specialty pharmacy: today’s prescription for a better tomorrow steve miller, md chief medical...
TRANSCRIPT
![Page 1: Specialty Pharmacy: Today’s Prescription for a Better Tomorrow Steve Miller, MD Chief Medical Officer](https://reader035.vdocuments.mx/reader035/viewer/2022062800/56649de45503460f94adb7f6/html5/thumbnails/1.jpg)
Specialty Pharmacy:Today’s Prescription for a
Better Tomorrow
Steve Miller, MDChief Medical Officer
![Page 2: Specialty Pharmacy: Today’s Prescription for a Better Tomorrow Steve Miller, MD Chief Medical Officer](https://reader035.vdocuments.mx/reader035/viewer/2022062800/56649de45503460f94adb7f6/html5/thumbnails/2.jpg)
2 2007 Express Scripts, Inc. All Rights Reserved.
What Are Specialty Medications?
• Injectable or non-injectable;
• Frequent dosing adjustments, or
• Intensive clinical monitoring, or
• Intensive patient training, or
• Limited or exclusive distribution, specialized handling or specialized administration, or
• Cost in excess of $500 for a 30-day supply
![Page 3: Specialty Pharmacy: Today’s Prescription for a Better Tomorrow Steve Miller, MD Chief Medical Officer](https://reader035.vdocuments.mx/reader035/viewer/2022062800/56649de45503460f94adb7f6/html5/thumbnails/3.jpg)
3 2007 Express Scripts, Inc. All Rights Reserved.
Anemia
Cancer
Growth Deficiency
Hemophilia
Hepatitis
Infertility
Multiple Sclerosis
Pulmonary HTN
Rheumatoid Arthritis
Many others
Know Your Specialty Patients
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4 2007 Express Scripts, Inc. All Rights Reserved.
Specialty Growth Continues to Outpace Traditional Drug Market
Source: Express Scripts analysis of IMS data.
![Page 5: Specialty Pharmacy: Today’s Prescription for a Better Tomorrow Steve Miller, MD Chief Medical Officer](https://reader035.vdocuments.mx/reader035/viewer/2022062800/56649de45503460f94adb7f6/html5/thumbnails/5.jpg)
5 2007 Express Scripts, Inc. All Rights Reserved.
Relatively Few People Use Specialty Drugs
88%
10%2%
0%
20%
40%
60%
80%
100%
Pre
vale
nce
WellAcute condition
Low-grade chronic
Chronic conditions and/or
procedures
Rare Diseases, Acute Complex,
Multiple co-morbidities
Medical Care 41:1153, 2003
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6 2007 Express Scripts, Inc. All Rights Reserved.
Each Specialty Patient Has Large Annual Costs
1,000
10,000
50,000
$0
$20,000
$40,000
$60,000
Ann
ual C
ost /
pt
WellAcute condition
Low-grade chronic
Chronic conditions and/or
procedures
Rare Diseases, Acute Complex,
Multiple co-morbidities
Medical Care 41:1153, 2003
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7 2007 Express Scripts, Inc. All Rights Reserved.
Specialty Patients Remain With Their Health Plans
• Continuous eligibility from July 2003 through June 2006
• Members utilizing their Rx benefit for MS or RA vs. non-utilizers of Rx benefit
• GIC data
82.0%
70.9%
0% 25% 50% 75% 100%
Utilizers
Non-utilizers
Health Plan Retention Rate
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8 2007 Express Scripts, Inc. All Rights Reserved.
Overall Specialty Trend: 21%
$0
$20
$40
$60
$80
2005 2006
$60.02$72.58
PMPY
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9 2007 Express Scripts, Inc. All Rights Reserved.
New Drugs Have A Growing Impact in Specialty Trend
59%43%
39%
40%
17%
0%
25%
50%
75%
100%
Non-Specialty Specialty
New Drugs
Utilization
Cost/Rx
Contribution to Trend
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10 2007 Express Scripts, Inc. All Rights Reserved.
