SEBs – A Public Payer Perspective Judy McPhee, Executive Director Nova Scotia Pharmaceutical Services

Why the interest in SEBs? Biologics are effective treatments for complex chronic conditions Patent expiries – more biosimilars will be available need to determine place in therapy for drug plans High average cost per prescription for biologics Lucentis: $1,706 Remicade: $4,223 Data source: pg. 33 PMPRB Compas Rx Report (2012/13 data). Enbrel: $1,865 Lantus: $139

Biologics are about 18% of provincial drug plan spending and costs growing rapidly over time and relative to other therapeutic categories.

Considerations Government objectives are consistent with “Triple Aim”: (Institute for Healthcare Improvement) Improving patient experience of care Improving health of populations Reducing the per capita cost of health care Evidence: what information is available to inform decisions Value: how do costs and outcomes compare for covered plan members Fiscal Realities: how to manage within limited budgets with growing number of plan members (public/private shifts; aging demographics)

Impact of SEBs for Drug Plans Challenges Limited evidence at market entry Gaps in knowledge about safety Infusion clinics & other health system costs Price differentials may not be great enough Savings dependent on therapeutic switching Opportunities Increased collaboration through PCPA Established research and evidence networks (e.g., DSEN / CADTH ) Better information using data and analytics Experience in other jurisdictions (Europe)

“Necessity is the mother of invention”. Payer Approaches “Necessity is the mother of invention”. ~ Plato Payers will continue to use full scope of approaches that are available: Traditional listings Proactive listing policies for new patients Real world evidence generation projects Mandatory switch approaches for some or all Delisting Purposeful price negotiations