Transcript Coronary Stents and Interventional Cardiology Products

DIR & PBS: Say What?!
February 19th 2014
Kelly Hofstatter, RN, MBA
Director, Cardiovascular Services
Chris Lindahl, RN, MS
Director, CV Clinical Field Specialist
Agenda
Peripheral anatomy and peripheral vascular
disease (PVD)
Procedures and products to treat PVD
Market trends and new technology
Premier awarded suppliers, tools and resources
Questions and discussion
Adjourn
2
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Peripheral anatomy and peripheral
vascular disease (PVD)
Peripheral vascular anatomy
4
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
Peripheral vascular disease (PVD)
Refers to any disease or disorder of the circulatory
system outside of the brain and heart
PVD most commonly affects the legs and feet
• Conditions affecting the veins include deep vein thrombosis
(DVT), chronic venous insufficiency, and varicose veins
• Peripheral Artery Disease (PAD) occurs when the arteries are
affected by atherosclerosis
Other arteries frequently affected include those supplying
blood to the brain, kidneys, and arms
5
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Peripheral vascular disease prevalence
Approximately 8 million
people in the United
States have PAD
PAD affects 12-20% of
individuals older than age
60
DVT affects approximately
1 in 1000 annually
Source: CDC 2013, NICE Clinical Guideline 2012
6
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Peripheral vascular disease symptoms
PAD
• Pain in legs upon exertion
• Claudication
• Cold or numb feet
• Non healing ulcers
• Decreased or absent
pulses
DVT
7
• Limb pain and tenderness
along the deep veins
• Swelling of calf or thigh
• Distention of superficial
veins
• Increased skin temperature
• Skin discoloration
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PVD diagnosis and treatment
PAD
DVT
• Diagnosis
» Angiogram
» Doppler Ultrasound
» Ankle Brachial Index
» Pulse Volume
Recording
» MRA
• Treatment
• Diagnosis
» Diagnostic ultrasound
» D dimer test
• Treatment
» Anticoagulation
» Compression stockings
» Inferior Vena Cava Filter
» Lifestyle modifications
» Angioplasty
» Atherectomy
» Stent placement
» Bypass Graft
» Amputation
8
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Carotid artery stenosis (CAS)
Carotid arteries: two
large arteries in the front
of the neck responsible
for providing oxygen rich
blood to the brain
Framingham cohort
prevalence: 7% in women
and 9% in men
750,000 strokes annually
in U.S.
Symptoms:
• Symptomatic: transient
visual loss, contralateral
weakness of arm, leg, or
face, visual defect
• Asymptomatic - dizziness,
weakness, syncope,
blurred vision, floaters
9
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CAS diagnosis and treatment
Diagnosis
• Carotid bruits
• Ultrasound
• Angiography
Treatment
• Asymptomatic – medical
therapy
• Symptomatic:
» Carotid endarterectomy
(CEA)
» Carotid stenting
10
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Questions
What does PVD stand for?
• Physical Vapor Deposition
• T.F. Green airport in Providence, Rhode Island
• Peripheral Vascular Disease
What is the most common area affected by PVD?
