Medication Management: Why it Should be Part of Every Benefit Plan Solutions in Drug Plan Management September 8, 2011 Deb Saltmarche BScHons(Pharm), RPh, MRPSGB

What I Will Cover Today Medication Management and CPSF Common opinions The opportunity – Medication management as a value component of plan design – How expanded services increase the value proposition The views expressed today are those of the presenter.

Why You Should Care – Medication Management Promotes the safe and effective use of medications and helps patients achieve improved outcomes Ideally a partnership between the pharmacist and the patient, supported by the payer Pharmacist working in an inter professional environment U.S.A: Medication Therapy Management coined by Congress in the Medicare Modernization Act 2003 England: Essential, Advance, Enhanced Canada: CPSF embraces the concept of Medication Management, and incorporates Enhanced and Expanded services

Why You Should Care - CPSF CPSF Standard definitions and terminology Integrated technology solutions Service standardization Financially viable Identifies cost effective services Services selected based on needs of patient & health system Value to Plan & Member Enhance patient experience and outcomes Enable service research, assessment, and comparison Help manage risk – decrease implementation costs – standard approach across pharmacies – scalable Flexible - combine individual components into unique programs Flexible - creative program development and marketing

Where Do Our Perspectives Converge The 2011 Teva CFP report Survey of Benefit Consultant and Plan Sponsors 78% agree pharmacists should get more involved with payers to control drug plan costs From a suggested list of 14 services, 46% agree that educating patients on generic drugs and suggesting low cost alternatives is an ideal role for pharmacists 1 The 2011 TEVA CFP Report: Private Payers’ Perceptions of Pharmacy

Where Do Our Perspectives Converge When asked whether services should be offered as basic, extra with fee, or not offered at all 74% think providing a 30 minute med review in a private setting should be an extra service 61% think providing drug and disease management services at home or workplace should be an extra service 60% think providing disease management services should be an extra service 1 The 2011 TEVA CFP Report: Private Payers’ Perceptions of Pharmacy

The Opportunity Time for a new dialogue, new partnerships Drug plan strategies with manageable patient impact, that deliver reasonable cost savings to employers, and that underscore the value of a health plan to the employee – Maximize knowledge and expertise of pharmacists, incorporate in to discussions on plan design and plan delivery – Capitalize on expanded scope of practice to improve drug plan design and manage costs – Work with Pharmacy to drive change in patient behavior – Partner to provide specialty services (high cost medications, biologics)

Maximizing Plan Design to Provide Value Plan Design: Expertise to develop formularies – Private plans with flat formularies – Rationale for formulary exclusion/inclusion; – Rationale for use of therapy within the formulary, step therapy to ensure cost effective approach to medication management where appropriate – Government plans have different demographics, different accountability. A formulary that works for a public plan may not necessarily be the right approach for a private plan needing for a healthy and productive workforce

Maximizing Plan Design to Provide Value Plan Design and Delivery: Expertise to drive generic uptake – Many plans do not have mandatory generic substitution – In the US generics are used to fill 75% of Rx, in Canada, less than 50% 1 – If Canadian generic utilization matched the US, Canadians would save $3B in the first year alone 1 – Patient education; equivalence of generics, dispense as written Rx, off formulary interchangeably (adaptation) – Pharmacy programs 1 CGPA

Maximizing Plan Design to Provide Value Plan Design and Delivery: Education on drug costs – Assist employers in educating employees on the value of their drug plan – Development of education materials; – Delivery of programs/materials Plan Delivery: Expertise to ensure that the right treatment is provided in the most cost effective way – Optimal outcomes dependent on consumer behavior – Pharmacist role in patient education and ongoing monitoring to improve adherence, decrease waste Partnerships to Better Manage Patient Expectations, Outcomes, and Plan Costs

Maximizing Plan Design to Provide Value - Expanded Scope of Practice Most cost effective treatment to the right patient at the right time A few examples: – Adaptation gives the ability to substitute for a non-formulary generic, and to substitute a generic without calling the physician – Access to lab tests allows more effective patient monitoring, increases access to community based disease state management e.g. – Diabetes – Cholesterol – Anticoagulation

Maximizing Plan Design to Provide Value - Expanded Scope of Practice – Therapeutic substitution allows alternate plan formularies to be implemented – Ability to refill helps mitigate intervals in continual therapy, helps adherence therefore outcomes Decrease unnecessary health issues/ER visits, absenteeism, due to unavailable medication – When a patient has run out of a medication and the physician is not available – When a physician may charge for a refill done over the phone, and the patient cannot pay out of pocket

Maximizing Plan Design to Provide Value - Expanded Scope of Practice Why is this important? – Opportunity for new approaches in medication management of outcomes New service delivery models Best utilization of resources, increase access Value/cost containment Enhanced inter-professional collaboration Enhanced patient care solutions Partnerships on New Approaches to Better Manage Patient Outcomes and Plan Costs

Value/Cost The top eleven MTM pharmacies in the US averaged $1300 cost avoidance per patient 1 Medication adherence resulted in substantial medical savings (hospital/ER) – benefit cost ratios ranged from 2:1 (<65 with dyslipidemia) to 13:1 (older patients with hypertension). Presenteeism 2 Plans are seeing an ROI of $4.73 for every $ spent on cost avoidance 1 Interventions to improve adherence showed significantly lower non adherence vs control (9% vs 16%) 3 1 Outcomes Pharmaceutical Healthcare 2 Health Affairs January 2011 vol. 30 no

We’ve heard it before……… The National Consumers League 3 year campaign to reduce $290 billion per year spend related to poor medication adherence Campaign revealed the following: – 1 out of 3 people never fill their prescriptions – Nearly 45% of the population has one or more chronic conditions that require medications – Nearly 3 out of 4 people do not take their medications as directed – More than 1/3 of medication-related hospital admissions are linked to poor adherence

Beneficiaries / patients are at the center of the healthcare system Pharmacies are the point-of-care for patients receiving medications in the community; they connect the patient to the medication Pharmacists are the point-of-service providers for drug plans; they are the public face of a drug plan, they manage optimal use of medications Collectively, it’s time to find new ways to collaborate, and capitalize on the opportunities that reform has created

Deb Saltmarche BScHons(Pharm), RPh, MRPSGB Saltmarche Consulting Unauthorized distribution or use this material is prohibited unless explicitly agreed to in writing