysosomal storage diseases
Pulmonary Arterial Hypertension,
Lysosomal storage diseases, IV
Multiple sclerosis
Hepatitis C, Inj
Respiratory SV, Inj
Psoriasis
Glossary: Inj = IM injection, IV = infusion.
Next Steps
• This product/service is contained in the HR Specialty
Products & Services Catalogue™
• Operational level details about this particular service
provider can be obtained in conference with the vendor
• The HR Mining &Distribution Co. is an independent and
contracted representative of the vendor
• Upon your request, we will arrange for an introduction
that can range from a simple, quick conference call to a
services overview / system demo
• Tom Ference 219-662-0201 (Chicagoland area) or
[email protected]
• Thank you for your potential interest in this fresh
thinking