• Legs and feet
• Coronary arteries
• Rhode Island
11
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Peripheral procedures and products
Peripheral angiography
Commonly performed to identify:
• Reduced blood flow to legs and
feet causing pain
• Narrowing of renal arteries,
which commonly causes high
blood pressure
• Blockage in the cerebral
arteries to prevent and repair
stroke
• Aneurysms
• Arteriovenous malformation
13
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Peripheral angiography procedure
14
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Peripheral angiography procedure
15
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Peripheral angiography procedure
16
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Peripheral angiography procedure
17
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Peripheral angioplasty
18
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Peripheral stents
Metal tubes that are inserted in an artery, vein, airway or
duct to open it and decrease the chance of it narrowing
again
Stent types
•
•
•
•
•
•
19
Biliary (bile duct)
Carotid (carotid artery)
Tracheobronchial (bronchus)
SFA stents (superficial femoral artery – upper leg)
Iliac stents (iliac artery)
Renal stents (renal artery)
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Increasing use of radial approach
20
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DIR and PBS conundrum
Interventional
radiologists
Cardiologists
Surgeons
Multiple disciplines performing a variety of procedures that
require numerous and highly specialized products yield a
lack of standardization and like supplies being located
within several departments
21
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Products for DIR and PBS
DIR
PBS
• Balloon catheters
» Workhorse
» High pressure
» SFA
» Cutting
• Guidewires
• Guide catheters
• Atherectomy catheters
• Embolization products
• Drainage catheters
• Sheaths/introducers
• Infusion products
• Inflation devices
22
• Biliary stents
• Renal stents
• Iliac stents
• Tracheobronchial
• Carotid stents
• Embolic protection
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Diagnostic and interventional radiology supplies
Sheath introducers
• Entry catheter used for introduction of
devices
Guidewires
• Metal wires intended to facilitate
placement of interventional devices
Catheters
• Diagnostic – deliver contrast media to
selected sites
• Guide – provide a pathway to
introduce devices into the blood
vessels
Balloons
• Indicated for dilatation of the narrowed
portion of the artery
23
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Diagnostic and interventional radiology supplies
Atherectomy catheters
• Rotary cutter catheter designed for the
removal of plaque from an artery
Infusion products
• Used for the administration of fluids,
including thrombolytic agents and contrast
media, into the peripheral vasculature
Inflation devices
• Used for inflation and deflation of balloon
catheters
Drainage catheters
• Used for abscess, nephrostomy and other
multipurpose drainage applications
24
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Embolization
The purpose of embolization is to
prevent blood flow to an area of the
body, which can effectively shrink a
tumor or block an aneurysm
(weakness in a vessel wall)
• The artificial embolus
used is usually one
of the following:
–
–
–
–
25
Coils
Particles
Foam
Plug
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2
Peripheral and biliary stents
Stents are specially designed mesh metal tubes that are
inserted via a catheter into a vessel or structure, acting as
mechanical scaffolding to prop open narrow openings in
the peripheral and central arteries, bile ducts, trachea, and
large bronchi.
26
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Peripheral and biliary stents
• Vascular (peripheral) stents are indicated for the
treatment of peripheral artery disease (PAD), a
narrowing of the arteries in the legs, renal or iliac
arteries
• Biliary stents are indicated for the treatment of
obstructions of the bile duct that frequently occur
from pancreatic cancer
• Carotid stents are indicated for the treatment of
carotid artery disease
• Embolic Protection Devices are used to catch any
clot particles dislodged during the procedure
27
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Embolic protection
Embolic protection devices are used to
capture and remove debris that becomes
dislodged during an interventional
procedure.
28
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Peripheral & biliary stent insights
Between 2003 – 2006, 1 million biliary stents were
implanted in the peripheral vasculature
• 90% of biliary stents are used
off-label
• The FDA issued warning
letters to all manufacturers to
refrain from marketing or
promoting off-label use
29
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PBS FDA indications
Abbott
Boston
Scientific
Covidien
J&J
Medtronic
ParaMount Mini
GPS
Visi-Pro
IntraStent LD
Protégé
Everflex
Protégé GPS
PRECISE
Transhepatic
S.M.A.R.T. Control
S.M.A.R.T. Flex
Pacer RX
Complete SE
Protégé RX
Precise Pro RX
Biliary
Supera Veritas
Xpert
Express SD
Express LD
WALLSTENT
Carotid
RX Acculink
Xact
WALLSTENT
Iliac
Omnilink Elite
Absolute Pro
Epic
Express LD
WALLSTENT
PALMAZ
S.M.A.R.T. Control
Renal
Herculink Elite
Express SD
PALMAZ
SFA
Tracheobronchial
Embolic
Protection
30
Assurant Cobalt
Complete SE
Everflex
S.M.A.R.T. Control
Complete SE
SpiderFX
ANGIOGUARD RX
FiberNet
WALLSTENT
Emboshield NAV6
RX Accunet
FilterWire EZ
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Questions
What is the most common method for diagnosing PVD?
