Portraying Value Stories

March 7, 2019

Jacob A. Jolly, PharmD, CSP

Program Director, Specialty Pharmacy

Vanderbilt University Medical Center

Bhavesh Shah, R.Ph, BCOP

Director of Specialty and Hematology/Oncology Pharmacy

Boston Medical Center Health System

Disclosures

• Dr. Jolly has nothing to disclose• Dr. Shah has nothing to disclose

Learning Objectives• 1. Understand the perspectives and goals for a

variety of stakeholders in the specialty pharmacy industry

• 2. Evaluate the utility of outcomes research in interfacing with patients, provider, payers, and manufacturers

• 3. Explore forward-facing ideas for how outcomes research and collaboration can contribute to the continued growth and relevance of a specialty pharmacy program.

Move to value based care

• All stakeholders will become accountable for their own outcomes

• Payers – cost of care• Manufacturers – clinical outcome of drug

compared to trials• Pharmacies – successful patient journey

• Outcomes research is a vehicle through which we can begin to measure value

Stakeholder Conversations

• Payer• Industry• Pharmacy Community• C-Suite• Providers/Patients

Payer

• Goals:• Control overall cost of healthcare

• Health-System SP Value• Accountability for admissions, ER visits, etc.• Ability to treat the patient holistically

Industry• Goals:

• Ensure patients access their drug quickly, safely, and efficiently

• Demonstrate value of drug post-clinical trial

• Health-System SP Value• Access to clinical data can facilitate shorter approval

process• Ability to manage monitoring requirements

seamlessly due to integration• Outcomes research can show real world value of drug

Pharmacy Community

• Goals:• Measure value and outcomes• Ensure effective benchmarking

• Health System SP Value• Theoretically have the ability to follow and

measure outcomes across the entire patient journey

• Academic medical centers – research community

C-Suite

• Goals• Treat patients effectively, safely, and with

high levels of quality• Ensure financial success and sustained

growth for their institution• Health System SP Value

• Demonstrate quality of practice• Outcomes research can play a part in

strategic partnership formation

Providers

• Goals• Treat patients as they find clinically appropriate• Manage medications continuously between visits• Lower the administrative burden to clinic staff and

providers

• Health System SP Value• Ability to increase continuity of care with frequent touch

points and seamless communication to providers• Demonstrate efficiency and speed of access and turn-

around-time

Patients

• Goals• Receive the best available care• Seamless healthcare experience

• Health System SP Value• Ability to demonstrate operational (TAT,

approval rate) and clinical (outcome) endpoints

• Integration with the healthcare team allows for continuity of care

Case #1 Payer Value Story

• VSP patients had significantly higher completion rates on HCV treatments

• VSP patients showed comparable cure rates to clinical trials• Achieving cures for patients with chronic hepatitis C [insert blurb

about cures saving money to the system in the long run?]

Case #2: Manufacturer Value Story

• Cure rates• Demonstrates the real-world value of their drug

• Access rates• VSP had 100% of patients access HCV treatment• 98% insurance approval

Case #3: Patient Value Story

• Patients achieved cure at comparable rates to clinical trials• 53% of patients paid $0.00 out-of-pocket for their HCV treatment

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A Story on Portraying ValueBoston Medical Center

Examples of Partnerships Developed Through Clinical Outcomes

- Payer story:2 Major commercial payer contracts BCBSMA, Harvard pilgrim

2 Managed care medicaid plans

- Pharma story:Access to limited distribution drugs

Pfizer example

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Current and Future Value Based or Outcome Based Contracting

Oncology ̶ Larotrectinib (Viktrakvi) ̶ Annual cost $393,000 per patient ̶ No response within 60 days then manufacturer refunds all costs

CAR-T cell ̶ Annual cost $475,000 per treatment ̶ With CMS (no response at 30 days then full refund)

Bevacizumab ̶ Genentech/Priority health ̶ % of rebate tied to median PFS for each patient

Biosimilar̶ % of conversion tied to rebates (example 80% conversion = 10% rebate, 85% conversion 15% rebate, etc…)

Biologics (non-oncology) ̶ IL-23 response < PASI 90 at 12 weeks tied to % in rebate

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Case study – Hepatitis C

0

200

400

600

800

1000

1200

1400

1600

1800

<1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Mortality among HCV Cases in Massachusetts1

Years to death from date of HCV diagnosis

Num

ber o

f dea

ths

1 Lijewski, et al, 2012. Timing of mortality among known HCV cases in Massachusetts, 1992-2009

76,122 HCV diagnoses were reported to the MDPH between 1992 and 2009. 8,499 of these reported HCV cases died and are represented in the figure. Data of 1/11/2011.

Median interval: 3 yearsMedian age: 53 Years

Payer Implications

- Financial - Cost of non-adherence

- Clinical- Morbidity and mortality

- BMC HCV treatment center of excellence - BMC/Major payer collaboration

Summary

• Knowing the perspectives and goals of stakeholders in the specialty pharmacy industry is important in developing meaningful outcomes research

• Outcomes projects can make an impact on many different stakeholder groups

• Outcomes projects and research can be a centerpiece in demonstrating value for key discussions across specialty pharmacy partners

Self-Assessment Questions

1. What is a goal that is commonly aligned between all stakeholder groups?

a. Controlling cost of healthcareb. Ensuring patients receive the benefit of their therapyc. Fostering the growth of a specialty pharmacy programd. All of the above

Self-Assessment Questions

2. Which are stakeholders to whom outcomes research can be important?

a. Patientsb. Manufacturersc. Payers/PBMsd. Pharmaciese. All of the above

Self-Assessment Questions

3. Outcomes projects and research may be instrumental as more focus in specialty pharmacy is on:

a. Value-based careb. Transparencyc. Fee-for-serviced. All of the above

Thank you