Transcript Creating a work contract that works

2015
ANNUAL
MEETING
Paul Meyer - Welcome
2014 Accomplishments
• Membership Growth
• New “Classic Plan” for Fast Implementation of Smaller
Members
• New Ability to Access Data In House
• Continued Financial Stability
• Updated Computer Systems
• New, Easier-to-Navigate Web Site
CEO Search
• Started Search in Late Autumn 2014
• Currently in Discussions with Prospects
• Hope to Announce New CEO by Summer
Open Board Seats
• Three Openings
• Three Qualified Candidates
– Joy Matthews
– Valarie Wunderlich
– Judy Peirick
• Voting Closes at 10:00 AM Today
• New Board Members Announced During Lunch
2015
ANNUAL
MEETING
Deb Thomsen – Cooperative Update
National CooperativeRx
Update
1.
2.
3.
4.
5.
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Welcome and Introductions
Cooperative Growth
Financial Achievements
Successful Clinical Programs;
Great Trend Numbers for 2014
Market Check
Welcome
Without YOU,
Our Members,
Prospective Members,
Consultants and TPAs,
We Would Not Exist!
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Introductions
National CooperativeRx
– Chris Schanz Strategic Account Executive
– Deb Thomsen Vice President
– Deb Sonnenberg Director of Operations
– Jen Dickman Communications
– Kyle Kapusta Sales Manager
– Mike Sugden National Sales Leader
– Patti Tews-Ruehle Sales Manager
– Penny Mandt Administrative Assistant
– Wayne Salverda, R.Ph. Senior Director of Clinical Services
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Introductions
Board Members
– Fred Brown
– Jim Malicki Secretary
– Judy Peirick
– Larry Richardson Treasurer
– Paul Meyer Board Chair
– Robin Mullins Vice Chair
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Introductions
CVS Health
– Adam Jones
– Deb Zuelke
– Keith Sadowsky
– Larry McCoy
– Laura Sterling
– Paschal Haywood
– Shawn Young
– William Ashmore
– Wilson Samuel
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Coalition Growth
(January 2014 – January 2015 Effective Dates)
19 new Plan Sponsor Members
with 29,786 Participants
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2014 Financial Achievements
• 2014 Year-end Financials (unaudited)
Revenue:
$2,276,255
Expenses: $1,956,460 (10% under budget)
Net Earnings: $319,795 (member dividends)
• Member Equity: $1,824,397
• Cooperative Patronage Dividends
2014:
$319,795
2013:
$208,000 (100% cash)
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Money Returned
to Members In 2014
• Rebates Distributed:
$10,142,821
• Rebate True-up:
$ 2,989,665
• Patronage
$
208,000
• Equity Released
$
323,000
$
228,766
(2006-07)
• Audit Returns
(2010-12)
TOTAL
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$13,892,252
Audit 2013
Annual review of all claims, pricing discounts off AWP,
dispensing fees, and rebate guarantees. This money will be
returned to Members in the next Audit Distribution.
• $10,983.04 reimbursement for discrepancies:
– Lower-Of / Per Claim Pricing: $10,789.04
– Dispensing Fees: $194
• No discrepancies regarding:
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Aggregate Pricing Guarantees
Claims Data Verification
MAC Pricing Assessment
Specialty Pricing
Rebate Guarantees
Impact of Cooperative
2013
2014
• Clinical Programs:
$ 440,000
—
• Annual Drug Spend:
$176,493,597
$177,806,848
• Annual # of Rx’s:
1,850,182
1,654,007
Clinical Programs to
Contain Costs
• National CooperativeRx has negotiated many clinical programs at
reduced or no cost (Rx Savings Guide)
• Dedicated dollars to purchase the programs/services that include a
Caremark fee (Safety and Monitoring, PA and Appeals, Historical Claims)
• Client specific plans to match your appetite for aggressiveness
• Ability to customize and modify Caremark Clinical programs
(Compound PA at 500.00)
• Unique Clinical Opportunities as large coalition client (Adherence Pilot
Opportunity)
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Plan Participants with
Telephone Contact Information on File
National CooperativeRx
70%
62%
66%
60%
50%
44%
40%
30%
20%
10%
0%
June 2013
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February 2014
February 2015
Generic Utilization
Generic Dispensing Rates (GDR) 2014
90.0%
86.5%
85.0%
81.3%
81.4%
CVS/caremark
National CooperativeRx
80.0%
75.0%
NatRx Best In Class
For each 1% increase in Generic Dispensing Rate (GDR), gross pharmacy
spend is estimated to decrease 1% up toward 2.5%.
