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SEBs – A Public Payer Perspective

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1 SEBs – A Public Payer Perspective
Judy McPhee, Executive Director Nova Scotia Pharmaceutical Services

2 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 Data source: pg. 33 PMPRB Compas Rx Report (2012/13 data). Enbrel: $1,865 Lantus: $139

3 Biologics are about 18% of provincial drug plan spending and costs growing rapidly over time and relative to other therapeutic categories.


5 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)

6 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)

7 “Necessity is the mother of invention”.
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

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