Market With Innovation

Transcription

1 Leading The Specialty Market With Innovation Alan Lotvin, M.D. Executive Vice President, CVS/specialty

2 Agenda Specialty Market Overview Performance Highlights Reinventing Specialty Pharmacy Well Positioned to Grow in Evolving Health Care Environment 2

3 Two Distinct Specialty Pharmacy Markets: CVS/specialty Well Positioned in Both Patient Choice Payor Directed Need: A Better Specialty Experience Need: Comprehensive Trend Management 3

4 Addressable Specialty Market is One of the Fastest Growing Segments in Health Care Addressable Specialty Market ($, billions) 16% CAGR E 2016E 2018E Medical Pharmacy Note: 1. Addressable specialty market currently excludes infused oncology. Source: NHE, Artemetrx, CVS Health Internal Analysis,

5 Three Key Drivers of Utilization Driver 1: New Drugs Driver 2: New Indications Driver 3: Age Rxs Per Millio on Members Per Month 8,500 7,000 5, New Drug Launches Patients in 60s vs. 20s 24 3X higher utilization YTD 2014 New Specialty Indications Utilization Trend 6X higher specialty PMPM Source: CVS/caremark Enterprise Analytics, data through 9/30/2014, 5

6 Drug Price Driven by Annual Price Inflation and Higher Launch Prices Average Inflation Monthly Price (%) $35,000 ($) Harvoni 10.6 $30,000 Sovaldi TM 8.5 $6,000 Revlimid Tecfidera $4,500 Tasigna Incivek $3, $1,500 $0 Copaxone Tysabri Cimzia i Humira Enbrel Source: CVS/caremark Specialty Analytics. Annual drug costs based on average wholesale price (AWP) accessed summer This slide contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Health. Source: CVS/specialty book of business. 6

7 Specialty Drugs Are a Fraction of the Total Cost for Patients with Rare and Complex Conditions 25% 3.6% Total Health Ca are Spend 11% 1% 5% All other medical costs All other drugs Medical costs associated with specialty condition of plan members use specialty drugs 25% 8% Specialty drugs Source: Milliman Specialty Medication Benchmark Study, 2013 analysis of 2011 data. 7

8 A Changing Specialty Marketplace Affects All Stakeholders Patient Payor CVS Health Therapies available for unmet medical needs Greater financial burden More choices but more complexity: oral, injectable, infused Key driver of overall drug trend Improvement in member health, more therapies Limited visibility in medical benefit Clients have a growing need for management strategies Opportunity to grow share in an expanding markets Greater risk of client dissatisfaction with trend management 8

9 Agenda Specialty Market Overview Performance Highlights Reinventing Specialty Pharmacy Well Positioned to Grow in Evolving Health Care Environment 9

10 Strong Organic Growth Enhanced by Strategic Acquisitions and Integrations CVS/specialty Dispensed Revenue ($, billions) Accordant Integration % CAGR Novologix Acquisition 13.6 Coram Acquisition; Specialty Connect Launch E 2015E Note: 1. Payor directed reflects exclusive and preferred relationships. 2. Dispenses at CVS/pharmacy excluded. Patient Choice Payor Directed 10

11 Patient Choice Market is Likely to Grow Fastest in the Future Key Sectors: 300 Individuals/Exchanges 264 Medicaid id Medicare Employer-sponsored E Growth in U.S. Insured Lives Source: CVS Health Internal Analysis; Medicare Trustees Report,2014; Avalere Medicaid Model, September 2014; Barclays Healthcare Industry Report, January 2013; McKinsey MPACT 6.2, September 2014; CBO Public Exchange Estimates, February 2014; Oliver Wyman,

12 Patient Choice Market is Likely to Grow Fastest in the Future Key Sectors: Individuals/Exchanges Public Private Medicaid Fee for Service Managed Medicare PDP MAPD Employer-sponsored Retirees Actives % Growth In Patient Choice Segment E Payor Directed Patient Choice Source: CVS Health Internal Analysis; Medicare Trustees Report,2014; Avalere Medicaid Model, September 2014; Barclays Healthcare Industry Report, January 2013; McKinsey MPACT 6.2, September 2014; CBO Public Exchange Estimates, February 2014; Oliver Wyman,

