Trends in Medication Management

Jayson Gallant, B.Pharm, M.Sc

Pharmacist, Health Benefit Management

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Agenda Legislative / Public Plan Trends Biosimilars Pipeline Focus on Oncology

Legislative / Public Plan Trends

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Multiple impactful trends

Federal Bill S-201 on genetic testing.

A report from the Conference Board of Canada estimates savings of $1B for switching three categories of medication from prescription to over-the-counter (OTC).

Nova Scotia’s human-rights board has ruled that a man suffering from chronic pain must have his marijuana prescription paid for by his employee-insurance plan.

Quebec Bill 81 allows for tendering processes for Basic Drug Plan listing of generic drugs.

Similar to other provinces, Quebec will implement a blood glucose test strip limitation to its public plan (RAMQ).

Operational changes to the Trillium Drug Program in Ontario allow for electronic claims transmission.

Access to Hepatitis C drugs is expanding in BC and more drugs are funded in Ontario.

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Quebec Bill 92 - Overview

Wide scope: Investigation powers of the RAMQ, commercial practices related to prescription drugs, voluntary termination of pregnancy

Transparency of pharmacy invoices

Financial support from pharmaceutical manufacturers

Private payer’s preferred provider networks

Delisting of drugs from the RAMQ List of Medications

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September 15th 2017: pharmacy invoices will be more transparent

Drug Cost

Wholesaler’s Mark-Up

Dispensing Fee (including retail markup or other fees)

$23.71

$1.54

$8.96

For drugs listed on the RAMQ List of Medications only

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Impacts of Bill 92

Plan members will be better equiped to seek pharmacies offering the best prices.

Pharmacists may potentially lower their prices or limit their price increases.

Invoices may become challenging to understand for plan members.

Plan design impact will be highly dependent on claim submission by pharmacies.

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No limits on limits! – Proton Pump Inhibitors

Source: Usage optimal à long terme des inhibiteurs de la pompe à protons. May 2016. https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Medicaments/INESSS_Avis_IPP_2016.pdf

Quebec will be implementing new PPI limitations on April 21, 2017

90-day Supply allowed within a 365-day period

Larger Supply allowed through exception codes

Projected savings for the Quebec Public Plan (RAMQ): 14M$ on a 167M$ PPI expenditure

Biosimilars Update

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Five biosimilar drugs are currently available

Biosimilar Reference Product Biosimilar Indications Product

Availability

OMNITROPE (somatropin) GENOTROPIN Growth Hormone Deficiency 2009

INFLECTRA (infliximab) REMICADE

Rhumatoid Arthritis / Ankylosing Spondylitis Plaque Psoriasis / Psoriatic Arthritis Crohn Disease / Ulcerative Colitis

* Not indicated for pediatric patients

September 2014

BASAGLAR (glargine insulin) LANTUS Type 1 / Type 2 Diabetes December 2015

GRASTOFIL (filgrastim) NEUPOGEN Neutropenia March 2016

BRENZYS (etanercept) ENBREL

Rhumatoid Arthritis / Ankylosing Spondylitis * Not indicated for

Plaque Psoriasis / Psoriatic Arthritis ** Not indicated for pediatric patients

September 2016

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The impact of biosimilars remains limited in private drug plans

According to the 2016 TELUS Health Book of Business, utilization and costs of three recently approved biosimilars represent : < 1 % of claimants for the chemical entity

< 0,5 % of costs associated to the chemical entity

TELUS Health Book of Business. Canada. 2016

INFLECTRA (infliximab)

BASAGLAR (glargine insulin)

GRASTOFIL (filgrastim)

BRENZYS (etanercept)

$ 0.37 % 0.25 % 0.41 % Too soon to tell

Claimants 0.84 % 0.61 % 0.99 %

New Claimants Only 3.75 % 2.5 % 1.2 %

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Biosimilar Pipeline Update

TELUS Health. Drug Pipeline Tracker. March 2017

Reference Drug Indications Manufacturers (Biosimilar Name) Anticipated Approval Date

AVASTIN (bevacizumab)

Cancer (many indications) Pfizer (PF-06439535) Health Canada is currently reviewing

a submission for bevacizumab

NEULASTA (pegfilgrastim) Neutropenia Mylan Health Canada is currently reviewing

a submission for pegfilgrastim

HUMIRA (adalimumab)

Rhumatoid Arthritis / Inflammatory

Diseases

Amgen (ABP501) Also: Sandoz, BI et Merck Q1-Q2 2018

LUCENTIS (ranibizumab)

Macular Degeneration

Pfenex (PF582) Also: Hospira, Novartis et Valeant Potentially 2018

HERCEPTIN (trastuzumab) Breast Cancer Celltrion (CT-P6)

Also: Pfizer Potentially 2018

RITUXAN (rituximab)

Lymphoma (RA – phase 3) Sandoz (GP2013) Potentially late 2018

Pipeline Update

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Pipeline Update

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Drug Indication Potential Impact Cost

OCALIVA (obeticholic acid)

Intercept

A farnesoid X receptor agonist indicated for primary biliary cholangitis (approx. 10,000 patients in Canada): Approved by the FDA in May 2016. Health Canada approval is expected in

the next few months.

Off-label use potential for non alcoholic steatohepatitis (NASH) a much more prevalent condition (2 to 5 % of the general population).

Cost expected to be $75,000 or more per year

CGRP Inhibitors

Many manufacturers

Monoclonal antibodies (biologic drugs) targeting CGRP indicated for the prevention of chronic and episodic migraines. Global forecasts seem to indicate that

approval will not be earlier than 2019.

Highly anticipated new drug class targeting a highly prevalent medical condition (approx. 8% of Canadians).

Expected cost between $9,000 to $20,000.

EUCRISA (Crisaborole)

Anacor / Pfizer

Indicated for atopic dermatitis and potentially psoriasis Approved by the FDA for mild to moderate

atopic dermatitis in December 2016.

This is considerably more expensive that other therapies for atopic dermatitis such as topical steroids or immunomodulators.

U.S. pricing has been set at $580 for a 60-gram tube

TELUS Health. Drug Pipeline Tracker. March 2017

Oncology

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Focus on Oncology Drug Trends

A high number of new oncology drugs were approved in the last few years.

These new drugs are often expensive and associated with an industry patient support program.

Novel therapeutic approachs: targeted therapy and immunotherapy.

Oral agents are more and more frequent as well as infusions clinics.

Regulatory approval is often expedited.

Thank You