Top Six Specialty Therapy Classes2005:2006
$0 $5 $10 $15 $20
Hepatitis C
GrowthDeficiencies
Blood CellDeficiencies
Cancer
Multiple Sclerosis
InflammatoryConditions
20052006
PM
PY
+ 22.8%+ 22.8%
- 8.3%- 8.3%
+ 4.0%+ 4.0%
+ 39.5%+ 39.5%
+ 19.0%+ 19.0%
+ 22.7%+ 22.7%
PMPY
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11 2007 Express Scripts, Inc. All Rights Reserved.
Top Six Specialty Therapy Classes2005:2006
$0 $5 $10 $15 $20
Hepatitis C
GrowthDeficiencies
Blood CellDeficiencies
Cancer
Multiple Sclerosis
InflammatoryConditions
20052006
PM
PY
+ 22.8%
- 8.3%- 8.3%
+ 4.0%+ 4.0%
+ 39.5%
+ 19.0%
+ 22.7%
PMPY
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12 2007 Express Scripts, Inc. All Rights Reserved.
A Common Disease Pathway
-1.5%
6.0%
1.4%
-1.8%
17.9%
0.1%
0.0%
-5% 0% 5% 10% 15% 20%
New Drugs
Intensity
Prevalence
Therapeutic Mix
Brand / Generic Mix
Price
Therapy Class #1: Inflammatory Conditions
Units / Rx
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13 2007 Express Scripts, Inc. All Rights Reserved.
A Common Disease Pathway
-1.5%
6.0%
1.4%
-1.8%
17.9%
0.1%
0.0%
-5% 0% 5% 10% 15% 20%
New Drugs
Intensity
Prevalence
Therapeutic Mix
Brand / Generic Mix
Price
Therapy Class #1: Inflammatory Conditions
Units / Rx
Fast Facts
Cost PMPY $19.04
Avg Cost/Rx
$1479
Rx/User/Yr 8.3
Class Trend 22.7%
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14 2007 Express Scripts, Inc. All Rights Reserved.
Price Increases Drove MS
0.4%
14.4%
0.2%
0.6%
2.7%
0.0%
0.0%
-5% 0% 5% 10% 15% 20%
New Drugs
Intensity
Prevalence
Therapeutic Mix
Brand / Generic Mix
Price
Therapy Class #2: Multiple Sclerosis
Units / Rx
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15 2007 Express Scripts, Inc. All Rights Reserved.
Price Increases Drove MS
0.4%
14.4%
0.2%
0.6%
2.7%
0.0%
0.0%
-5% 0% 5% 10% 15% 20%
New Drugs
Intensity
Prevalence
Therapeutic Mix
Brand / Generic Mix
Price
Therapy Class #2: Multiple Sclerosis
Units / RxFast Facts
Cost PMPY $13.60
Avg Cost/Rx
$1470
Rx/User/Yr 9.65
Class Trend 19.0%
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16 2007 Express Scripts, Inc. All Rights Reserved.
Cancer Pipeline Starts to Mature
0.2%
13.1%
-5.1%
-2.6%
8.3%
26.4%
-0.3%
-10% 0% 10% 20% 30%
New Drugs
Intensity
Prevalence
Therapeutic Mix
Brand / Generic Mix
Price
Therapy Class #3: Cancer
Units / Rx
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17 2007 Express Scripts, Inc. All Rights Reserved.
Cancer Pipeline Starts to Mature
0.2%
13.1%
-5.1%
-2.6%
8.3%
26.4%
-0.3%
-10% 0% 10% 20% 30%
New Drugs
Intensity
Prevalence
Therapeutic Mix
Brand / Generic Mix
Price
Therapy Class #3: Cancer
Units / Rx Fast Facts
Cost PMPY $10.44
Avg Cost/Rx
$1593
Rx/User/Yr 3.92
Class Trend 39.5%
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18 2007 Express Scripts, Inc. All Rights Reserved.
Cautious Use in More Patients
0.7%
1.8%
2.4%
-5.9%
5.3%
0.0%
0.0%
-10% 0% 10% 20%
New Drugs
Intensity
Prevalence
Therapeutic Mix
Brand / Generic Mix
Price
Therapy Class #4: Blood Cell Deficiencies
Units / Rx
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19 2007 Express Scripts, Inc. All Rights Reserved.
