slides - Express Scripts

Good Intentions, 

Bad Behavior and 

A Better Tomorrow 

Steve Miller MD 

SVP and Chief Medical Officer

What a Year 2010 Was! 

Healthcare Reform Passes 

Election Implementation Results Begins 

Watson Republican Beats majorities Humans 

in Carbon-based the House and life-forms in 

Charlie Sheen 

many shown more to be states 

Any questions? inferior at 

Jeopardy! 

Outcomes Conference 2011 

2

“The good physician 

treats the disease; 

the great physician 

treats the patient.” 

Sir William Osler 

Founding Professor of Medicine 

Johns Hopkins Hospital 

1849 - 1919 


3

Medical Training Before Dr. Osler 

•Classrooms were 

amphitheaters 

•Students had no contact with 

patients 

•Physicians met their first 

patients only after graduating 

from medical school 


4

Dr. Osler Introduced Bedside Instruction 


5

Dr. Osler Introduced Medical Internships 


6

We Are Still Learning from Dr. Osler 

“It is much more important 

to know what sort of 

a patient has a disease 

than what sort of 

a disease a patient has.” 

Forgetting Dr. Osler’s lessons 

has driven an 

explosion in waste. 


7

$400 

$403 Billion Wasted in 2010 

$350 

$300 

$250 

HD Adherence 

$200 

$150 

$100 

$50 

$0 

HD Mix 

Safer 

Dispensing 

Adherence 

Mix 

Mix Channel Adherence 


8

25% 

2010 Overall Drug Trend: 3.6% 

20% 

15% 

10% 

Overall 

•3.6% 

Traditional 

•1.4% 

Specialty 

•19.6% 

5% 

0% 

2006 2007 2008 2009 2010 

Overall Drug Trend 

Traditional Drug Trend 

Specialty Drug Trend 


9

Monthly Copay 

Member Cost-Share Continues to Fall 

$60 

25% 

$50 

$40 

$30 

$20 

$10 

22.5% 22.0% 

20.2% $54.19 

19.3% 

$47.76 

Overall copays fell by $0.32 per Rx 

to a new low member share of 

19.3% 

$12.47 $12.15 $12.33 $11.98 2.6% 2.6% 

20% 

15% 

10% 

5% 

Fraction of total Rx cost 

$0 

Overall Traditional Specialty 

2009 2010 


0% 

10

Drug cost inflation rate 

Brand Inflation Climbed to 9.7% 

10% 

8% 

6% 

7.6% 

Brands 

9.7% 

0% 

-2% 

-4% 

Generics 

-6% 

4% 

2% 

-8% 

-10% 

-9.0% 

-10.2% 

0% 

-12% 

2008 2010 2008 2010 


11

Your Decisions Drive 

Your Members’ Behaviors 

Market and Behavioral Analysis 

Market Factors 

Prevalence 

Cost per prescription 

Units per prescription 

Patent expirations 

New drug entrants 

Behavioral Factors 

Drug mix 

Channel 

Therapy adherence 

Total Behavioral 

Savings Opportunity 


12


Prevalence 

0.3% 

Drug Cost 

4.2% 

Units per Rx 

0.0% 

Patent Expirations 

-1.7% 

New Drugs 

Adherence 

0.3% 

1.7% 

Drug Mix 

-1.1% 

-2% 0% 2% 4% 6% 


13


Prevalence 

0.3% 

Market 

Factors 

Drug Cost 

Units per Rx 

0.0% 

4.2% 


-1.7% 

New Drugs 

0.3% 

Behavioral 

Factors 

Adherence 

Drug Mix 

-1.1% 

1.7% 

-2% 0% 2% 4% 6% 


14

2010 Traditional Drug Trend: 1.4% 

Prevalence 

-0.7% 

Market 

Factors 

Drug Cost 

Units per Rx 

0.2% 

3.5% 


-1.9% 

New Drugs 

0.2% 

Behavioral 

Factors 

Adherence 

Drug Mix 

-1.7% 

1.9% 

-2% -1% 0% 1% 2% 3% 4% 


15

Obesity Is Now the Norm 

Ages 2 - 19 

Adults 

34% 

68% 

66% 

32% 

Normal 

http://www.cdc.gov/nchs/fastats/overwt.htm. Accessed March 18, 2011. 

Overweight/Obese 


16

Obesity and Diabetes Maps Match 

Obesity by County, 2007 

Behavior Is Key 

Diabetes by County, 2007 

www.cdc.gov/obesity/data/trends.html. Accessed March 16, 2011. 


