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Outcomes Conference 2007

CONFERENCE RECAP

Express Scripts 2006 Drug Trend Report
Julayna Meyer, RPh, MBA, Express Scripts
AUDIO 24 MB (42:32) (audio file)
SLIDES (PPT file)

Julayna Meyer, vice president of research and trend management, discussed the prevailing nonspecialty trends described in the 11th edition of the Express Scripts Drug Trend Report and presented their implications for smart decision making.

Brand prices rose 6.9% in 2006, while generic prices fell 5.7%, which shows how generics continue to play a major role in managing prescription-drug trend. Another key factor is brand drugs going off patent, which helps to move patients towards the generic alternative. Two blockbuster examples are Zocor® and Zoloft®, which will make an even larger impact in 2007.

Lowest Drug Trend in a Decade
The 2006 drug trend of 5.9% is another step forward from last year’s rate of 7.9% and corresponds with the increased use of generics, which dramatically began in 2002. Express Scripts projects a slight rise in drug trend over the next several years, but the numbers will remain in the single digits.

More than $50 billion worth of brand drugs are scheduled to lose patent during the next five years. Important examples include Prevacid® in 2009 and Lipitor® in 2010. Through the GenericsTodaySM program, Express Scripts took action in 2006 on the Zocor opportunity to raise the generic fill rate and deliver a lower drug trend. This change had a huge impact on driving the lipids therapy class and keeping its trend at a low 3.6% in 2006.

Hypnotics Are Growing Quickly
The hypnotics therapy class is currently ranked No.19 but it is exploding, with trends of 36.9% in 2006 and 33% in 2005. The key drivers for this large increase were price, prevalence and intensity. This class is the highest in direct-to-consumer advertising, and it has become a national story. There is some good news, however, as the first viable generic was approved in this category for Ambien®. Moving patients to the generic will play an important role in controlling this growing trend.

Adding Programs Drives Savings
Clients who added greater than two programs and participated in the GenericsToday program enjoyed a trend of only 1.8% during 2006. This speaks volumes to the importance of continuing to look for new opportunities to manage your trend, said Meyer. Looking at the future, greater management will lead to a lower trend. Opportunities abound for managing out waste, including the proton-pump inhibitor class and growing hypnotics spend.

Specialty Pharmacy: Today’s Prescription for a Better Tomorrow
Steve Miller, MD, MBA, Express Scripts
AUDIO 21 MB (37:27) (audio file)
SLIDES (PPT file)

Dr. Steve Miller, chief medical officer & vice president of specialty pharmacy, discussed solutions to control future specialty pharmacy costs and prevailing trends.

Specialty medications are often injectable or noninjectable medications that require frequent dosing adjustments, intensive clinical monitoring and patient training, limited or exclusive distribution, and cost in excess of $500 for a 30-day supply. The average drug in this category costs $1,500 per month, and they treat diseases like cancer, multiple sclerosis and rheumatoid arthritis.

Specialty Growth Continues to Outpace Traditional Drug Market
Twenty percent of drug spend comes from specialty medications, but relatively few people use these types of drugs. This portion is projected to grow to 26% by 2010. Specialty patients use a disproportionate part of the costs, and they remain with their health plans for lengthy periods of time because it is so vital to them. A positive aspect is that clinical programs (such as prior authorization for growth hormone) can have a significant financial impact on specialty with little patient disruption.

The overall specialty trend was 21% in 2006, and new drugs have a growing impact on this figure. Seventeen percent of the increase (3.6%) was due to new drugs, which is much larger than with regular prescription drugs, where their effect is insignificant.

Biopharmaceutical Pipeline Continues to Grow
Moving forward, there are over 600 biopharmaceuticals products in the pipeline. This trend is being driven by the Human Genome Project, breakthroughs in the field of biopharmaceuticals, and a philosophical change in the pharmacy industry. The specialty pipeline is for common chronic illnesses, and new indications are expanding utilization.

The routes of administration are also becoming more complex, and new delivery devices should dramatically change this field. The growing pipeline should lead to continued high trend, which is projected to remain within 20% to 25% each year going forward to 2010.

Specialty Patients Require Special Care
Patients using a specialty pharmacy have access to professionals specifically trained in specialty pharmacy. As a result, patients are better educated about their illnesses, are better able to manage their healthcare and are more compliant with therapy due to these benefits. For example, multiple sclerosis patients have 10% greater adherence with CuraScript than when using retail pharmacies.

One therapy class, hepatitis C, was the only specialty category with negative trend (-8.3%), and this fact was partially due to the availability of generics. Unfortunately, the bad news is that hepatitis C remains prevalent, but the number of patients seeking treatment has decreased. The financial impact of this disease is also huge, as exemplified by liver transplants, which cost $300,000 to $900,000 per transplant. The worldwide burden of hepatitis C will be an estimated $830 billion between 2010 and 2019, with 190,000 additional deaths. Compliance is critical with clearing the hepatitis virus, which offers an important example of the specialty pharmacy’s value.

Access to Lifesaving Medications Act
Introduced in 2007, this bipartisan act aims to allow for biogenerics, which could offer tremendous generic savings. Express Scripts has conservatively estimated that $3.5 billion savings would occur in the first year alone, and the savings could amount to $71 billion over 10 years. Numerous biologic drugs will be losing patent protection during that time, but serious opposing forces remain to keep this bill from happening. This bill is currently under debate in Congress and could have a crucial impact on controlling specialty pharmacy trend. Dr. Miller urged plan sponsors to take an active role in supporting this legislation.

