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Surya Singh: "From Development to Delivery in the US"

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October 28, 2018

This one-day conference explored the current pharmaceutical pricing landscape by bringing together leaders from the pharmaceutical industry, policymakers, legal practitioners, and scholars to engage in novel, interdisciplinary discussions to better understand current challenges and articulate best practices to address these issues. Participants assessed the current challenges presented in drug pricing policy, from development to delivery, in both the United States and international context. We also explored and articulated best practices to expand access to medicines and worked toward developing a plan for disseminating these practices more widely.

PLEASE NOTE: THESE SLIDES MAY NOT DISPLAY PROPERLY ONLINE, BUT THEY ARE READABLE IF DOWNLOADED.

October 28, 2018

This one-day conference explored the current pharmaceutical pricing landscape by bringing together leaders from the pharmaceutical industry, policymakers, legal practitioners, and scholars to engage in novel, interdisciplinary discussions to better understand current challenges and articulate best practices to address these issues. Participants assessed the current challenges presented in drug pricing policy, from development to delivery, in both the United States and international context. We also explored and articulated best practices to expand access to medicines and worked toward developing a plan for disseminating these practices more widely.

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Surya Singh: "From Development to Delivery in the US"

  1. 1. ©2018 CVS Health and/or one of its affiliates: Confidential & Proprietary From Development to Delivery in the U.S. Surya Singh, MD Vice President & CMO, Specialty, CVS Health
  2. 2. 2©2018 CVS Health and/or one of its affiliates: Confidential & Proprietary Advances in Pharmacotherapy Have Transformed the Treatment of Complex Diseases Image source: CVS Health Creative Resource Library, accessed 2018. Future 19th Century Plant Derived Treatments Early 20th Century Chemical Synthesis Late 20th Century Small Molecules Early 21st Century Biologics Gene Therapy (monogenic) Gene Editing Treatment of Polygenic Disorders 45616
  3. 3. 3©2018 CVS Health and/or one of its affiliates: Confidential & Proprietary Rising launch prices The Complexity of Patients and Market Changes Require Broad Set of Interventions Rising spend across benefits Complex multi-drug regimens Technology driving clinical innovation Pipeline (new drugs, indications) Emerging management models Biosimilars Value-based management 41591
  4. 4. 4©2018 CVS Health and/or one of its affiliates: Confidential & Proprietary $0 $40 $80 $120 $160 $200 $240 1997 1998 2002 2004 2006 2007 2008 2011 2013 2013 2014 2014 2015 2016 2017 Higher Launch Prices Contribute to Rising Specialty Spend ANNUAL PRICE IN THOUSANDS1 1. CVS Specialty™ analysis of Medispan data. Annual drug costs based on average wholesale price (AWP) accessed December 2017. This slide contains references to brand- name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Specialty. Manufacturers set drug prices based on their perception of value Launch prices increase year after year Pricing may not reflect indication efficacy
  5. 5. 5©2018 CVS Health and/or one of its affiliates: Confidential & Proprietary Duke-Margolis Value-Based Advisory Group Framework
  6. 6. 6©2018 CVS Health and/or one of its affiliates: Confidential & Proprietary VBM Approaches are Helping Payors Meet Outcome and Cost Goals Pricing and/or rebates align with drug’s effectiveness for the specific indication Efficacy validated by independent P&T Committee Indication-Based Aligns costs with drug’s effectiveness at achieving a specified clinical marker, such as cholesterol, A1C levels or other biomarker levels Outcomes-Based PMPM cost threshold defined; manufacturer may provide additional value if threshold is exceeded Cost Cap-Based Use of cost- effective analyses to determine if the therapy being evaluated meets a pre-defined threshold for cost per unit of benefit Value-Based Plan Design P&T Committee (The CVS Caremark Pharmacy and Therapeutics Committee). PMPM (Per member per month). 45128AL
  7. 7. 7©2018 CVS Health and/or one of its affiliates: Confidential & Proprietary Dupixent Case Study: Value-Based Benchmarking Helps Improve Access 350K-400K eligible U.S. patients First biologic, and no near-term competitor Expected launch price: $60K/year BACKGROUND – A NEW TREATMENT FOR SEVERE ATOPIC DERMATITIS PRE AND POST-ICER ASSESSMENT RESULT: Quicker uptake, improved patient access, costs lower than predicted and improved overall payor/manufacturer relationship PRE-ASSESSMENT: Stiff prior authorization to limit access and concerns over future premiums and cost-sharing POST-ASSESSMENT: ICER recommended price 50% less than market expectation; reasonable access was successfully negotiated Source: Institute for Clinical and Economic Review, 2017.

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