• Coronary angiogram
• Peripheral angiogram
• Magic 8 ball
What device is used to deliver a stent?
• Catheter
• FedEx
• Amazon drone
31
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Market trends and technology
DIR U.S. market share
Diagnostic Interventional Radiology
Dollars in millions and percent of market share
FY 2011 – total value = $1.5 Billion
Boston Scientific
$365 M
24%
Others
$454 M
30%
Abbott
$58 M
4%
J&J
$187 M
12%
ev3
$88 M
6%
Bard, C.R.
$94 M
6%
Terumo
$132 M
9%
Cook Inc.
$147 M
9%
Source: IMS
Others include but not limited to: AngioDynamics, Merit, Teleflex, Vascular Solutions
33
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DIR U.S. market share by sub-category
Diagnostic Interventional Radiology by Sub-category
Dollars in millions and percent of market share
FY 2011 – total value = $1.5 Billion
PTA Guiding Catheters
$26 M
Diagnostic Catheters
2%
$71 M
5%
Infusion Catheters/Others
$104 M
7%
Drainage Catheters
$23 M
1%
Embolization/Embolic
$422 M
28%
PTA Balloons
$234 M
15%
Introducers/Sheaths
$313 M
20%
Guidewires
$332 M
22%
Source: IMS
34
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DIR Premier market share
Diagnostic and Interventional Radiology
Dollars in millions and percent of market share
7/1/2011 – 6/30/2012 total value = $203.3 Million
Merit
$11M
5%
Medtronic
AngioDynamics
$3 M
B.Braun
$9 M
2%
$6 M
4%
3%
Abbott
$11 M
5%
Arrow
$1 M
1%
Boston Scientific
$61 M
30%
Bard
$16 M
8%
Covidien
$37 M
18%
Cook
$49 M
24%
Source: Premier Supplier Reported Spend
35
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PBS U.S. market share
Peripheral and Biliary Stents
Dollars in millions and percent of market share
FY 2011 – total value = $686 Million
Atrium Medical
$31 M
5%
Cook Inc.
$24 M
3%
Medtronic
$13 M
2%
Others
$19 M
3%
J&J
$203 M
30%
ev3
$71 M
10%
Bard
$83 M
12%
Abbott
$102 M
15%
Boston Scientific
$140 M
20%
Source: IMS
Others include but not limited to: IDEV technologies, Gore, Insitu Technologies, Braun
36
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
PBS Premier market share
Peripheral and Biliary Stents
Dollars in millions and percent of market share
7/1/2011 – 6/30/2012 total value = $91 Million
Cook
$6 M
7%
Medtronic
$4 M
4%
IDEV
$2
2%
Covidien
$27 M
29%
Bard
$14 M
15%
Boston Scientific
$16 M
17%
Abbott
$24 M
26%
Source: Premier Supplier Reported Spend
37
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DIR and PBS trends
Chronic total occlusion (CTO)
devices
• Designed to facilitate placement
of guidewires beyond stenotic
lesions
Long balloon catheters
• Used in lower leg arteries,
requires less inflations and
reduces procedure times
SFA indicated stents
• Stronger and more flexible stents
are being used with success
Drug-eluting SFA stents
• Designed to reduce restenosis
rates and require fewer repeat
interventions
38
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DIR and PBS on the horizon
Adjustable length balloons
• Provides more flexibility
during the procedure
• Limits SKUs
Renal denervation
• Treating resistant
hypertension with
radiofrequency ablation
Drug-coated balloons
• Currently in trials, standard
balloons coated with
Paclitaxel and combined
with a hydrophilic spacer
(Paccocath or Cotavance)
39
PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.
Peripheral Drug-Eluting Balloons
40
Source: BIOLUX P-I: First-in-human, randomized controlled trial of Passeo-18 Lux DRB vs. POBA in femoropopliteal arteries
12 Month Results; TCT, October 2013.
PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.
Questions
Name at least two product sub-categories in DIR?
• Balloon catheters and guidewires
• Guidewires and vascular closure devices
• Balloons & party hats
Name an emerging DIR technology.