13 Nearly 60% of Specialty Scripts Dispensed Through CVS Health Channels CVS Health Share of CVS/caremark Specialty Prescriptions 85% 59% 46% Book of Business Employer Health Plan Opportunity to drive additional enterprise share with health plans Notes: 1. Enterprise share (includes Specialty mail & CVS retail) and are estimated full year Book of Business includes Medicare Part D Individual products, excluded from Employer and Health Plan 13

14 Agenda Specialty Market Overview Performance Highlights Reinventing Specialty Pharmacy Well Positioned to Grow in Evolving Health Care Environment 14

15 CVS/specialty is Reinventing Specialty Pharmacy Management Patient Choice Payor Directed Strategy: Delivering a Better Specialty Experience Strategy: Offering Comprehensive Trend Management 15

16 Our Innovative Solutions Work Together to Support a Better Patient Experience Specialty Connect Care Team +A Accordant or CVS/pharmacy pickup Mail Delivery Expert Pharmacist-led CareTeam Embedded Accordant Rare Disease Nurse Centralized Clinical Support 16

17 Specialty Connect: Making it Easier to Start Specialty Therapy What do I do with a new specialty prescription? 1 in 4 turned away because The drug is not carried The pharmacy cannot bill the correct benefit The pharmacist is not trained on the therapy Patients turned away may delay or never start therapy Specialty prescriptions accepted at any CVS/pharmacy, regardless of PBM Source: 2011 New England Opinion focus group of specialty patients, calls to 150 retail pharmacies (CVS and competitors) on January 13-15,

18 Managing the Needs of Complex Patients Where can I get help managing my therapy and condition? PATIENT A complete clinical team dedicated to my condition Standard for Every Patient Enhanced for CVS/caremark Member Pharmacy Coordinator: verify benefits and confirm delivery preference Specialty Pharmacist: help manage side effects and support adherence + Rare Disease Management Nurse: help manage symptoms, comorbid conditions and lifestyle changes 18

19 Embedding Nurses as Standard Step in Specialty Pharmacy Process Maximizes Engagement Rates Engagement Rates UP TO 13X 65% 36% 5-10% Traditional Disease Management Standard Accordant Embedded Accordant 11% reduction in total health care costs associated with managed conditions WellNet Interactive President, Judith Mueller Discusses How an Integrated Approach to Medical, Care and Disease Management Can Drive Engagement Rates to Over 50 Percent When Properly Managed and Incented). Up to 13X higher patient engagement than traditional DM. *Up to 11.1% reduction in overall spend. Accordant - Comprehensive Data Warehouse; SQL Server Greensboro, NC: care management Health Services, a CVS/caremark Company;

20 Specialty Connect: Making it Easier to Receive Specialty Medications What works best for me? or Prefer CVS/pharmacy Are concerned about missing temperature-sensitive, re e high-cost shipments during workday Have a trusted pharmacist relationship at CVS/pharmacy Prefer Mail Delivery Are comfortable with home delivery Have limited mobility or transportation Do not live near a CVS/pharmacy Receive home infusions ~50% choose in-store pickup; available to all CVS/pharmacy customers Soure: CVS/caremark Enterprise Analytics, (1/1/14 8/28/14), September

21 Key Stakeholders Recognize Value of a New Specialty Pharmacy Experience Patient and Physician Ability to serve 97% of patients at CVS/pharmacy 89% agree that retail access makes life easier 13% more patients optimally adherent Payor 23% fewer diseaserelated admissions 7% fewer ER visits Up to 11% total health care savings Extends health plan care management model CVS Health Recognition of differentiated model More than $1billion in new specialty revenue, including ~ $400 million in new business integrated with Accordant Improved inventory management Sources: CVS/specialty Internal Analysis, Market Probe Specialty Patient Satisfaction Survey Dashboard Analytics and Outcomes analyses of fspecialty Connect patient outcomes Costs for Hospital Stays in the United States, HCUP Statistical Brief #146. January Agency for Healthcare Research and Quality, Rockville, MD; National Center for Health Statistics; Health, United States, 2012; Source of reduction rates: Accordant internal analysis of BOB data, Projections based on CVS Caremark data. 21

