EMPLOYERS’ FORUM OF INDIANA

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EMPLOYERS’ FORUM OF INDIANA

PERSPECTIVE ON HIGH DRUG COSTS

EFI All-Stakeholder Meeting

Indianapolis, IN

Wednesday, September 25, 2019

Gloria Sachdev, PharmD

President and CEO, Employers’ Forum of Indiana

Gloria@employersforumindiana.org

SHADYWhat is the best-selling drug in the world?

Humira- launched in US in 2003; $19,000 in 2012 and $38,000 in 2018 (after rebates)

- TNF blocker for inflammatory conditions, called a biologic

- US has 4 FDA approved biosimilars:

a. Hadlima by Abbvie in 2019, co-market with Merck

b. Hyrimoz by Sandoz in 2018

c. Cyltezo by Boeringer Ingelheim in 2017

d. Amjevita by Amgen in 2016

- Not available in US because of a 20-year US patent protection for Humira which expires in 2023

- BUT BIOSIMILARS AVAILABLE IN EUROPE AS OF 2018

- NHS agency of England negotiated price decrease by 75% & now cost is $4500 annually for high dose

How much money did Abbvie make on Humira in 2018?

$20 billion

SUPER SHADY3. What is the most expensive drug in the world? Zolgensma for $2 million

- Used to treat spinal muscular atrophy (SMA effects 1 in 10,000 live births)

- One-time gene therapy treatment

4. What is the recent DRAMA about this drug?

- FDA approved in May 2019 - BUT in March 2019 Novartis learned that chief

scientists submitted FAKE data to FDA and Novartis didn’t tell the FDA

- They eventually fired their chief scientists in August 2019

- FDA decided to keep this medication on the market for now

Results of Forum Employer Survey Regarding Prescription MedicationConducted by the Employers’ Forum of Indiana in Partnership With the National Alliance of Healthcare Purchasers’ Coalition

sent August 2019

SELECT YOUR COMPANY’S INDUSTRYN=13

46%

8%

31%

8% 8%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Educational

Services

Finance and

Insurance

Manufacturing Professional,

Scientific, and

Technical

Services

Transportation,

Warehousing

and Utilities

INDICATE THE SIZE OF YOUR ACTIVE EMPLOYEE POPULATION N=12

42%

17%

8%

33%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Between 1,001 - 5,000 Between 5,001 -

10,000

Between 10,001 -

20,000

Over 20,000

WHAT IS YOUR AVERAGE DRUG SPEND PER COVERED LIFE (PMPY)?N=12

8%

17%

33%

25%

17%

0%

5%

10%

15%

20%

25%

30%

35%

Less than $100 $101-$500 $501-$1,000 $1,001-$2,000 $2,001-$3,000

WHAT IS YOUR PERSPECTIVE REGARDING YOUR DRUG SPEND?N=13

54%

46%

0%

10%

20%

30%

40%

50%

60%

Too high and not

sustainable

Too high and

sustainable

Reasonable Too low

BESIDES COST, WHAT ARE YOUR KEY CHALLENGES WITH MANAGING YOUR DRUG TREND?N=13

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%PB

Ms

offe

rin

g a

dru

g

form

ula

ry b

ase

d o

n v

alu

e

of th

e d

rug

De

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wh

ich

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g t

o

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e f

rom

fo

rmu

lary

Issu

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ith

PB

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on

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Kn

ow

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wh

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ost

s

go

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gh

me

dic

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.

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ha

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me

)

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pp

rop

ria

te t

he

rap

ies

MAJOR CHALLENGE MEDIUM CHALLENGE MINOR CHALLENGE NOT A CHALLENGE N/A

WHICH ELEMENTS OF THE PHARMACY BENEFIT ARE CAUSING THE MOST DISSATISFACTION AMONG EMPLOYEES?N=13

23%

54%

0%

23%

8%

33% 33%

25%25%

42%

25%

8%

0%

10%

20%

30%

40%

50%

60%

High Dissatisfaction Medium Dissatisfaction Low Dissatisfaction Not Dissatisfied

High Deductibles Increased Premiums Higher cost-sharing

HOW SATISFIED ARE YOU WITH…..N=13

46%

15%

0%

38%

54%

77%

15%

23% 23%

0%

8%

0%0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Your independent consultant Your PBM Your health plan

Highly Satisfied Satisfied Somewhat Satisfied Not Satisfied

WHAT ARE KEY AREAS YOU INCLUDE WHEN DEVELOPING YOUR CONTRACTS? (MARK ALL THAT APPLY)N=13

62%

15%

62%

31%

62%

100%

46%

0%

20%

40%

60%

80%

100%

120%

INDICATE WHICH OF THE FOLLOWING STRATEGIES YOU ARE USING TO ADDRESS HIGH COST DRUGSN=13

0%10%20%30%40%50%60%70%80%

Fu

lly

tra

nsp

are

nt

PB

M

Cu

sto

m e

xc

lusi

on

for

dru

g fo

rmu

lary

Re

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ase

d

pric

ing

Dire

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to

ph

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ac

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co

ntr

ac

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Hir

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a

ph

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ac

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co

nsu

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for

org

an

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n

Dire

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th

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nu

fac

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ase

d

co

ntr

ac

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Gro

up

pu

rch

asi

ng

Currently in place Will be in place next 12-24 months Considering for future

Not considering Don’t Know

OPEN DISCUSSION