• Drug-coated balloons
• Drug-coated catheters
• Drug-coated guidewires
41
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
Diagnostic and Interventional
Radiology contracts
Premier spend for diagnostic and interventional radiology
Subcategory
Boston
Scientific
Cook
Covidien
J&J/
Cordis*
Bard
PTA balloon
34.8%
2.9%
10.2%
X
27.7%
Embolization
products
57.3%
16.5%
Atherectomy
Merit
Abbott
11.1%
Total %
Angio
B. Braun Medtronic by subDynamics
category
0.3%
8.1%
28.5%
57.4M
13.6%
27.3M
12.7%
25.5M
12.0%
24.2M
7.6%
15.3M
7.2%
14.6M
5.4%
10.9M
5.3%
10.7M
8.4%
4.6%
9.3M
20.7%
1.2%
2.3M
0.9%
1.8M
0.8%
1.5M
0.1%
0.3M
26.2%
100%
Guidewires
43.3%
28.4%
6.9%
X
Drainage
catheters
29.3%
44.7%
Accessories
30.8%
67.3%
Other
14.4%
67.3%
4.7%
41.4%
X
19.2%
17.7%
2.2%
7.3%
0.9%
1.9%
17.7%
Diagnostic
catheters
Sheaths and
introducers
Inflation
devices
Guide
catheters
Infusion
products
6.5%
72.5%
X
56.3%
11.8%
X
IVUS
100%
16.6%
83.4%
6.5%
39.9%
10.9%
43.1%
12.6%
11.2%
X
8.8%
44.8%
5%
Total
spend
Percent by
26.9%
21.7%
16.6%
9.9%
7.2%
5.0%
4.9%
3.8%
2.7%
1.3%
100%
223M*
supplier
-Data based on spend information reported by supplier from 7/1/11-6/30/12
-Highlighted in yellow is the Premier market share leader
*J&J/Cordis was unable to provide detailed spend information. We estimated based on 2011 US market share that J&J/Cordis has 22M in spend.
43
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
DIR awarded suppliers
Abbott
B. Braun
Boston Scientific
Covidien/ev3
J&J/Cordis
Medtronic
Merit
Surgical Specialties
44
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
Abbott (PP-CA-228)
Tier 1
Tier 2
Tier 3
<25% OR
multi vendor
25% - <50% OR
tri vendor
50%+ OR dual vendor
PTA balloons
54.3%
savings
3.0%
additional savings
3.1%
additional savings
Guidewires
50.0%
savings
6.9%
additional savings
3.4%
additional savings
Weighted % off of
list price
54.0%
savings
3.2%
additional savings
3.1%
additional savings
Abbott
Value-add matrix
Additional percentage off
tier pricing
Balloons
Non-cardiac stents
45
T1
T2
T3
T1
0%
0%
0%
T2
0%
3%
5%
T3
0%
5%
7%
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
B. Braun (PP-CA-230)
Tier 1
Tier 2
Tier 3
Access
$25,000 - <$150,000
OR
30% market share
$150,000+
OR
50% market share
PTA balloons
3.3%
savings
3.0%
additional savings
3.6%
additional savings
Sheath/ introducers
11.5%
savings
8.6%
additional savings
5.0%
additional savings
Drainage catheters
21.0%
savings
3.0%
additional savings
3.9%
additional savings
Guidewires
12.7%
savings
2.2%
additional savings
2.2%
additional savings
Infusion products
10.5%
savings
7.2%
additional savings
5.9%
additional savings
Weighted % off of
list price
4.3%
savings
3.6%
additional savings
3.8%
additional savings
B. Braun
46
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
Boston Scientific (PP-CA-231)
Tier 1
Tier 2
Tier 3
Tier 4
<15%
15% - <40%
40% - <60%
60%+
Boston
Lower tier requirements from last agreement
47
Weighted
expiring vs. new
Tier 1
Tier 2
Tier 3
Tier 4
Balloons
0%
0%
0%
0%
Embolization
0%
0%
0%
0%
Guidewires
0%
0%
0%
0%
Other
0%
0%
0%
0%
Overall
0%
0%
0%
0%
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
Covidien (PP-CA-232)
Covidien
Tier 1
Balloons
Tier 2
Balloons
Tier 3
Balloons
Tier 4
Balloons
Tier 5
Balloons
Tier 6
Balloons
<76
