Transcript Slide 1
Specialty Pharmacy’s Role in Patient Persistence & Compliance Dick Rylander President BioPharmaceutical Strategies LLC Former VP Commercial Operations & IT Actelion Pharmaceuticals, US Speaking Qualifications • 26 years with Parke-Davis – 16 product launches including Lopid; Lipitor; Rezulin; Procan SR; ERYC; Loestrin and others – Sales; management; marketing; managed care; incentive planning and special projects • 5 ½ years with Actelion Pharmaceuticals as VP Commercial Operations & IT – Developed the specialty distribution systems for Tracleer and Zavesca • Accredo; Caremark; PharmaCare; Gentiva and Curascript – Responsible for managed care; contracting; reimbursement services; IT; data/analytics; forecasting; inventory management, pricing, market research, training, sales force alignment, CRM… Specialty vs. Retail • In the presentation we’ll: – Define the audiences – Outline some of their needs – Consider their different perspectives – Look at what impacts compliance – Share some examples of specialty efforts – Frame the strengths/weaknesses of various channels – Define when to use specialty Who are the audiences? Specialty Phcy Patient Employer Payers Retail Phcy Manufacturer Who is expecting what? Manufacturer • They spend a LOT of money finding patients and getting an Rx written • 30-40% of Rx’s written never get filled • Dropout rates over the first 6-12 months are HIGH • Every patient retained as long as possible is one that contributes to sales and outcomes Who is expecting what? Patient • • • • • They don’t now if they can afford the medication's) They worry about side effects They may not understand their disease They may be afraid to ask questions They may believe they need to make sacrifices to get and take their medications Who is expecting what? Retail Phcy • Handle high volumes of patients • Are pressed to carve out time to counsel and advise patients • Work on small margins and are stretched thin • Have broad general knowledge of many diseases but may not have depth • Insurance is more focused on mass market high volume drugs where patients don’t need special support Who is expecting what? Specialty Phcy • • • • • Mail Order rather than retail based (most) Centralized personnel and services Tend to deal heavily in smaller disease states Tend to deal with more expensive medications Deal with insurance plans for approval, appeals, etc., on a daily basis • May have more depth of knowledge in specialty diseases Who is expecting what? Payers • They want to know that the medication is effective and will treat the condition…the first time • They need to believe that the treatment is cost effective • They need to know that this will reduce hospitalization, ER visits and other costly services Who is expecting what? Employer • • • • Needs to know their money is being well spent That their long term cost exposure is limited That the medication and treatment choices are right That the therapeutic choices will reduce recurring costs What are the common needs? Manufacturer Patient Retail Phcy Specialty Phcy Payers Employer • Once an Rx gets to the pharmacy: – – – – – Get it filled quickly At the lowest cost to the patient Get refills fast Answer questions Minimize any concern that will stop the patient from taking the medication – Deal with any AE’s or SAE’s – If there are problems getting insurance approval or if the co-pay is too high get it resolved – Keep the patient on therapy for the duration of treatment Compliance, Adherence and Persistency • What are the barriers to patients getting and taking medications and continuing to get refills and what can Specialty Pharmacy do better than retail or manufacturers themselves? Patient Barriers • • • • • • • Fear of medications Fear of cost Not understanding the disease Worry about side effects Insurance issues (poor or none) Co-pay’s unaffordable Misinformation Access Barriers • • • • Formulary restrictions Prior-Authorization process Timing delays Co-pay’s Who are some of the major SPP’s? • • • • • • • Accredo (Medco) Caremark CuraScript/Priority (Express Scripts) Aetna Specialty (Aetna) PharmaCare (CVS) RxCrossRoads (OmniCare) Walgreens Specialty (Walgreens) Statistics and Data • 75% of health plans use SPP’s • By 2008 biotech drugs may account for 25% of drug spend • There are over 600 biotech drugs in development which may require SPP’s • More and more drugs will be specialty and require special handling, education, training and assistance Stats & Data • Clinical outcome programs administered by SPP’s: – MS: 95%+ compliance vs. 80% in retail – PAH: Flolan’s central line infection rate was .044 vs. a national average of .45 (a 10 fold difference) – Hemophilia: Option Care program after 3 years (in one case example) had a 96% compliance rate vs. <50% prior – RA: Caremark data shows 97% compliance vs. 78% at retail and adherence rates of 89% vs. 80% Examples of programs at SPP’s CuraScript Examples of programs at SPP’s Examples of