Examining New Oncology Distribution Channels and the ......Examining New Oncology Distribution Channels and the Integrated Role of Specialty Pharmacy Matt Farber Senior Director, Oncology

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

Questions and Thank you

Any questions?

[email protected]

202-340-5120

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