To support or learn more about biogeneric legislation, visit The Right Prescription.

The Active Ingredients of Change
Emily Cox, RPh, PhD, Express Scripts
AUDIO 15 MB (26:03) (audio file)
SLIDES (PPT file)

Dr. Emily Cox, senior director of research & analysis, described programs that provide effective communications to patients about savings opportunities, based upon the drugs they are currently taking.

The Evolution from Patient to Healthcare Consumer
A growing number of members are becoming engaged in their decisions about prescription drugs, seeking information on drug-therapy alternatives and the prices of these alternatives. For example, 21% of the users on Express Scripts’ website used the Price Check feature during Q4 2006. Members are seeking healthcare information on the Internet, and when they do, nearly half believe that it is improving their self-care and affecting decisions.

Plan sponsors play a critical role in establishing the framework for members as they make decisions about prescription drugs. They determine the alternatives members choose from within the formulary, the specific prices and benefit design, and how members are communicated with to receive essential details. The “main ingredient” is relevant information that describes the savings available, which must be provided at the right time and with the proper assistance.

What Patients Don’t Know About Their Prescription-Drug Benefit

  • 64% could not correctly identify the type of pharmacy benefit plan they enrolled in.
  • 60% could not correctly identify the amount of their generic copayment.
  • 50% indicated their physician or pharmacist never or seldom talked to them about generics.

Adding the Active Ingredients
Several active ingredients work to influence the effectiveness of the information that plan sponsors provide to members:

  • Opportunity – Making sure you provide the information at the time in which the member is most engaged in the decision-making process.
  • Incentive – Members sometimes need an additional short-time incentive to choose the lower-cost option.
  • Assistance – Changing medications requires considerable assistance, which provides a barrier in making this adjustment.

Opportunity
The Rx Savings Select program uses a letter to introduce plan-sponsor contributions, present alternative drugs and describe possible savings. Another possible action is giving a timely reminder when members are facing a decision such as a formulary change. Providing that information “just in time” when they’re most engaged in the process influences the movement significantly to the preferred product, said Dr. Cox.

Incentive
The $0 Generic Copay program provides an additional short-term incentive to members who choose the generic and delivers significant differences across all therapy classes. In recent history, less than 1% returned to the branded product when the zero-dollar offering ended.

Assistance
The Home Delivery Outreach program offers assistance to members and encourages them to select the preferred drug instead of a nonformulary branded product. We offer to call the physician for the patient to institute the change, and this assistance has a significant effect.

Customizing information, informing at the right time, offering short-term incentives and layering on assistance can deliver a major impact. The prescription-drug benefit is ripe for consumerism, and there are great opportunities to influence change by educating members.

Preparing for What’s on the Prescription-Drug Benefit Horizon
Brenda Motheral, RPh, MBA, PhD, Express Scripts
AUDIO 17 MB (30:00) (audio file)
SLIDES (PPT file)

Dr. Brenda Motheral, senior vice president of research & product management, examined key industry issues while offering new insights and practical solutions.

The Partnership Model
Plan sponsors place more responsibility on consumers, but they would like to retain control over the rules of how members use that benefit. We’re currently seeing a combination of these aspects within the marketplace. In the future, supply chain and plan-sponsor directed models will continue to drive value for pharmacy benefit management.

Medicare Part D
The hypothesis was that Part D beneficiaries would take advantage of lower-cost generics to avoid hitting the donut hole. However, the reality is that many beneficiaries are hitting the donut hole unnecessarily and could take advantage of lower-cost generics.

Express Scripts’ research has shown that there is a direct correlation between a higher generic fill rate and the lower percentage of members reaching the donut hole. For example, Plan C has a generic fill rate of 40%, with 45% hitting the donut hole. If they employed methods to raise their generic fill rate to 65%, the other figure would drop by 10%.

Wal-Mart $4 Generics
The hypothesis from Wal-Mart was that low prices on selected generics would result in more volume of other generics and brands as well as increased nonpharmacy store sales. However, their market share increased by just 1% overall, which lead to a minimal market impact on prescription-drug use. Dr. Motheral gave three reasons for this minor effect:

  1. Members didn't always save as much as advertised, and the payment was closer to $6 due to program limitations.
  2. Members did not want to unbundle their prescriptions and use multiple pharmacies.
  3. Many patients do not consider Wal-Mart a convenient choice.

Consumer-Directed Health Plans
The hypothesis was that employees enrolled in a high-deductible plan will use more generics and over-the-counter alternatives while discontinuing unnecessary medications. Compared to traditional insurance, Express Scripts discovered that consumer-direct health plan members did reduce brand use, but they also significantly lowered generic use. Without additional educational programs, enrollees did not use more generics, and compliance decreased in many therapy classes.

What’s Ahead in 2008

  • Wellness incentives (such as smoking cessation incentives) have the potential to make an impact in the prescription-drug benefit.
  • Lowering brand copayments for valuable medication classes (such as diabetes and asthma) has been highly touted in the past six to 12 months and will continue to be studied.

Using specialists to manage plan sponsors’ healthcare and the coordination between those clinical managers is becoming very important.



PPT files require Microsoft PowerPoint®.
Audio files may require RealPlayer™ or QuickTime.

 

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