1. Pharmacy Costs: “Can I Make a Difference?” September, 2014

2. Cost Shifting and Inflation is Outpacing Workers’ Earnings 2 Results: 47M Uninsured Rising Underinsured Results: 47M Uninsured Rising Underinsured

3. Our Community Physicians Business Payor Mix Pharmacists Patients

4. Changes to Pharmacy Insurance Benefits Bigger deductibles Higher copays All generic formularies Health Savings Account

5. Value !! 5 Value = Outcome Cost

6. Who pays for Healthcare? Uninsured (Cash) Federal Government (Medicaid, Medicare, etc.) Employer NOT Insurance 6

7. Why Does This Matter? Sam’s Brewery 1000 Guys making Beer Cholesterol Management LDL 44% Lipitor 20 mg $200 // simvastatin 40mg $20 Copay $50x10=$500/Copay $20x10=$200 1000 x $150=$150,000 x10 refills =$1,500,000 1000 X $10=$10,000 x 10 refills =$100,000 $1,400,000 7

8. Where are all of the Medicaid patients coming from? John and Mary and their two kids John, $15.37/hour or $31,970/year Mary and Daughter, office visit with BCBS/ UHC/Humana 20 minutes, 150% Medicare @ $100 = $150 Mary and Daughter, office visit with Medicaid 20 minutes, 50% Medicare @ $100 =$50

9. New Ideas?? ACA or UCA ACO……..Medical Home Clinical AND Cost 9

10. Physician Scorecards ** * Quality $

11. Biologicals and Genomics 245 Employees, 550 Lives Top 25 by Drug Spend Usual suspects: Lipitor, Nexium, Advair, Cymbalta Top 8 Rx’s: Lovenox, Oxycontin, Copaxone, 5 HIV meds 72% of Dollars spent 5 patients

12. WPQC Wisconsin Pharmacy Quality Collaborative Unity Group Health Network Healthplan United Healthcare Wisconsin Medicaid 12

13. 13 (in billions) $93.1 billion in Brand Drugs Off-Patent from 2008-2015 2008: Risperdal, Lamictal, Fosamax, Imitrex 2009: Adderall, Prevacid, Topamax, Valtrex 2010: Effexor XR, Flomax, Cozaar, Hyzaar 2011: Lipitor, Actos, Protonix, Zyprexa, Levaquin, Aricept 2012: Plavix, Singulair, Seroquel, Lexapro, Diovan, Avandia 2013: Cymbalta, Celebrex, Aciphex 2014: Nexium, Vytorin, Zetia, Lyrica, Nasonex 2015: Abilify 13 2009 Generics—The Calm Before the Storm

14. 14 Questions? Comments? Comments?