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

2. 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

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

5. 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)

6. 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)

7. “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