Specialty Pharmacy: What You Need To Know. William Pong, Pharm.D., MBA

Transcription

1 Specialty Pharmacy: What You Need To Know William Pong, Pharm.D., MBA

2 DISCLOSURE I have no actual or potential conflict of interest in relation to this program/ presentation

3 OBJECTIVEs Navigating the landscape Discuss trend drivers Review impact to health system and patients Roadmap to implementation Loyola s journey

4 NAVIGATING THE LANDSCAPE

5 WHAT IS SPECIALTY PHARMACY? High cost $$$$ Medications Complex regimens Require ongoing monitoring (REMs) and patient education Special handling Biologics, injectable/infusion/oral Chronic or rare diseases Prior Authorization - care coordination

6 TRUE DEFINITION??? CMS for 2017 defined: Tier for Specialty Drugs $670 minimum cost threshold 2017 // National Pharmaceutical Services, a division of Pharmaceutical Technologies, Inc.

7 SPECIALTY DRUGS Oncology Rheumatology Immunotherapy (G.I.) HIV Neurology Hepatology

8 STAKEHOLDERS Providers Payers Drug MFRs Patient Pharmacies LDDs 340B

9 BARRIERS TO CARE Access to medication Delayed start of therapy Interruption in therapy Fragments continuity of care Poor adherence High therapy abandonment rate

10 SPECIALTY PHARMACY LANDSCAPE COMPLEXITY

11 WHY IS IT IMPORTANT? National Growth in Drug Spend Drug Development Trends Specialty Pharmacy Trend

12 NATIONAL GROWTH IN SPECIALTY PHARMACY - Drug Channels 2017

13 IMS Institute of Healthcare Informatics Specialty pharmaceuticals almost doubled from 2010 to 2015, and spending on this subset of drugs was responsible for 70% of overall drug spending growth during this timeframe. Each year since 2010, more than half of new drug approvals by the FDA have been specialty medications // National Pharmaceutical Services, a division of Pharmaceutical Technologies, Inc.

14 SPECIALTY PHARMACY TRENDS In 2016, pharmacies dispensed about $115 billion in specialty drugs Specialty pharmacy is one of the fastest growing segments in health care and is projected to exceed $300 billion in annual spend by 2021, up from $180 billion in 2016 Drug topics February, 16, 2017 Specialty Pharmacy Times, June 21, 2017

15 PIPELINE 2016 Profile: Biopharmaceutical Research Industry, PhRMA, April 2016

16 PIPELINE % of medicines in development have the potential to be first-in-class treatments. PHRMA 2017 Profile Phrma.org

17 SPECIALTY PIPELINE

18 Impact and Benefits to Health Systems and Patients Clinically and Financially

19 IMPACT TO HEALTH SYSTEM AND PATIENTS Patient Benefit Clinical Efficiency Provider Satisfaction Revenue Capture Clinic Efficiency

20 CLINICAL BENEFITS Med Management & Safety (Med Rec, Drug Interactions) Patient Education & Medication Adherence Med Access (Navigation, Efficiency, Care Coordination) Reduced Patient and Provider Frustrations Reduce/ Eliminate White or Brown Bagging

21 FINANCIAL BENEFITS Savings to support indigent care Investing in clinical resources to support patients Reduction in hospital & ED visits Reduce overall cost to the system Reduce cost in an ACO population

22 HOW DO WE GET THERE?

23 Road to Implementation Strategic Plan Performa ROI Model

24 PERFORMA AND ROI Volume projections (# of Prescriptions) Medical specialties (Oncology, Hepatology, etc.) Capture rates (payers, LDD, etc.) Reimbursement Cost of Goods Resource Expenses Patient experience, med adherence, LOS, and financial contribution

25 Example of a Three Year Projection

26 Quality ROI Connect patient and providers at point of care Pharmacist driven coordination of care Eliminate patient and provider frustrations Improve medication access Improve medication adherence Improve patient satisfaction

27 MEASUREABLE OUTCOMES Quality (timeliness to start therapy) Improvement or cure Adherence (completion of therapy) Reduce overall cost of care Reduce readmissions Patient experience metrics

28 PATIENT AND ORGANIZATION BENEFITS Patient Benefits Improve access to medications Access to indigent care Improve med adherence, safety, and education Efficiency and Satisfaction Access to resource for care quality and coordination Organization Benefits Improve clinic efficiency Reduce patient and prescriber frustrations Increase savings to support health system Reduce overall cost of care to system Support employee prescription program

29 MODELS HS Owned & Operated Partnerships Big Bang or Incremental Growth Build to Last Turtle or Hare

30 HOSPITAL OWNED MODEL Go big or go home

31 HOSPITAL OWNED CONSIDERATIONS Time to market is long Payer contracts Capital and certification requirements Market is moving constantly Changing Trends: New molecules, generics, biosimilars, LDD, PBM established specialty Rxs.

32 PARTNERSHIP MODEL Systematic approach

33 PARTNERSHIP CONSIDERATIONS Speed to market (3 to 6 months) Partner(s) selection Program complexity Compliance risk Transparency risk Trust with capture reconciliation

34 STRATEGY Access to Capital Speed to market NPV / ROI Short and long term goals Regional Market conditions Health system market cap Current hospital and patient challenges Changing landscape, MFR, Generics, LDDs, Payers, PBMs,

35 THE LOYOLA JOURNEY

36 LOYOLA UNIVERSITY MEDICAL CENTER Academic Medical Center 570 beds Chicago Suburb Maywood, IL (20 minutes west of Chicago) On Campus Services Main Hospital Ambulatory clinics and surgical centers Outpatient oncology center Outpatient retail pharmacy Off Campus Services Ambulatory specialty clinics Outpatient oncology centers Home infusion pharmacy

37 LUMC Specialty Pharmacy Mission Model evaluation Strategy Results

38 MISSION AND GOALS Our Mission We, Trinity Health, serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities. Our Vision As a mission-driven innovative health organization, we will become the national leader in improving the health of our communities and each person we serve. We will be the most trusted health partner for life.

39 LOYOLA JOURNEY Begin with Oncology Recognize the transformation to oral Clinical efficiency to support patient & providers Fragmentation of continuity of care Revenue leakage

40 What Value will the program bring? Key drivers in Specialty Rx Patient Providers Payers Organization

41 LUMC Model

42 Oncology Growth - Patients

43 Oncology Growth - Revenue

44 Oncology Program Key Performance Since Program Inception (7/2014): Patient Services unique patients. Med Dispenses - total of 4,915 prescriptions. Creation of Loyola s Indigent Care Program Financial Assistance Program assistance for 63 patients, provided $1,775,850 of funding Financial Performance - generated over $8M in savings.

45 2017 Oncology Program Performance Highlights

46 CLINICAL BENEFIT IMPROVEMENTS

47 NPV Oncology Specialty Program

48 ROI Oncology Specialty Program

49 Specialty Program Growth in Other Disease States Prescription Dispenses

50 Specialty Program Growth in Other Disease States Revenue

51 Specialty Program Growth in Other Disease States Drugs / Resources

52 WIN-WIN FOR EVERYONE Patients Providers Organization Payers Profession

53 Key Takeaways Unmet Needs: Patient continuity of care, access, specialty provider support Hospital / health system alignment: Strategic goals Access to capital Projected ROI Market Conditions: Competitor pharmacies -Health systems, contract pharmacies, PBM own and/or partnerships Payer access and Manufacturer (Limited / Designated distribution) Pipeline (current and future impact)