Annual units
76 - 200
Annual units
201 – 300
Annual units
301+
Annual units
IDN: Members at
50% - <80%
IDN: Members at
80%+
Tier 7
Tier 8
Tier 9
Tier 10
Tier 11
Tier 12
Atherectomy/CTO Atherectomy/CTO Atherectomy/CTO Atherectomy/CTO Atherectomy/CTO Atherectomy/CTO
<71
Annual units
71 – 140
Annual units
141 - 210
Annual units
211+
Annual units
IDN: Members at
50% - <80%
IDN: Members at
80%+
Tier 13
Ancillary
Tier 14
Ancillary
Tier 15
Ancillary
Tier 16
Ancillary
Tier 17
Ancillary
Tier 18
Ancillary
<76
Annual units
76 – 150
Annual units
151 - 225
Annual units
226+
Annual units
IDN: Members at
50% - <80%
IDN: Members at
80%+
Reduced the number of tiers from last agreement
48
Weighted
expiring vs.
new
Tier 1
Tier 2
Tier 3
Tier 4
Tier 5
Tier 6
Balloons
15.0%
savings
15.2%
savings
9.7%
savings
10.5%
savings
9.7%
savings
10.5%
savings
Atherectomy
0.3%
increase
0.4%
increase
3.8%
savings
0.3%
savings
0.3%
savings
0.3%
savings
Ancillary
0.2%
savings
0.2%
savings
0.2%
savings
0.2%
savings
0.2%
savings
0.2%
savings
Overall
2.7%
savings
2.5%
savings
4.5%
savings
2.0%
savings
1.9%
savings
2.0%
savings
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
J&J/Cordis (PP-CA-233)
Tier 1
Tier 2
Tier 3
Tier 4
Cordis
49
<$100,000
$100,000 - <$200,000
$200,000+
$500,000+ OR
70% market share
in stents (units)
PTA balloons
53.8%
savings
1.5%
additional savings
1.2%
additional savings
Local pricing
only
Guidewires
32.3%
savings
2.3%
additional savings
1.2%
additional savings
Local pricing
only
Guide catheters
44.4%
savings
2.6%
additional savings
1.1%
additional savings
Local pricing
only
Sheaths/
introducers
62.2%
savings
1.3%
additional savings
1.7%
additional savings
Local pricing
only
Diagnostic
catheters
38.2%
savings
1.6%
additional savings
1.0%
additional savings
Local pricing
only
Weighted % off of
list price
53.0%
savings
1.5%
additional savings
1.2%
additional savings
Local pricing
only
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
Medtronic (PP-CA-234)
Tier 1
Tier 2
Tier 3
<$75,000
OR
<25%
$75,000 - <$150,000 OR
25% - <50%
$150,000+
OR
50%+
PTA balloons
47.2%
savings
2.7%
additional savings
2.7%
additional savings
Average % off of list
price
47.2%
savings
2.7%
additional savings
2.7%
additional savings
Medtronic
50
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
Merit (PP-CA-235)
Tier 1
Merit
Premier Tier
51
Embolization products
29.1%
Savings
Drainage
catheters
18.8%
savings
Diagnostic catheters
30.2%
savings
Guidewires
9.1%
savings
Infusion products
40.5%
savings
Weighted % off of list price
30.9%
savings
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
Supplier vs. supplier
Boston as the base
Abbott
J&J/Cordis
Subcategory
% of Spend
Access
Top Tier
% of Spend
PTA balloons (overall)
2%
26.9%
favorable
17.4%
favorable
24%
Below the knee
28%
High pressure
38%
Workhorse
2%
26.9%
favorable
17.4%
favorable
13%
Covidien
Access
Top Tier
50.2%
favorable
43.9%
favorable
57.9%
favorable
35.9%
favorable
37.0%
favorable
36.3%
favorable
42.1%
favorable
27.8%
favorable
% of Spend
73%
90%
67%
7%
Guidewire
Access
Top Tier
25.0%
favorable
3.0%
favorable
31.7%
favorable
11.3%
favorable
33.3%
39.5%
favorable
favorable
77.8%
30.1%
unfavorable unfavorable
Embolization products
Overall
26.9%
favorable
Boston as the base
B. Braun
