Magellan Rx Report Summer 2016 Multiple Myeloma: Medical Drug Management Long-Acting Injectable Value Based PBM – Summer Rare Disease, Major Strategies: Improving Antipsychotics – Potential Implications for 2016 Economic Impact Outcomes Solution for Nonadherence Various Stakeholders Magellan Rx Report MEDICALsupportive AND care PHARMACY vs therapeutic BENEFIT• MANAGEMENT medical vs pharmacy clinical comparability/economics/formulary design acute vs chronic/physician uptake• Biosimilars: Overcoming Challenges to Ensure Cost-Effective Care magellanrx.com Forecast YOUR Future 50% SPECIALTY RX Specialty drug costs are projected to BY 2018 represent half of total drug costs within the next two years, 50% of which occurs on the medical benefit. Do you have the right tools to manage this spend? 50% 50% of spend is on the of spend is on the pharmacy benefit. medical benefit. At Magellan Rx Management, we help payers forecast their specialty spend across numerous therapeutic categories on both the pharmacy and medical benefit. Our customized forecasts are based on unique member population and utilization trends specific to each payer. Let us help you stay ahead of specialty trends. Connect with us to learn more. Patients, Science, and Innovation are the foundation of everything we do. At Celgene, we believe in an unwavering commitment to medical innovation, from discovery to development. Our passion is relentless—and we are just getting started. magellanrx.com © 2015 Celgene Corporation 07/15 US-CELG150237 inVentiv Health Managed Markets • Date: 6.7.16 • Client: Celgene • Product: Above-Brand 33346a.indd 1 6/8/16 7:23 AM Ad Page 1/1 • Name: 42144_ccpsmm_HCPOPM_Ad_Magellan_r1lo01.indd MAGELLAN • Trim: 8.375" x 10.875" • Live: 7.75" x 10.25" • Bleed: 0.125" Cosmos Communications 1 Q1 Q2 C M Y K js 33346a 06.8.16 133 9 Forecast YOUR Future 50% SPECIALTY RX Specialty drug costs are projected to BY 2018 represent half of total drug costs within the next two years, 50% of which occurs on the medical benefit. Do you have the right tools to manage this spend? 50% 50% of spend is on the of spend is on the pharmacy benefit. medical benefit. At Magellan Rx Management, we help payers forecast their specialty spend across numerous therapeutic categories on both the pharmacy and medical benefit. Our customized forecasts are based on unique member population and utilization trends specific to each payer. Let us help you stay ahead of specialty trends. Connect with us to learn more. Patients, Science, and Innovation are the foundation of everything we do. At Celgene, we believe in an unwavering commitment to medical innovation, from discovery to development. Our passion is relentless—and we are just getting started. magellanrx.com © 2015 Celgene Corporation 07/15 US-CELG150237 inVentiv Health Managed Markets • Date: 6.7.16 • Client: Celgene • Product: Above-Brand 33346a.indd 1 6/8/16 7:23 AM Ad Page 1/1 • Name: 42144_ccpsmm_HCPOPM_Ad_Magellan_r1lo01.indd MAGELLAN • Trim: 8.375" x 10.875" • Live: 7.75" x 10.25" • Bleed: 0.125" Cosmos Communications 1 Q1 Q2 C M Y K js 33346a 06.8.16 133 9 Welcome to the Features Magellan Rx Report 6-7 Managed Care Newsstand Published By Magellan Rx Management 15950 North 76th Street 8-14 Scottsdale, AZ 85260 Multiple Myeloma: A Rare Disease Tel: 401-344-1000 with a Major Economic Impact Fax: 401-619-5215 [email protected] magellanrx.com 20-26 Medical Drug Management Strategies Publishing Staff Todd C. Lord, PharmD, AE-C, CDOE Themmi Evangelatos, PharmD, MSBA 28-29 Carolyn Farnum, BS Magellan Trend Report: Key Insights Into Steve D. Cutts, PharmD, AE-C, CDOE Haita Makanji, PharmD Developing Strategies for Medical Benefit Sagar Makanji, PharmD Specialty Drug Management Advertising and Sales Todd Lord 30-40 401-344-1023 Long-Acting Injectable Antipsychotics: [email protected] A Solution to Nonadherence? The content of Magellan Rx Report—including text, graphics, images, and information obtained from third parties, licensors, and other material (“content”)—is for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or 42-45 treatment. Magellan Rx Report does not verify any claims or other information appearing in any of the advertisements contained in the publication and cannot take responsibility for any losses or Biosimilars — Overcoming Challenges to other damages incurred by readers in reliance on such content. Developed by StayWell. Ensure Cost-Effective Care Editorial Advisory Board Saira A. Jan, MS, PharmD Mona M. Chitre, PharmD, CGP 46-48 Director of Pharmacy Strategy and Vice President Pharmacy Management, Value-Based PBM — Implications for Clinical Integration, Excellus BlueCross BlueShield Horizon Blue Cross Blue Shield of NJ, Various Stakeholders Clinical