Tuesday, February 24Speaker: Alan Lukazewski, Director of Clinical Pharmacy

Moderator: Mel Grau, Marketing Coordinator

3 Pharmacy Trends for 2015

Speaker: Alan Lukazewski, RPh

• 30 years of pharmacy

experience

• Certified diabetes

educator

• Certified geriatric

pharmacist, with

expertise in mitigating

adverse drug events

POLL: What percentage of generic

drugs experienced price

increases in the last two years?

• More than half of generic drugs

experienced price increases in just 2 years

– Some increases as high as 1,000%

– Now some more expensive than brand drugs!

• In recent years, there has been a drastic

rise in pharmaceutical costs overall.

POLL: Over 50%

Agenda

2015 Pharmacy Trends

Generic Drug Inflation

“Me-Too” Drugs

Specialty Drug Crisis

Adverse Drug Events

Generic

Inflation

• 1,000% price increases on some drugs

– Ex: Digoxin, a common heart medication, cost

less than $10 per script, but is now over $100

• Why?

– FDA sanctions

– Reduced competition

– Raw ingredient shortages

“High-cost” generics

Top 10 generic drug increasesProduct NADAC per Unit

(July 2013)NADAC per Unit

(July 2014)% Change in NADAC

per Unit

Tetracycline 500 mg capsule $0.05 $8.59 +17,714%

Tetracycline 250 mg capsule $0.06 $4.26 +7,340%

Captopril 25 mg tablet $0.02 $0.83 +4,434%

Captopril 12.5 mg tablet $0.02 $0.67 +3,937%

Captopril 50 mg tablet $0.03 $1.31 +3,806%

Captopril 100 mg tablet $0.06 $2.04 +3,570%

Clomipramine 75 mg capsule $0.42 $8.15 +1,818%

Doxazosin mesylate 1 mg tab $0.05 $0.62 +1,169%

Fluconazole 100 mg tablet $0.14 $1.50 +996%

Doxazosin mesylate 2mg tab $0.06 $0.56 +899%

NADAC = National Average Drug Acquisition CostSource: Pembroke Consulting analysis of Center for Medicare & Medicaid Services data files

• PBM program to reduce drug spend

– Interchange to therapeutic alternatives

• Ex: Captopril is currently on the WEA Trust Value

Choice Drug Plan, but will be removed and another

Value Choice drug, Lisinopril, is the recommended

option.

• Will also add another Value Choice option in a

related category called Losartan.

– We will provide advance notification to

members

2015 forecast: PBM changes

Branded

“Me-Too” Drugs

Branded “me-too” drugs

• New drugs with no therapeutic or safety

advantage over existing, lower-cost,

branded drugs

• Costs are 30-40% higher

• Inhalers of combined steroids and

bronchodilators are used for Chronic

obstructive pulmonary disease (COPD)

• Examples: Advair and Symbicort

– Symbicort can cost 124% more than Advair

– Changing to Advair can save $100 per script

Example: COPD drugs

• Nasal inhalers for seasonal rhinitis

• Examples: Veramyst and Fluticasone

– Veramyst Nasal Spray and Fluticasone are

same active ingredient and equivalent in

efficacy

– Moving to Fluticasone saves $96 per script

Example: COPD drugs

• Implement MedPerform High- Preferred

Drug List (PDL)

• Substitute with equally effective, lower cost

equivalents

Forecast: Formulary changes

Specialty

Drugs

Specialty drugs, defined

High cost (>$1200/Rx)

Treats complex disease

Requires closer monitoring

Requires special handling, storage, distribution

Limited distribution

Requires patient administration training

Skyrocketing costs

• Specialty drugs

– Less than 4% of drugs dispensed

– More than 30% of drug spend

– By 2018: more than 40% of drug spend

– Average of $3,100 per script

• vs. $29 generic and $240 brand non-specialty

• Ex: Sovaldi, Enbrel, Humira, Remicade, Harvoni

• Strengthen preauthorization process

– Minimize unnecessary use

• Formulary preferred agents

– Lower cost in therapeutic category

• Manage utilization

– Adherence

– Duration of therapy

– Prevent or mitigate adverse effects

Cost management strategies

Adverse Drug

Events

• Unintended effects of a medication

– Causes symptoms that require medical

attention

– Can affect quality of life or how you function

• Ex: Martha and Remicade

– Infection rate as high as 32%

Adverse drug event, defined

ADE: incidence

0

0.5

1

1.5

2

2.5

3

3.5

4

25-44 years old 45-64 years old 65+ years old

Adverse Drug Events leading to MD Visits per 10,000 persons per year

per 10,000 persons per year

Impact of Adverse Drug Events

Ambulatory Care : $1,300Increased Hospital Stay: $7,000 - $13,000

Strongest Predictors:

• Total number of

medications taken

• Total number of

chronic conditions

Important Predictor:

• Age

Predicting ADE

0

20

40

60

80

100

120

0 1 2 3 4 5 6 7 8 9 10

# Drugs

% Patients w/adverse events

% Patientsw/adverse effects

• Encourage your

employees to review

their medications

yearly

• Provide information

about alternative

methods

Preventing ADE

Thank you for

joining us!