Subcategory
% of Spend
PTA balloons (overall)
12%
12%
17.4%
favorable
50.2%
favorable
37.0%
favorable
Medtronic
Access
Top Tier
12.6%
4.7%
unfavorable unfavorable
19%
32.6%
favorable
34.7%
favorable
12.6%
4.7%
unfavorable unfavorable
19%
32.6%
favorable
34.7%
favorable
Top Tier
27.9%
favorable
Merit
% of Spend
Access
19.2%
favorable
% of Spend
Access
Top Tier
6.9%
favorable
6.9%
favorable
1.0%
favorable
1.0%
favorable
Below the knee
High pressure
Workhorse
Guidewire
29%
Embolization products
Overall
52
12.6%
4.7%
unfavorable unfavorable
32.6%
favorable
34.7%
favorable
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
Peripheral and Biliary Stent
contracts
Premier spend peripheral and biliary stents
Subcategory
IDEV
Total % by
subcategory
Total
spend
3.1%
64.1%
59.7M
13.8%
12.9M
10.3%
12.0%
11.2M
39.5%
60.5%
10.2%
9.4M
20.2%
14.0%
100%
117.2M*
Covidien
J&J/
Cordis*
Abbott
Boston
Bard
Cook
Medtronic
Biliary
stents
31.2%
X
9.9%
15.5%
23.7%
9.5%
7.2%
Embolic
protection
57.5%
X
39.7%
Carotid
stents
8.6%
X
81.2%
X
20.4%
Vascular
stents
Percent by
supplier
23.0%
2.8%
12.0%
4.8%
4.0%
1.6%
-Data based on spend information reported by supplier from 7/1/11-6/30/12
-Highlighted in yellow is the Premier market share leader
*J&J/Cordis was unable to provide detailed spend information. We estimated based on 2011 US market share that J&J/Cordis has 24M in spend.
54
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
PBS awarded suppliers
Abbott
Boston Scientific
Covidien/ev3
J&J/Cordis
Medtronic
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PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
Abbott (PP-CA-236)
Tier 2
Tier 3
<25% Noncardiac or multi
vendor for noncardiac
25% - <50%
Non-cardiac or
tri vendor for
non-cardiac
Tier 4
50%+ Non<50% Carotid
cardiac or dual
or multi vendor
vendor for nonfor carotids
cardiac
Weighted
expiring vs.
new
Access
non-cardiac
Top noncardiac
Access
carotid
Top carotid
Biliary
4.4%
savings
22.6%
savings
N/A
N/A
Vascular
17.4%
savings
13.4%
savings
N/A
N/A
Carotid
N/A
N/A
0%
7.7%
savings
Embolic
protection
N/A
N/A
0%
10.8%
savings
Overall
12.8%
savings
16.7%
savings
0%
9.1%
savings
Tier 5
Tier 6
50% - <80%
Carotid or dual
vendor for
carotids
80%+ Carotid or
sole vendor for
carotids
Value-add matrix
Non-cardiac stents
Balloons
Abbott
Tier 1
T1
T2
T3
T1
0%
0%
0%
T2
0%
3%
5%
T3
0%
5%
7%
Additional percentage off tier pricing
Market share leader in carotid stents
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PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
Boston Scientific (PP-CA-237)
Boston
Scientific
Tier 1
Tier 2
Tier 3
<30%
30% - <60%
60%+
Lower tier requirements from last agreement
Weighted expiring
vs. new
Tier 1
Tier 2
Tier 3
Biliary
0.0%
0.0%
0.0%
Carotid
0.0%
0.0%
0.0%
Embolic protection
0.0%
0.0%
0.0%
Overall
0.0%
0.0%
0.0%
Market share leader in vascular stents
57
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
Covidien (PP-CA-238)
Tier 1
Covidien
Access
Tier 2
Tier 3
Tier 4
Tier 5
Tier 6
IDN
IDN
All members
All members
121 – 230
231 – 350
351+
receive tier 3
receive tier 4
Annual units Annual units Annual units
pricing for 50% - pricing for 80%+
<80% participation
participation
Market share leader in biliary stents and embolic protection
58
Weighted
expiring vs.
