Transcript Generic Price Reforms Pharmacist Perspective

Medication Management: Why it
Should be Part of Every Benefit
Plan
Solutions in Drug Plan Management
September 8, 2011
Deb Saltmarche BScHons(Pharm), RPh, MRPSGB
What I Will Cover Today
• Medication Management and CPSF
• Common opinions
• The opportunity
– Medication management as a value component of
plan design
– How expanded services increase the value
proposition
The views expressed today are those of the presenter.
Why You Should Care – Medication
Management
• Promotes the safe and effective use of medications and
helps patients achieve improved outcomes
• Ideally a partnership between the pharmacist and the
patient, supported by the payer
• Pharmacist working in an inter professional environment
• U.S.A: Medication Therapy Management coined by
Congress in the Medicare Modernization Act 2003
• England: Essential, Advance, Enhanced
• Canada: CPSF embraces the concept of Medication
Management, and incorporates Enhanced and
Expanded services
Why You Should Care - CPSF
CPSF
Value to Plan & Member
• Standard definitions and
terminology
• Integrated technology
solutions
• Service standardization
• Financially viable
• Identifies cost effective
services
• Services selected based on
needs of patient & health
system
• Enhance patient experience and
outcomes
• Enable service research,
assessment, and comparison
• Help manage risk
– decrease implementation
costs
– standard approach across
pharmacies
– scalable
• Flexible - combine individual
components into unique
programs
• Flexible - creative program
development and marketing
Where Do Our Perspectives Converge
The 2011 Teva CFP report
• Survey of Benefit Consultant and Plan
Sponsors
• 78% agree pharmacists should get more
involved with payers to control drug plan costs
• From a suggested list of 14 services, 46%
agree that educating patients on generic drugs
and suggesting low cost alternatives is an ideal
role for pharmacists
1
The 2011 TEVA CFP Report: Private Payers’ Perceptions of Pharmacy
Where Do Our Perspectives Converge
When asked whether services should be offered
as basic, extra with fee, or not offered at all
• 74% think providing a 30 minute med review
in a private setting should be an extra service
• 61% think providing drug and disease
management services at home or workplace
should be an extra service
• 60% think providing disease management
services should be an extra service
1
The 2011 TEVA CFP Report: Private Payers’ Perceptions of Pharmacy
The Opportunity
Time for a new dialogue, new partnerships
• Drug plan strategies with manageable patient impact, that
deliver reasonable cost savings to employers, and that
underscore the value of a health plan to the employee
– Maximize knowledge and expertise of pharmacists,
incorporate in to discussions on plan design and plan
delivery
– Capitalize on expanded scope of practice to improve drug
plan design and manage costs
– Work with Pharmacy to drive change in patient behavior
– Partner to provide specialty services (high cost
medications, biologics)
Maximizing Plan Design to Provide Value
• Plan Design: Expertise to develop formularies
– Private plans with flat formularies
– Rationale for formulary exclusion/inclusion;
– Rationale for use of therapy within the formulary,
step therapy to ensure cost effective approach to
medication management where appropriate
– Government plans have different demographics,
different accountability. A formulary that works for a
public plan may not necessarily be the right
approach for a private plan needing for a healthy
and productive workforce
Maximizing Plan Design to Provide Value
• Plan Design and Delivery: Expertise to drive
generic uptake
– Many plans do not have mandatory generic
substitution
– In the US generics are used to fill 75% of Rx, in
Canada, less than 50%1
– If Canadian generic utilization matched the US,
Canadians would save $3B in the first year alone1
– Patient education; equivalence of generics, dispense
as written Rx, off formulary interchangeably
(adaptation)
– Pharmacy programs
1
CGPA www.canadiangenerics.ca
Maximizing Plan Design to Provide Value
• Plan Design and Delivery: Education on drug costs
– Assist employers in educating employees on the value of
their drug plan
– Development of education materials;
– Delivery of programs/materials
• Plan Delivery: Expertise to ensure that the right
treatment is provided in the most cost effective way
– Optimal outcomes dependent on consumer behavior
– Pharmacist role in patient education and ongoing
monitoring to improve adherence, decrease waste
Partnerships to Better Manage Patient Expectations, Outcomes, and Plan
Costs
Maximizing Plan Design to Provide Value Expanded Scope of Practice
• Most cost effective treatment to the right
patient at the right time
• A few examples:
– Adaptation gives the ability to substitute for a
non-formulary generic, and to substitute a generic
without calling the physician
– Access to lab tests allows more effective patient
monitoring, increases access to community based
disease state management e.g.
– Diabetes
– Cholesterol
– Anticoagulation
Maximizing Plan Design to Provide Value Expanded Scope of Practice
– Therapeutic substitution allows alternate plan
formularies to be implemented
– Ability to refill helps mitigate intervals in continual
therapy, helps adherence therefore outcomes
• Decrease unnecessary health issues/ER visits,
absenteeism, due to unavailable medication
– When a patient has run out of a medication and the
physician is not available
– When a physician may charge for a refill done over
the phone, and the patient cannot pay out of
pocket
Maximizing Plan Design to Provide Value Expanded Scope of Practice
• Why is this important?
– Opportunity for new approaches in medication
management of outcomes
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New service delivery models
Best utilization of resources, increase access
Value/cost containment
Enhanced inter-professional collaboration
Enhanced patient care solutions
Partnerships on New Approaches to Better Manage Patient Outcomes and
Plan Costs
Value/Cost
• The top eleven MTM pharmacies in the US averaged $1300
cost avoidance per patient1
• Medication adherence resulted in substantial medical savings
(hospital/ER) – benefit cost ratios ranged from 2:1 (<65 with
dyslipidemia) to 13:1 (older patients with hypertension).
Presenteeism2
• Plans are seeing an ROI of $4.73 for every $ spent on cost
avoidance1
• Interventions to improve adherence showed significantly
lower non adherence vs control (9% vs 16%)3
1 Outcomes
Pharmaceutical Healthcare www.getoutcomes.com
2 Health Affairs January 2011 vol. 30 no. 1 91-99
3 http://www.ncbi.nlm.nih.gov/pubmed/17004019
We’ve heard it before………
• The National Consumers League 3 year campaign to reduce
$290 billion per year spend related to poor medication
adherence
• Campaign revealed the following:
– 1 out of 3 people never fill their prescriptions
– Nearly 45% of the population has one or more chronic
conditions that require medications
– Nearly 3 out of 4 people do not take their medications as
directed
– More than 1/3 of medication-related hospital admissions
are linked to poor adherence
Beneficiaries / patients are at the center of the healthcare system
Pharmacies are the point-of-care for patients receiving medications in
the community; they connect the patient to the medication
Pharmacists are the point-of-service providers for drug plans; they are
the public face of a drug plan, they manage optimal use of
medications
Collectively, it’s time to find new ways to collaborate, and capitalize on
the opportunities that reform has created
Deb Saltmarche BScHons(Pharm), RPh, MRPSGB
Saltmarche Consulting
[email protected]
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