Presentation on theme: "SEBs – A Public Payer Perspective"— Presentation transcript:
1SEBs – A Public Payer Perspective Judy McPhee, Executive DirectorNova Scotia Pharmaceutical Services
2Why the interest in SEBs? Biologics are effective treatments for complex chronic conditionsPatent expiries – more biosimilars will be availableneed to determine place in therapy for drug plansHigh average cost per prescription for biologicsLucentis: $1,706Remicade: $4,223Data source: pg. 33 PMPRB Compas Rx Report (2012/13 data).Enbrel: $1,865Lantus: $139
3Biologics are about 18% of provincial drug plan spending and costs growing rapidly over time and relative to other therapeutic categories.
5Considerations Government objectives are consistent with “Triple Aim”: (Institute for Healthcare Improvement)Improving patient experience of careImproving health of populationsReducing the per capita cost of health careEvidence: what information is available to inform decisionsValue: how do costs and outcomes compare for covered plan membersFiscal Realities: how to manage within limited budgets with growing number of plan members (public/private shifts; aging demographics)
6Impact of SEBs for Drug Plans ChallengesLimited evidence at market entryGaps in knowledge about safetyInfusion clinics & other health system costsPrice differentials may not be great enoughSavings dependent on therapeutic switchingOpportunitiesIncreased collaboration through PCPAEstablished research and evidence networks (e.g., DSEN / CADTH )Better information using data and analyticsExperience in other jurisdictions (Europe)
7“Necessity is the mother of invention”. Payer Approaches“Necessity is the mother of invention”.~ PlatoPayers will continue to use full scope of approaches that are available:Traditional listingsProactive listing policies for new patientsReal world evidence generation projectsMandatory switch approaches for some or allDelistingPurposeful price negotiations