The Future of Biologics in Part D

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Presentation transcript:

The Future of Biologics in Part D Eric Toppy Director of Marketing Strategy Payer, Policy and Emerging Markets Centocor Ortho Biotech Services, LLC

Disclaimer The following content and opinions do not necessarily reflect the views and Opinions of Centocor Ortho Biotech Services, LLC

Medicare Source: political cartoonist.com

Part D- A Success Story Part D Sources: WSJ-July 5, 2005 The Hill. com -Jan 11, 2007

Success Defined

Success Defined

Choice..Choice…Choice

Where are they? Source: Kaiser Family Foundation

The Gap Source: Kaiser Family Foundation

“D” & Impact on Biologics Sub-Q Growth Accelerated Commoditization Multiple Customer Benefits Consumers Physicians Payers Membership growth Rebate Revenue

The “Benefit”

Donut Hole The “Donut Hole” in Part D is….. Local establishment where MA-PD enrollment occurs A New diet craze sweeping the nation Patient who pays TROOP of $4,000 Place that most beneficiaries don’t visit due to pressures of competitive marketplace-gap coverage

Commercial Part D Programs Cafeteria Plan Open & Closed Formularies Two Markets Drug Benefit Naïve Part D switch Adverse Selection

Biologics & Health Plans Consumer Choice CMS recommendations Minimal benefit offering P&T Product Review Timing Part B vs. Part D Physician vs. self administered Medical Education Reimbursement CAP Program

CMS 2009 Health Plans to post drug formularies BIO Position- All information that includes step edits, prior authorizations, quantity limits Continuation of Specialty Tiers BIO position- Impact on Patient Affordability Home Health Care Reimbursement 2009

Possible Threats to Biologics in Part D Back to the Future Reduction in Part D payments Elections Reference Pricing BioSimilars Comparative Effectiveness-AHRQ Employer Shift = Increased MLR

The Future of Biologics and Part D Biomarker/Genomics Competing Gov’t needs Reward for Innovation? EMRs Pay for Performance Report Cards Small Molecule Biologics

Thank You and Questions