new
Tier 1
Tier 2
Tier 3
Tier 4
Tier 5
Tier 6
Carotid
0%
0%
0%
0%
0%
0%
Embolic
protection
23.1%
increase
21.3%
increase
13.8%
increase
15.0%
increase
13.8%
increase
15.0%
increase
Biliary
1.7%
savings
2.0%
savings
2.3%
savings
2.7%
savings
2.3%
savings
2.7%
savings
Overall
4.4%
increase
3.9%
increase
1.9%
increase
1.9%
increase
1.9%
increase
1.9%
increase
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
J&J/Cordis (PP-CA-239)
Tier 1
Tier 2
Tier 3
Tier 4
Cordis
Average % off of
list price
59
<$100,000
$100,000 - <$200,000
$200,000+
$500,000+
OR 70% market share
in stents (units)
51.6%
savings
4.2%
additional savings
1.6%
additional savings
Local pricing only
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
Medtronic (PP-CA-240)
Tier 1
Tier 2
Tier 3
<$75,000 OR
<25% market share
$75,000 - <$150,000 OR
25% - <50% market share
$150,000+ OR
50%+ market share
Medtronic
60
Weighted
expiring vs.
new
Access
vs.
Access
Tier 2 vs.
Tier 1
Tier 2 vs.
Tier 2
Tier 3 vs.
Tier 2
Tier 3 vs.
Tier 3
Top tier vs.
Top tier
Biliary
1.9%
savings
4.8%
increase
2.1%
savings
3.8%
increase
5.6%
savings
0.0%
Embolic
protection
2.4%
savings
1.8%
savings
2.4%
savings
1.8%
savings
2.4%
savings
0.9%
savings
Overall
1.9%
savings
3.8%
increase
2.2%
savings
2.8%
increase
5.2%
savings
0.3%
savings
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
Supplier vs. Supplier
Base
supplier
Subcategory
Abbott
Subcategory Access Top Tier
Boston
J&J/Cordis
Covidien
Medtronic
% of
% of
% of
% of
% of
Access Top Tier
Access Top Tier
Access Top Tier
Access Top Tier
Spend
Spend
Spend
Spend
Spend
Covidien
Biliary
1.3%
50.4%
86.6%
39.9%
12.6%
94.2%
Base
Base
Base
Medtronic
Iliac
16.9%
22.9%
96.1%
32.0%
28.9%
98.3%
22.2%
12.9%
100%
Abbott
Renal
11.1%
28.2%
99.9%
31.8%
22.8%
84.2%
14.1%
10.6%
86.7%
Covidien
SFA
6.0%
42.1%
12.7%
49.9%
29.9%
98.6%
Base
Base
Base
Abbott
Carotid
Base
Base
Base
3.8%
26.3%
56.1%
38.7%
33.2%
100.0%
14.3%
29.6%
98.7%
Abbott
Embolic
Protection
Base
Base
Base
25.3%
24.7%
93.9%
8.8%
33.6%
100%
Base
Base
Base
Base
Base
Base
20.8%
5.8%
84.7%
Abbott did not cross many items against other suppliers but other suppliers crossed to Abbott
61
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
DIR and PBS tools and resources
Launch tools
Contract details
Value analysis toolkit
Pricing options
Terms and conditions
Clinical overview
Clinical primer
Clinical guidelines
Analytical tools
Data cleansers
Cost modeling tools
Reimbursement
Additional
resources
Cross-references
PBS FDA indications
Additional resources
63
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
Value analysis toolkits
64
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
Clinical resources
65
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
Analytical tools
Data Extract Report
• Log in to MySpend
• Access contract launch extract reports folder
» DIR extract report
» PBS extract report
Data cleanser
• Standardizes manufacturer names and UOM
• DIC/DIR tool identifies DIC or DIR contract
• Sub-categories identified
» DIR: guidewires, balloons, catheters, etc.