17

Top Three Traditional Classes 

Each Is Linked to Obesity 

15% 

High Cholesterol 

6.3% Trend 

Diabetes 

12.5% Trend 

Cardiovascular 

-0.4% Trend 

10% 

5% 

0% 

-5% 

--10% 

Class Trend Market Factors Behavioral Factors 

Outcomes Conference 2011

0% 

-2% 

-4% 

Two Other Classes to Watch 

Ulcer Disease 

Attention Disorders 

25% 

20% 

15% 

-6% 

-8% 

-14% 

10% 

5% 

17% 

-10% 

0% 

-12% 

-5% 

-14% 

-10% 



19

2010 Specialty Drug Trend: 19.6% 

Prevalence 

7.0% 

Market 

Factors 

Drug Cost 

Units per Rx 

-0.8% 

9.2% 


-0.1% 

New Drugs 

1.1% 

Behavioral 

Factors 

Adherence 

Drug Mix 

0.0% 

3.3% 

-2% 0% 2% 4% 6% 8% 10% 


20

Top Three Specialty Classes 

30% 

Inflammatory 

23.5% Trend 

Multiple Sclerosis 

25.4% Trend 

Cancer 

23.7% Trend 

25% 

20% 

15% 

10% 

5% 

0% 

-5% 



PMPY 

Specialty Is More than the 

Top Four Traditional Classes Combined 

$350 

$300 

$250 

$200 

$150 

High 

Cholesterol 

Diabetes 

Medical 

Benefit 

$100 

$50 

$0 

Cardiovascular 

Depression 

Traditional 

Pharmacy 

Benefit 

Specialty 


22

400% 

Medical Benefit Is 

Growing Out of Control 

300% 

200% 

100% 

0% 

-100% 

Inflammatory 

Conditions 

Multiple 

Sclerosis 

Cancer 

Pulmonary 

HTN 

Blood Cell 

Deficiency 

Pharmacy Benefit 

Medical Benefit 

ESI DTR 2010: Division of medically billed specialty drug spend by site of 

care. Thomson Reuters MarketScan ® Commercial Database, 2005-2008. 


23

100% 

Specialty Pharmacy Is 

Leaving Physicians’ Offices 

80% 

60% 

76% 74% 

70% 

63% 

All Other: 

•Emergency Rooms 

•Urgent Care Centers 

40% 

•Inpatient Sites 

20% 

•Outpatient Facilities 

0% 

2005 2006 2007 2008 

Physicians' Offices 

All Other 

ESI DTR 2010: Division of medically billed specialty drug spend by site of care. 

Thomson Reuters MarketScan ® Commercial Database, 2005-2008. 


24

Physician Strategies 

Are Vital to Success in Specialty 


25

Big Challenges, Big Solutions 

Specialty 

Pharmacy Benefit 

Management 

Express Scripts 

Medical Benefit 

Management 

Care Continuum 

Specialty 

Pharmacy and 

Distribution 

CuraScript 


26

Harness Patients’ Good Intentions… 

…and cut 33% 

of America’s pharmacy-related waste 


27

We Commissioned Harris Interactive 

Nationally recognized firm specialized in 

assessing consumer attitudes and beliefs 

• Representative sample of American adults 

• N = 2,099 

• Current users of daily prescription medications 

• Provided realistic scenarios of various Rx-related 

choices (e.g., Home Delivery vs. Retail) 


Source: Harris Interactive & Express Scripts, 2011

If Consumers are Satisfied with 

Current Behavior… 

~0% 

~0% 

~0% 

of people taking brand-name meds would 

rather be taking generics 

of people getting maintenance meds in retail 

would rather be in Home Delivery 

of people going to more expensive retail 

stores would switch to lower-cost retail stores 


But Harris Interactive 

Found That… 

~0% 82% 

~0% 70% 

~0% 40% 

of people taking brand-name meds would 

rather be taking generics 

of people getting maintenance meds in retail 

would rather be in Home Delivery 

of people going to more expensive retail 

stores would switch to lower-cost retail stores 


Dr. Osler Would Be Proud 

Treat the patient, not the disease. 

• Treating diseases, Challenges not patients, lie ahead. has created a 

huge amount of waste. 

• While Specialty total trend requires is controlled, a holistic challenges approach. lie 

ahead. 

• Treat the entire 

Activate 

spectrum 

intent. 

of the specialty 

patient, not just the disease. 

• Understanding how to activate intent is crucial to 

healthcare success moving forward. 


31

slides - Express Scripts

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