programs at SPP’s Accredo offered this example: Unspecified Drug (confidentiality) Known compliance issues (52-55%) Built categories based on Pt. answers Created risk identifiers Model combined objective + subjective responses Result: Compliance climbed to 90% ONCOLogic™ Value Proposition 2003 Persistancy Data CuraScript 93 Retail Avg 65 CuraScript has demonstrated superior Oncology patient management through compliance assistance programs: • Over 1,000 active patients on service for oral oncology agents 5.6 3.9 Compliance % Avg. Refill Rate Xeloda Average Refill Rate 5.6 cycles/ Average Days 117.6 Compliance Calculation Report • CuraScripts approach to determining compliance results uses a formula: TOTAL DAY SUPPLY TOTAL QTY FOR POTENTIAL FOR TIME PERIOD TIME PERIOD END OF TIME TOTAL DAYS OF (JAN-NOV 2004) PERIOD THERAPY PATIENT_RN PRODUCT FIRST FILL (JAN-NOV 2004) POTENTIAL DAYS OF THERAPY FOR TIME PERIOD (JAN-NOV 2004) WEEKS OF EXPECTED QTY FOR ADJUSTED QTY THERAPY FOR TIME PERIOD (JAN-NOV FOR TIME TIME PERIOD 2004) (RAPTIVA PERIOD (JAN(JAN-NOV 2004) DOSED 1X/WEEK) CARRYOVER NOV 2004) COMPLIANCE RATE US Bioservices • Harold G. Hilley, Vice President US Bioservices with 12 years in specialty suggests: Retail Specialty Patient Contact Reactive Proactive Drug Availability 1-2 day delivery Carried in stock Special clinical support Limited Specialized knowledge about knowledge lots of drugs Availability of clinical staff Regular hours 24/7 Dispensing vs. patient care Fill many Rx’s Lower volume Actelion - Tracleer When we planned for the launch we believed we would need certain services: 1) Each patient needed to be touched to understand their financial challenges, co-pay, etc. 2) Special effort made to get prior-auth approval 3) Someone to handle appeals of denials 4) Regular follow up with patients to make sure they got their questions answered 5) Access to payers, state Medicaid's, etc. 6) Monitoring and report of AE’s/SAE’s Tracleer (cont’d) • We chose four (4) SPP’s based on their ability to meet our anticipated needs • We designed: – A closed data system with daily reporting – An incentive system to: • assure getting patients on therapy within defined periods of time • maintain patients on therapy – Reporting to tell us how they performed Tracleer Results • We built an enrollment system that coordinated with the SPP’s to find those “in plan” with payers • We tracked the speed and identified reasons which cases were delayed and why • We worked with the SPP’s to understand why patients discontinued and built compliance efforts • We steadily improved the percentage of patients getting on and staying on therapy How does Specialty compare to Retail? This presumes a drug “X” that has special requirements for prescription, testing, is expensive, has temperature handling restrictions, needs to special monitoring or other requirements Speed of Co-Pay Delivery Assistance SPP Retail +++ ++ + = Low +++++ = High +++++ +++ Prior Auth’s Filing Appeals Training & Education AE’s & SAE’s ++++ ++ ++++ ++ +++++ ++ +++++ ++ Compliance Inventory Product Results Control Knowledge +++++ +++ +++++ + +++++ +++ Retail pharmacy excels at delivering mass market products (high volume) that require lower levels of support that can be carried in inventory or be obtained from a wholesaler in 24 hours where the patient has insurance (with a co-pay that is not an issue) or pays cash. When does it make sense to consider SPP’s? When: Prescription volume is limited It is a niche disease or smaller population Patients are likely to have co-pay issues Ongoing patient education & training is needed Prior-Auth’s are likely Side effects need to be managed Appeals will be necessary Quality data is needed Quick response is important You need better compliance, adherence and persistence SPP’s & Manufacturers • It’s a partnership – – – – Sharing information Consulting on outcome data and desired results Developing marketing plans together Planning for future success as a TEAM References • “The Rise and Role of Specialty Pharmacy” Biotechnology Healthcare October 2005. David Suchanek http://www.biotechnologyhealthcare.com/journal/fulltext/2/5/BH0205031.pdf • “A Practical Approach to Addressing a Longer-Term Benefits Strategy” Employee Benefit Plan review November 2005. David Carver and F. Randy Vogenberg http://www.aon.com/about/publications/pdf/issues/vogenberg_carver_practicalapproach_nov05.pdf • “Specialty Pharmacies Seek Ways to Deliver Financial and Clinical Outcomes to Payers” Specialty Pharmacy News July 2005. http://www.aishealth.com/DrugCosts/specialty/SPN_SPs_Seek_Ways_to_Deliver_Outcomes.html • “Overview of a Specialty Pharmacy” CuraScript Specialty Pharmacy Management Guide and Trend Report. 2004. http://www.expressscripts.com/ourcompany/news/industryreports/specialtytrendreport/2004/overview.pdf • DrugTrend Report: Managing Generation Rx. Vol 7, May 2005, Medco • Special case examples from Accredo; Caremark, CuraScript and US Bioservices