Examining New Oncology Distribution Channels and the Integrated Role of Specialty PharmacyMatt Farber
Senior Director, Oncology Disease State Management
Walgreens
Role of the Specialty Pharmacy
Specialty pharmacy is a model that deals primarily with medications and pharmaceuticals that:
• Treat complex and rare diseases
• May require special handling
• Require ongoing patient care and monitoring of side effects
• Are high in cost
• Subject to limited or restricted distribution
• Require complex payer support
• Are approved with a Risk Mitigation Strategy (REMS)
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Role of the Specialty Pharmacy
Increased emphasis on:
• Patient-centric care
• Medication education and clinical support
• Collaboration with other healthcare team members
• Ability to use metrics to drive optimization of patient care
• Ability to assist patient in accessing supportive resources
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Medications used to treat:
• Complex conditions
• Rare conditions
Primary Administration
• Injected
• Oral
• Infuseds
Specialty Products
Such as:
▪ Hepatitis C
▪ Fertility
▪ HIV
▪ Multiple sclerosis
▪ Oral oncology
▪ Psoriasis/Psoriatic Arthritis
▪ Respiratory syncytial virus
▪ Crohn’s Disease
▪ Rheumatoid Arthritis
▪ Transplant
▪ Rare/Orphan Conditions
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Specialty pharmacy history
1990s 2000 Today Tomorrow
Betaseron, Crixavanand Synagis launched
Impact ofthe Hub,oral oncology explodes
Orphan drugs take the stage
Biosimilarsandgenerics
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Role of Specialty Pharmacy
Specialty Pharmacy lives at the intersection of the key players in oncology care
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Specialty Pharmacy
Patients
Physicians Payers
Pharma
Why turn to SP?
• Data is king!!
• REMS coordination/ management
• Inventory management
• Benefit management
• Cost control
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What industry needs to consider
Pharma
• SPs need to be able to engage patients effectively
• Collect clinical and patient feedback to meet quality reporting requirements of new payment models
• Help patients and providers understand the implications of specific medications
Payers
• Decrease inappropriate utilization
• Ensure dosing accuracies
• Reduce acquisition cost
• Coordinate reimbursement and eligibility 8
Adherence
• Given the high cost of therapies, adherence is vital
• Better clinical outcomes
• Cuts down on waste
• Patients falling off therapies cost the system more money
• All SPs will have programs to address this
• Walgreens Connected Care program
• Set program that is in contact with patients throughout their treatment, from before the script is filled to preset check-ins (Day 10, 20), and prior to refills
• Call schedule can be customized
• Ultimately, we are collecting data on adherence and reasons for non adherence
• From clinical to financial to other reasons9
Adherence
• As an example, in oncology, here are a few of the data points being collected with each patient:
• Number of missed doses and reasons
• Side Effects
• Customizable
• Refills
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Purpose of Walgreens Connected Care℠Oncology Program
Identify patients at risk for non-adherence
• Less than 80% of doses taken• Experiencing side effects
• Dosing instructions
• Tips for remembering doses• Side effect management
• Care Notes related to patient-reported issues
11©2014 Walgreen Co. All rights reserved. Confidential and proprietary information.
Identify patients at risk for non-adherence
Offer support/care through clinician counseling
Keep provider informed
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Walgreens Connected Care℠ Oncology Program
Connected Care
Oncology
• All patients for all self-administered anti-cancer medications
• Foundational clinical program
Cycle Management
Program
• Subset of Connected Care Oncology
• Increased level of support
• Medication specific
Split Fill
(Monitored Dispense)
• Subset of CMP - by payer
12©2014 Walgreen Co. All rights reserved. Confidential and proprietary information.
Cycle Management Program
Key components of the program include:
• Initial assessment by clinician
Patient and caregiver education
• Mid-cycle and End-of-cycle assessments by clinician
Documentation of side effects (targeted by medication)
Side effect grading for selected side effects
Adherence assessment
Counseling on side effects/adherence barriers
Oncology Report Card faxed to physician
• Monthly follow-up calls
Escalation to a clinician as needed
©2014 Walgreen Co. All rights reserved. Confidential and proprietary information.
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Self-administered products
©2014 Walgreen Co. All rights reserved. Confidential and proprietary information.
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CMP Medications Non-CMP Medications
Afinitor**
Bosulif
Erivedge
Gleevec
Inlyta
Jakafi
Mekinist
Nexavar**
Sprycel**
Stivarga
Sutent**
Tafinlar
Tarceva**
Targretin**
Tasigna**
Thalomid
Tykerb
Votrient**
Xalkori
Xtandi
Zelboraf
Zolinza**
Zytiga
Hycamtin
Intron A
Matulane
Pomalyst
Revlimid
Sylatron
Temodar*
Xeloda*
*generics also included**split fill eligible
What does the future hold?
• Specialty pharmaceutical spending is on the rise and is expected to increase from approximately $55 billion in 2005 to $1.7 trillion in 20302 , according to the Pharmaceutical Care Management Association. That reflects an increase from 24% of total drug spend in 2005 to an estimated 44% of a health plan’s total drug expenditure in 2030
• Currently, three pharmacies -- Express Scripts, CVS Caremark and Walgreens -- make up more than 50% of the specialty drug market while the rest of the market is comprised of hundreds of smaller specialty pharmacies, including Diplomat pharmacy and Omnicare’s advanced care scripts
15http://www.imshealth.com/deployedfiles/imshealth/Global/North%20America/United%20States/Managed%20Markets/5-29-14%20Specialty_Drug_Trend_Whitepaper_Hi-Res.pdf
