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Published byJuan Hataway Modified over 9 years ago
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Pharmacy Costs: “Can I Make a Difference?” September, 2014
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Cost Shifting and Inflation is Outpacing Workers’ Earnings 2 Results: 47M Uninsured Rising Underinsured Results: 47M Uninsured Rising Underinsured
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Our Community Physicians Business Payor Mix Pharmacists Patients
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Changes to Pharmacy Insurance Benefits Bigger deductibles Higher copays All generic formularies Health Savings Account
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Value !! 5 Value = Outcome Cost
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Who pays for Healthcare? Uninsured (Cash) Federal Government (Medicaid, Medicare, etc.) Employer NOT Insurance 6
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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=$200 1000 x $150=$150,000 x10 refills =$1,500,000 1000 X $10=$10,000 x 10 refills =$100,000 $1,400,000 7
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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% Medicare @ $100 = $150 Mary and Daughter, office visit with Medicaid 20 minutes, 50% Medicare @ $100 =$50
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New Ideas?? ACA or UCA ACO……..Medical Home Clinical AND Cost 9
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Physician Scorecards ** * Quality $
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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
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WPQC Wisconsin Pharmacy Quality Collaborative Unity Group Health Network Healthplan United Healthcare Wisconsin Medicaid 12
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13 (in billions) $93.1 billion in Brand Drugs Off-Patent from 2008-2015 2008: 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 13 2009 Generics—The Calm Before the Storm
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14 Questions? Comments? Comments?
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