SEBs – A Public Payer Perspective Judy McPhee, Executive Director Nova Scotia Pharmaceutical Services
Aug 08, 2015
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