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Bending the Trend
Book of Business
National
CooperativeRx
CVS/caremark
Employer
Express-Scripts
Commercially Insured
Trend
NonSpecialty
Specialty
Trend
Trend
8.2%
41.2%
-0.6%
12.7%
31.6%
7.0%
13.1%
30.9%
6.4%
National CooperativeRx overall Trend and Non-Specialty Trend less than
CVS/caremark and Express Scripts
Source: WisconsinRx/National CooperativeRx CVS/caremark RxInsights 2014 report and ad-hoc claims analysis
http://lab.express-scripts.com/drug-trend-report/?utm_source=corpbanner&utm_medium=banner&utm_campaign=dtr201
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Hepatitis C
3-5 Million Infected
3 of 4 may not even be aware they’re infected
4 new drugs approved in 2014
$84,000-150,000 for a 12 week treatment
Hep C accounted for 4.2% of overall trend
Over half of the increase in specialty cost (11.6 M) was
accounted for by Hep C cost (7M)
• HCV prevalence varies widely from state to state: 1.3% to
0.4%
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HCV Disease and Cost Progression
$500,000
$84,000 $150,000
$115,000
$24,000
12 Week Treatment Annual Costs for
Course
Paitents with HCV
For Every 100
People
Infected with
HCV
75-85 Will
Develop
Chronic
Infection
$60,000
Annual Cost for
Annual Costs for
Patients with End Patient with Liver
State Liver Disease
Cancer
Transplant Costs
Per Patient
60-70 Will
Develop
Chronic Liver
Disease
1-5 Will Die of
Cirrhosis or
Liver Cancer
5-20 Will
Develop
Cirrhosis
Source: www.PhRMA.org Twenty-Five Years of Progress Against Hepatitis C: Setbacks and Stepping Stones, December 2014
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Incidence of Acute Hepatitis C
USA by Race/Ethnicity Years 2000-2011
Reported cases/100,000 population
1.4
American Indian/Alaskan Native
Asian/Pacific Islander
Black
White
Hispanic
1.2
1
0.8
0.6
0.4
0.2
0
2000
2002
2004
Source: http://www.cdc.gov/hepatitis/Statistics/2011Surveillance/Slide4.4.htm
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2006
2008
2010
Compounds
Compounding: When a licensed pharmacist combines, mixes or alters
ingredients in response to a prescription. This tailors medication to the
medical needs of a patient.
• Safety and efficacy
• 7,500 pharmacies specialize in compounding services
• 2,500 of these added since 2009
• HIPPA required reimbursement
• Compounds can be warranted for various reasons
Source: CVS Caremark White Paper Compound Medications for Topical Use, March 2014
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Bending the Trend
Book of Business
National
CooperativeRx
CVS/caremark
Employer
Express-Scripts
Commercially Insured
Trend
NonCompounds
Specialty
Trend for
Specialty
Gross Cost
Trend
Compounds
Trend
PMPM
8.2%
41.2%
-0.6%
93.1%
$1.47
12.7%
31.6%
7.0%
374.0%
$3.95
13.1%
30.9%
6.4%
128.4%
$3.84
National CooperativeRx member-owner groups potentially avoided more than
$5,000,000 in drug spend for compounds compared to benchmarks.
Source: WisconsinRx/National CooperativeRx CVS/caremark RxInsights 2014 report and ad-hoc claims analysis
http://lab.express-scripts.com/drug-trend-report/?utm_source=corpbanner&utm_medium=banner&utm_campaign=dtr201
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National CooperativeRx
Market Check
Our current 3 year agreement contains language to evaluate
agreement for market competitiveness.
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Changing Market Dynamics – especially in a 3 year
agreement
Market Review is underway and we will report results
Potential adjustments will be agreed to contractually by
9/1/2015 and become effective 1/1/2016
Results will either demonstrate that we have the strongest
contract available, or will show room for negotiation and the
Cooperative will work on your behalf while closing any gaps.
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Thank You!
“Together we control our
collective success…
Individually we surrender
control of our destiny”
YOU are that Strength!
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2015
ANNUAL
MEETING
Thank you!