Presentation to Expert Patients Forum Innovative Pathways to Drug Access in Private Drug Coverage Plans November 19, 2015 Glenn Monteith Vice President Innovation and Health Sustainability November 19, 015

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Players involved in private market – insurers and others

Plan Members 19 Million

Plan Sponsors 500,000+

Advisors & Consultants

3,000

Insurance Carriers

24

Pharmacy Benefit

Managers 3

Community Pharmacies

8,600

•  Many players and decision-makers are involved in private drug plans

Diseases Have Major Impacts on Canadian Economy

Diseases affect productivity at work, both physically and/or mentally Examples:

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1 Source: http://www.phac-aspc.gc.ca/media/nr-rp/2011/2011_0919-bg-di-eng.php 2 Source: Cranswick K., Dosman D. Eldercare: Canadian Social Trends. 2008, Vol. 86, pp. 48-56 and Fast, et al. A Profile of Canadian Chronic Care Providers: A Report Submitted to Human Resources and Development Canada. Univ. of Alberta. Edmonton : s.n., 2002.

$7,000 / employee / year

Presenteeism

$10,000 / employee / year

Abstenteeism

•  The Public Health Agency of Canada has estimated that the costs of

these diseases on the economy are over $200 billion every year

•  Half is due to patients being unable to work1

Chronic Diseases Have a Big Impact on Productivity and Absenteeism

Top 15 drivers of lost work time Total cost of condition of employees with a primary condition

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Source: Kessler’s HPQ—Adjusted to work Force (2007) Source: Collins et al, Assessment of chronic conditions on work performance, absence and total economic impact for employers, NEOJM, 2005

Cost containment measures used by private drug plans

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Generic substitution

•  Not mandatory – physician may prescribe innovative medicine and write “no substitution”

•  Mandatory – in all cases, a generic drug, if available and considered “interchangeable” then it will be dispensed, or, plan only pays up to cost of generic drug and plan member must pay the difference in price to access the innovative medicine *exceptions process for some plans

Get to know your plan options and ask questions of your pharmacist/pharmacy when getting a prescription filled.

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Prior Authorization GWL 100+ Drugs

Tiered Formulary

Therapeutic Sub / Mac Price

Case Management

Summary of Scorecard Findings – 2013 Actuals

•  PDP drug cost growth in 2013 is the lowest in recent years.

•  Drug cost growth of 2.2% was in line with the Forecast CAGR (1.6% to 2.8%) for the 2013-2017 forecast period.

•  Generic savings was higher than forecast; as anticipated generic pricing changes had the greatest impact.

•  Impact from new medicine entry was lower due to a mix consisting of fewer specialty medicines than forecast.

•  Though marginal, the aging event had a slightly higher impact than forecast due to growth in the number of older claimants and increase in utilization amongst these older claimants.

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Closing thoughts

•  Private drug plans are important to providing access to innovative medicines and vaccines

•  Get to know your plan and inform yourself of how plan design features can impact access

•  Coordination of benefits between plans (e.g. public and private or two private plans) can be complex

Rx&D advocates for timely, quality access to innovative medicines and vaccines so people get the treatments they need when they need them.

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