1. Society of Human Resource Managers
November 20th, 2014 Luncheon

2. Topics of Discussion Specialty Medications – Rapidly Increasing Prices
Healthcare Costs – Where does all that money go?
Value Based Reimbursement Models – Medical Home Platforms
The Uninformed – The Marketplace and ACA

3. Specialty Medications

4. Integration – the only way to stay a step ahead in specialty
Specialty percent of pharmacy spend, 2008–2020 (projected)
More than half of all specialty drug spend is hidden in the medical benefit. ?
60% Medical benefit % Pharmacy benefit

5. Specialty drugs have a huge impact on total health care costs50
Specialty drugs
…times more expensive than traditional drugs
…% of total drug spend by 2018
…% of drug spend is paid on medical side

6. By 2018, more than 50 percent of all drug spend will be specialty

7. Specialty Utilization Management Programs
Category
Target Drug Examples
AUTOIMMUNE INFLAMMATORY DISORDERS
Enbrel, Humira, Xeljanz
CANCER-ORAL
Gleevec, Sutent, Tasigna,
CYSTIC FIBROSIS
Cayston, Kalydeco,
ENZYME DEFICIENCIES
Kuvan, Carbaglu, Zavesca
GROWTH HORMONES
Genotropin, Humatrope, Norditropin,
HEPATITIS
Sovaldi, Olysio, Victrelis
LUNG DISORDERS
Actimmune
MULTIPLE SCLEROSIS
Avonex, Rebif, Tecfidera
PULMONARY HYPERTENSION
Revatio, Tracleer, Adcirca
OTHERS
Apokyn, Chenodiol, Forteo, Xenzaine
UM programs are aligned to BCBSWY preferred products to drive maximum value

8. Healthcare Costs

9. The Healthcare Dollar

10. A Problem and Employers’ Reactions

11. What Individuals and Employers Can Do?

12. Value Based Reimbursement Models

13. mediQhome

14. The Uninformed

15. The Uninformed – The Marketplace and ACA
89% of uninsured did not know Open Enrollment started 11/15/14
69% knew little or nothing of the Marketplace
53% do not know funding has been set aside for subsidies and cost share reductions