SEBs – A Public Payer PerspectiveJudy McPhee, Executive DirectorNova Scotia Pharmaceutical Services

Why the interest in SEBs?

• Biologics are effective treatments for complex chronic conditions

• Patent expiries – more biosimilars will be available• need to determine place in therapy for drug plans

• High average cost per prescription for biologics• Lucentis: $1,706• Remicade: $4,223

• Enbrel: $1,865• Lantus: $139

• Biologics are about 18% of provincial drug plan spending and costs growing rapidly over time and relative to other therapeutic categories.

Considerations

• Government objectives are consistent with “Triple Aim”:(Institute for Healthcare Improvement)

• Improving patient experience of care• Improving health of populations• Reducing the per capita cost of health care

• Evidence: what information is available to inform decisions

• Value: how do costs and outcomes compare for covered plan members

• Fiscal Realities: how to manage within limited budgets with growing number of plan members (public/private shifts; aging demographics)

Impact of SEBs for Drug Plans

Challenges• Limited evidence at

market entry• Gaps in knowledge

about safety• Infusion clinics & other

health system costs• Price differentials may

not be great enough• Savings dependent on

therapeutic switching

Opportunities• Increased collaboration

through PCPA• Established research

and evidence networks (e.g., DSEN / CADTH )

• Better information using data and analytics

• Experience in other jurisdictions (Europe)

Payer Approaches

“Necessity is the mother of invention”.~ Plato

• Payers will continue to use full scope of approaches that are available:• Traditional listings• Proactive listing policies for new patients• Real world evidence generation projects• Mandatory switch approaches for some or all• Delisting• Purposeful price negotiations