CLINICAL AND PHARMACOECONOMIC DRUG REVIEW

APRIL 12,2016 2016 CADTH SYMPOSIUM

ANNE-MARIE SMITH, BSC. PHARM.

Practice Lead, Drug Plan Solutions

Agenda

• Pharmacy Benefit Management – Medication Advisory Panel – Clinical Review – BIA and PE Model

Our Philosophy Balancing Clinical Efficacy & Affordability

Medavie Private Plan Overview

Managed 90%

Open or Non Managed

10%

• Comprehensive review of medications to ensure they are proven effective, medically necessary, and cost effective

• Panel composed of Medical Specialists, GPs, pharmacists, nurses , actuary and a Pharmacoeconomist

• Unique private industry cross functional panel that meets monthly

Medication Advisory Panel (MAP)

5

Plan Design Recommendations Outcome Description

Full Benefit Drug fully covered Tier 1 vs. Tier 2 on tiered formulary

Full Benefit w/Max Dollar or Quantity Cap

SA Criteria Drugs are covered after clinical criteria has been met

STG Drugs are covered in concert with government funded programs

Decline Drug is not covered

7

Clinical Studies

Literature Reviews

Specialist Opinions

BI/PE Analysis

Productivity Presenteeism Disability Absenteeism

Affordability Limit?

Drug Submission Assessment Process

Clinical

• True Comparators • Length of Clinical Trials

Budget Impact

• Demographics • Incidence by age • Projected market share

Pharmacoeconomic Model • Sick days • Absenteeism • Presenteeism • Productivity • Disability

Drug Submission Limitations

Questions ?

Thank you