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Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

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Page 1: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

Can the Specialty Beast Be Tamed?

Steven B. Miller, MDExpress Scripts

Page 2: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

2

Specialty Growth Continues to Outpace Traditional Drug Market

Source: Express Scripts analysis of IMS data.

21%

Page 3: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

3

Specialty Growth Continues to Outpace Traditional Drug Market

Source: Express Scripts analysis of IMS data.

21%

27%

Page 4: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

4

Specialty Growth Continues to Outpace Traditional Drug Market

Source: Express Scripts analysis of IMS data.

21%

27%

Page 5: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

5

Agenda

Page 6: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

6

What Are Specialty Medications?

Page 7: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

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Overall Specialty Trend: 14%

PMPY

Page 8: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

8

“Specialty”: Now the #1 Therapy Class

PMPY

Page 9: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

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Utilization Drove Trend More Than Last Year

PMPY

Page 10: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

1010

Key Specialty Therapy Classes2006:2007

PM

PY

+ 17%+ 17%

+ 1%+ 1%

- 10%- 10%

+ 20%+ 20%

+ 16%+ 16%

+ 18%+ 18%

PMPY

+ 6%+ 6%

Page 11: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

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Key Specialty Therapy Classes2006:2007

PM

PY

PMPY

+ 17%+ 17%

+ 1%+ 1%

- 10%- 10%

+ 20%+ 20%

+ 16%+ 16%

+ 18%+ 18%

+ 6%+ 6%

Page 12: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

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Expanded and Earlier UseInflammatory Conditions

Page 13: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

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Expanded and Earlier UseInflammatory Conditions

Page 14: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

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Price Drove TrendMultiple Sclerosis

Page 15: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

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Price Drove TrendMultiple Sclerosis

Page 16: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

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Price Drove TrendMultiple Sclerosis

Page 17: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

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Price, Place and ProductCancer

Page 18: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

1818

Price, Place and ProductCancer

Page 19: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

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Price, Place and ProductCancer

Page 20: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

2020

Safety Changed the Landscape

Blood Cell Deficiency

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2008 Express Scripts, Inc. All Rights Reserved.

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Safety Changed the Landscape

Blood Cell Deficiency

Page 22: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

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Prevalence and Price Overwhelmed Mix

Growth Hormone

Page 23: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

2323

Prevalence and Price Overwhelmed Mix

Growth Hormone

Page 24: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

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Growth Hormone Use Is Rapidly

Moving Into Older Patients

Users above age 20

Page 25: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

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Medical Shifted to PharmacyAnticoagulants

Page 26: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

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Medical Shifted to PharmacyAnticoagulants

Page 27: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

2727

Where are the Patients Going?

Hepatitis C

Page 28: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

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Where are the Patients Going?

Hepatitis C

Page 29: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

Hepatitis C Prevention Is Working

US has 3.2 Million Chronically Infected and 10,000 Annual Deaths

29

http://www.cdc.gov/ncidod/diseases/hepatitis/resource/PDFs/disease_burden.pdf accessed March 24, 2008

Page 30: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

Hepatitis C Prevention Is Working

US has 3.2 Million Chronically Infected and 10,000 Annual Deaths

30

http://www.cdc.gov/ncidod/diseases/hepatitis/resource/PDFs/disease_burden.pdf accessed March 24, 2008

Page 31: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

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Specialty Growth Continues to Outpace Traditional Drug Market

Source: Express Scripts analysis of IMS data.

21%

27%

Page 32: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

32

Follow-on Biologic Savings Opportunity

ESI studied four classes of specialty drugs

Page 33: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

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Follow-on Biologic Savings Opportunity

ESI studied four classes of specialty drugs

Page 34: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

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In the first ten years: $71 Billion Savings

$ B

illio

ns

Inflation and prevalence drive trend in this modelInflation and prevalence drive trend in this model

Page 35: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

Every Study Says “Billions”

Page 36: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

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Key Issues

Page 37: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

2007 Was An Active Legislative Year for Follow-On

Biologics

High-level excerpts of selected issues; not a complete description of legislative proposals.

Page 38: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

2008 Biogenerics Legislation

Page 39: Can the Specialty Beast Be Tamed? Steven B. Miller, MD Express Scripts

2008 Express Scripts, Inc. All Rights Reserved.

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Conclusions