» PBS: carotid, iliac, SFA, etc.
Cost modeling
• Calculates financial impact of new agreements on current spend
• Allows modeling to analyze savings opportunity with conversion
to contracted suppliers
66
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
DIC/DIR Data Cleansing tool
67
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
PBS Data Cleansing tool
68
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
Cost Modeling tool - example
STAY WITH CURRENT SUPPLIER
TIERING AND RESULTS SUMMARY
Grand Total
(all categories)
Pick Tier For Suppliers Below
69
Grand Total
Market Share
Current Balloons Current Balloons
Quantity
Spend
Current Balloons
Market Share ($)
Future Balloons
Spend
Balloons
(Incr)/Svgs $
Balloons
(Incr) / Svgs %
Abbott
Ti er 11: 20% - 39% Total Purcha s es
$
449,486
37%
1,472
$
292,256
47%
$
286,696
$
5,560
2%
Boston Scientific
Ti er 2: 25% - 39%
$
432,262
36%
1,316
$
309,904
50%
$
307,139
$
2,765
1%
J&J
Ti er 2: ≥ $100,000
$
217,492
18%
0
$
-
0%
$
-
$
-
0%
Medtronic
Ti er 1: <30%
$
92,620
8%
68
$
14,960
2%
$
12,240
$
2,720
18%
Merit Medical
Ti er 1: Acces s Ti er
$
24,465
2%
0
$
-
0%
$
-
$
-
0%
Oscor
Ti er 1: <$500,000
$
-
0%
0
$
-
0%
$
-
$
-
0%
St. Jude
Ti er 1: Premi er Ti er
$
-
0%
0
$
-
0%
$
-
$
-
0%
Arrow
Ti er 1: <$15,000
$
553
0%
0
$
-
0%
$
-
$
-
0%
$
11,045
2%
Error Items
$
170
Total Excluding Error Items
$
1,216,877
0%
100%
2,856
$
-
$
617,120
0%
100%
$
606,075
PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.
Product cross-references
70
PROPRIETARY & CONFIDENTIAL – © 2012 PREMIER INC.
PBS FDA indications
Abbott
Boston
Scientific
Covidien
J&J
Medtronic
ParaMount Mini
GPS
Visi-Pro
IntraStent LD
Protégé
Everflex
Protégé GPS
PRECISE
Transhepatic
S.M.A.R.T. Control
S.M.A.R.T. Flex
Pacer RX
Complete SE
Protégé RX
Precise Pro RX
Biliary
Supera Veritas
Xpert
Express SD
Express LD
WALLSTENT
Carotid
RX Acculink
Xact
WALLSTENT
Iliac
Omnilink Elite
Absolute Pro
Epic
Express LD
WALLSTENT
PALMAZ
S.M.A.R.T. Control
Renal
Herculink Elite
Express SD
PALMAZ
SFA
Tracheobronchial
Embolic
Protection
71
Assurant Cobalt
Complete SE
Everflex
S.M.A.R.T. Control
Complete SE
SpiderFX
ANGIOGUARD RX
FiberNet
WALLSTENT
Emboshield NAV6
RX Accunet
FilterWire EZ
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
PremierConnect™ cardiovascular community
• Tools and resources
• Best practices
• Discussion threads
72
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
Questions
Name a supplier with contracts for both DIR and PBS.
• B. Braun
• Boston Scientific
• Merit
Which tool will identify the contract and sub-category?
• Data Cleansing tool
• Black and Decker power tool
• Ronco Veg-O-Matic
Name an incumbent supplier not awarded
a new contract.
• Abbott
• Cook
• J&J/Cordis
73
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.
Questions and discussion
74
PROPRIETARY & CONFIDENTIAL – © 2013 PREMIER INC.