22 CVS/specialty is Reinventing Specialty Pharmacy Management Patient Choice Payor Directed Strategy: Delivering a Better Specialty Experience Strategy: Offering Comprehensive Trend Management 22

23 Our Innovative Solutions Work Together to Enable Comprehensive Trend Management Condition-specific prior authorization Enabled by Novologix technology platform Cross-benefit view identifies more therapy options 12% savings Site of care management Facilitated by Coram Infusion network Patient receives therapy at low-cost, convenient site of care 17% savings Medical claims editing Enabled by Novologix technology platform Claim reviewed for correct price and utilization 2.5% savings Notes: 1. 12% incremental savings in select categories vs. drug-specific prior authorization % savings: CVS Caremark Specialty Client Solutions and Trend Management, Projections based on CVS/caremark 2012 claims data; commercial population. Individual client experience will vary based on member and provider demographic characteristics and other factors. Client-specific modeling available upon request % savings: CVS Caremark Specialty Client Solutions and Trend Management, 2013, internal analyses for estimated program savings. 23

24 Retail Infusion as the Next Innovation 97% to 98% of Infusions with Select Therapies Could Be Performed in Lower-cost Sites of Care Pilot: Expand Access with CVS/pharmacy Retail Footprint Payors in California and Texas selected exclusive infusion network In-store infusion suite staffed by experienced nurses: specialty therapies and ambulatory infusion suite protocols Early indicators show 96% satisfaction; pilot results expected in Q Source: Press Ganey data,

25 Cost Management Opportunities in Specialty Pharmacy: Biosimilars Specialty Drugs Losing Exclusivity ($, billions) Epogen 2.8 Rituxan Neulasta 3.3 Humira Remicade Herceptin 1.7 Avastin 2.7 Oncology 2014E 2015E 2016E 2018E 2019E Multiple Sclerosis Human Growth Hormones Autoimmune Biosimilars likely to behave more like brands than generics Source: CVS/caremark internal data, This slide contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Health. 25

26 Successful Management of Competitive Brands in Specialty Requires Exclusion Formularies % Market Share (totals to 100%) # of Excluded Products 31 6 Exclusion Formulary Preferred Product Tiered Formulary Non-preferred Product Future Exclusions effectively change mix Exclusion opportunities are growing 26

27 With More Tools Available, Payors Can Build a Comprehensive Trend Management Strategy Illustrative Trend 20% Integrated PA 6% Site of Care 3% Claims Editing & Repricing 2% Specialty Formulary 2% Generic Programs 1% Pricing Models 1% Exclusive Network 1% Remaining Trend 4% Comprehensive CVS/specialty Tools Source: CVS/caremark Specialty Client Solutions and Trend Management, 2013, internal analyses for estimated program savings. 27

28 Positioned for Today, Preparing for Tomorrow Made the Right Moves Differentiated programs for patients and payors Expanded the addressable market for CVS Health Still Only CVS Specialty Connect TM better patient experience Accordant specialty patient management Looking Ahead Continued Innovation Condition-focused, integrated trend management Opportunity to enter infused oncology space Sustainable Growth Broadest platform to drive specialty share gains Focus on fastest growing sub-sectors of specialty 2014 CVS Leading Health the Specialty Market with Innovation 28

29 Appendix

30 Claims for Drugs Billed Under the Medical Benefit Can Vary Significantly Allowed Amount $35,000 Analysis of Claims for Infused Remicade, IBD $30,000 $25,000 DOSE FOR 220 LB MALE 50 UNITS $20,000 $15,000 $10,000 $5,000 $ APPROPRIATE RANGE Units Billed Home Office Hospital/Outpatient AWP Notes: 1. This slide contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS/caremark. Source: Milliman data,

31 Automated Claims Editing and Repricing Can Save 2-3 Percent of Medical Pharmacy Spend Analysis of Claims for Infused Remicade, IBD Allowed Amount $35,000 $30,000 DOSE FOR 220 LB MALE 50 UNITS $25,000 $20,000 $15,000 $10,000 $5,000 $0 APPROPRIATE RANGE Home Office Hospital/Outpatient AWP Note: 1. This slide contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS/caremark. Projections based on CVS/caremark data. 2. Individual results will vary based on plan design, formulary status, demographic characteristics and other factors. Source: Milliman data,