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The Future of Biologics in Part D

Published byKristin Estella McGee Modified over 5 years ago

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Presentation on theme: "The Future of Biologics in Part D"— Presentation transcript:

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

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

3 Medicare                                                                                                                                        Source: political cartoonist.com

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

5 Success Defined

6 Success Defined

7 Choice..Choice…Choice

8 Where are they? Source: Kaiser Family Foundation

9 The Gap Source: Kaiser Family Foundation

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

11 The “Benefit”

12

13 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

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

15 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

16 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

17 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

18 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

19 Thank You and Questions

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