1. Controlling the Bottom Line

2. What is specialty pharmacy? Wide variations in definitions Compounded drugs Biotech drugs Expensive drugs Workman’s Compensation focuses more on compounded drugs Group health focuses more on biotech drugs

3. Specialty Drug Spending Injectable, infused, and oral drugs Multiple sclerosis, inflammatory conditions, cancer Fastest growing segment of pharmacy spending Covered under medical or pharmacy benefit Specialty Drug Spending Trend Projections as % of Pharmacy $ - Express Scripts Drug Trend Report 2011

4. Specialty Drug Spending - Express Scripts Drug Trend Report 2011

5. Specialty Drug Growth Patent expirations of “blockbuster” drugs High cost of development for all drugs Maximum therapuetic value in traditional drug classes Narrow, but growing, target population Higher margins Positive health outcomes

6. Minimizing the cost Monitor usage of specialty drugs through your TPA, PBM, or both Look for return on investment Adherence and Compliance Hospital avoidance Side effect monitoring Work with providers focused on these therapies Patient assistance programs