Professor, Rutgers State Allen Luskin, MD University of New Jersey Director, Center for Respiratory Health, Dean Medical Center, A. Mark Fendrick, MD Clinical Associate Professor of Professor of Medicine and Health Medicine, University of Wisconsin Management and Policy, Schools of Trends Medicine and Public Health, University Winston Wong, PharmD of Michigan President, W-Squared Group 52 Stephen Kogut, PhD, MBA, RPh Pipeline Trends Associate Professor, College of Pharmacy, University of Rhode Island ISSN: 2159-5372 10444M Dear Managed Care Colleagues, Welcome to our summer the integration process, framing up the unique aspects of issue of the Magellan Rx managing the uptake of these agents. Report. In this issue we Additionally, in this issue we delve into the interface of the continue focusing on key clinical and financial impact of managing potentially costly managed care trends and clinical conditions. First, we explore the potential role of long- opportunities — so it is no acting injectable antipsychotics as a solution to nonadherence surprise specialty pharmacy in a potentially vulnerable patient population with significant management remains mental health needs. Meanwhile, our article on multiple Mostafa Kamal a priority. Clinical and myeloma considers the significant economic implications for economic considerations payors of this relatively rare disease. demand payor attention as specialty spending continues to grow, within both the Our article “Value-Based PBM — Implications for Various medical and pharmacy benefit. The importance of specialty Stakeholders,” serves as a capstone to each of the preceding management will only increase as more first-in-class, discussions. It explores not only the evolving needs of payors groundbreaking therapies promise to reach the market in the in navigating the increasingly complex dynamics of medical not-so-distant future. and pharmacy specialty management, but touches upon the shift occurring as payors expect refinement and sophistication The clinical opportunities associated with these therapies in the services they seek from their PBM. The days of robust are accompanied by fiscal and operational challenges. claims adjudication and formulary management services These demand innovative, forward-looking, and insightful representing adequate support by a PBM have given way to management strategies. This issue of the Magellan Rx Report a new level of service expectations. Value-based services includes a summary of some of the key findings of our — including outcomes-based contracting, site-of-care Magellan Rx Trend ReportTM, setting the stage for discussions management, support around medical management, and data of what the next era of specialty management will require. analytics to help achieve success in medical management — The Trend Report looks at the evolution of management identify and address gaps in care, and demonstrate success and cost trends, including the unique perspective offered with clinical programs such as STAR ratings and HEDIS when assessing both medical and pharmacy spending measures are no longer optional, they are essential. and management strategies, as it frames up potential opportunities for the future. Trends in medical formulary To learn more about Magellan Rx Management and our value- management, including product preferencing and site-of-care based PBM services, supporting the initiatives of payors of the management are highlighted, giving insight into the evolution future, please feel free to contact us at MagellanRxReport@ and uptake of these strategies and opportunities for the magellanhealth.com. As always, I value any feedback that you future. may have, and thanks for reading! Our medical management strategies article picks up on this Sincerely, theme, as it further explores trends highlighted in the Trend Report and provides some real-world perspectives on how payors can proactively establish and implement management solutions that position them for success in the future. The Magellan Rx Report Summer 2016 Summer Report Rx Magellan Summer Multiple Myeloma: biosimilars article explores the clinical and cost-savings Mostafa Kamal 2016 Rare Disease, Major Medical Drug Management Economic Impact Strategies: Improving Long-Acting Injectable Outcomes Antipsychotics – Potential opportunities available as biosimilar entrants make their way Chief Executive Officer Solution for Nonadherence Value Based PBM – Implications for to the market and how payors and providers can navigate Magellan Rx Management Magellan Rx ReportVarious Stakeholders MEDICALsupportive AND care PHARMACYvs therapeutic • BENEFIT MANAGEMENT medical vs pharmacy a c u t e v s c h r o n i c / p h y s i c i a n u p t a k e• SUBSCRIBE