Specialty Pharmacy-Archimedes presentation by Brenda Motheral

21 Pages·2017·1.06 MB·English

by  Adam Hobgood

Sp eci al t y Dr u g
M an agem en t : Wh at You
M u st K n ow
Brenda Motheral, RPh, MBA, PhD
CEO, Archimedes
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Specialty Drug Forecast
Across Pharmacy and Medical
The Specialty Challenge
$1,147
• Price, Price, Price $1,026
$915
$811
• Siloed vendors
$722
• Lack of cost transparency
• Overprescribing and questions
of value
• Vendor conflicts of interest
2016 2017 2018 2019 2020
© ARCHIMEDES 2018 Confidential and Proprietary
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H.P. Acthar Pricing
Drug Pricing Is
Receiving
Scrutiny
Lifetime limits on coverage
removed by ACA
Source: Truven. Accessed at https://amp.businessinsider.com/drug-price-gouging-explained-on-baml-
conference-call-2017-
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The Coverage Conundrum
Duplicate claims, Benefit shopping,
Inappropriate use and site of care
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Duplicate Billing
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Rem icade Cost by Channel
(600 mg Infusion)
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The Value of
Specialty Drugs
is in Question
▫ Many cancer drugs are
approved by the FDA
based on surrogate
end points
▫ 86% of these cancer
drugs did NOT
lengthen patients lives
after 4+ years on the
market
Source:Chambers et al. Health Affairs. 2014., Kim and Prasad. JAMA. 2016.
Source: Kim and Prasad, JAMA, 2015.
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PBM Conflicts of Interest
Formularies are Rebate-Driven PA Programs are Ineffective Stockpiling
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Overall Specialty
Spend
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Specialty Drug
Savings
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