Pharmacy Costs: “Can I Make a Difference?” September, 2014
Cost Shifting and Inflation is Outpacing Workers’ Earnings 2 Results: 47M Uninsured Rising Underinsured Results: 47M Uninsured Rising Underinsured
Our Community Physicians Business Payor Mix Pharmacists Patients
Changes to Pharmacy Insurance Benefits Bigger deductibles Higher copays All generic formularies Health Savings Account
Value !! 5 Value = Outcome Cost
Who pays for Healthcare? Uninsured (Cash) Federal Government (Medicaid, Medicare, etc.) Employer NOT Insurance 6
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 $20x10=$ x $150=$150,000 x10 refills =$1,500, X $10=$10,000 x 10 refills =$100,000 $1,400,000 7
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% $100 = $150 Mary and Daughter, office visit with Medicaid 20 minutes, 50% $100 =$50
New Ideas?? ACA or UCA ACO……..Medical Home Clinical AND Cost 9
Physician Scorecards ** * Quality $
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
WPQC Wisconsin Pharmacy Quality Collaborative Unity Group Health Network Healthplan United Healthcare Wisconsin Medicaid 12
13 (in billions) $93.1 billion in Brand Drugs Off-Patent from : 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 Generics—The Calm Before the Storm
14 Questions? Comments? Comments?