Cautious Use in More Patients
0.7%
1.8%
2.4%
-5.9%
5.3%
0.0%
0.0%
-10% 0% 10% 20%
New Drugs
Intensity
Prevalence
Therapeutic Mix
Brand / Generic Mix
Price
Therapy Class #4: Blood Cell Deficiencies
Units / Rx
Fast Facts
Cost PMPY $5.01
Avg Cost/Rx
$1683
Rx/User/Yr 4.54
Class Trend 4.0%
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20 2007 Express Scripts, Inc. All Rights Reserved.
Cautious Use in More Patients
Therapy Class #4: Blood Cell Deficiencies
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21 2007 Express Scripts, Inc. All Rights Reserved.
More Use and Higher Doses
10.7%
5.6%
1.9%
-3.2%
6.3%
0.3%
0.0%
-10% 0% 10% 20%
New Drugs
Intensity
Prevalence
Therapeutic Mix
Brand / Generic Mix
Price
Therapy Class #5: Growth Deficiencies
Units / Rx
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22 2007 Express Scripts, Inc. All Rights Reserved.
More Use and Higher Doses
10.7%
5.6%
1.9%
-3.2%
6.3%
0.3%
0.0%
-10% 0% 10% 20%
New Drugs
Intensity
Prevalence
Therapeutic Mix
Brand / Generic Mix
Price
Therapy Class #5: Growth Deficiencies
Units / Rx
Fast Facts
Cost PMPY $4.59
Avg Cost/Rx
$2552
Rx/User/Yr 8.47
Class Trend22.8
%
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23 2007 Express Scripts, Inc. All Rights Reserved.
Growth Hormone Use Is Rapidly Moving Into Older
Patients
23%
25%
24%
20%
22%
24%
26%
2004 2005 2006
GH users above age 20
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24 2007 Express Scripts, Inc. All Rights Reserved.
Generic Drugs Impact Specialty
-0.1%
6.7%
1.7%
5.7%
-11.0%
0.0%
-10.1%
-15% -10% -5% 0% 5% 10%
New Drugs
Intensity
Prevalence
Therapeutic Mix
Brand / Generic Mix
Price
Therapy Class #6: Hepatitis C
Units / Rx
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25 2007 Express Scripts, Inc. All Rights Reserved.
Generic Drugs Impact Specialty
-0.1%
6.7%
1.7%
5.7%
-11.0%
0.0%
-10.1%
-15% -10% -5% 0% 5% 10%
New Drugs
Intensity
Prevalence
Therapeutic Mix
Brand / Generic Mix
Price
Therapy Class #6: Hepatitis C
Units / RxFast Facts
Cost PMPY $3.45
Avg Cost/Rx
$1133
Rx/User/Yr 10.17
Class Trend -8.3%
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26 2007 Express Scripts, Inc. All Rights Reserved.
What Have We Learned?Where Do We Go?
• Specialty drugs are an increasingly large part of the pharmacy spend
• Few patients are impacted today
• Programs can have a significant financial impact with little patient disruption
• Generic drugs can make a difference… even in specialty
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27 2007 Express Scripts, Inc. All Rights Reserved.
Biopharmaceutical Pipeline Continues To
Grow
Source:PhRMA, International Federation of Pharmaceutical Wholesalers & Biotech Industry Organization
10 2992
197
100
240
369
600
1990 1995 2000 2005
Biotech Drugs on the Market
Biotech Drugs in Development
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28 2007 Express Scripts, Inc. All Rights Reserved.
Most of the Specialty Pipeline Is for Common Illnesses
0 10 20 30 40 50 60 70 80
Oncology
Rheumatoid Arthritis
Crohn's Disease
Hepatitis C
Multiple Sclerosis
PsoriasisPhase 2
Phase 3
Applications Submitted
Number of Drugs
![Page 29: Specialty Pharmacy: Today’s Prescription for a Better Tomorrow Steve Miller, MD Chief Medical Officer](https://reader035.vdocuments.mx/reader035/viewer/2022062800/56649de45503460f94adb7f6/html5/thumbnails/29.jpg)
29 2007 Express Scripts, Inc. All Rights Reserved.
New Indications Are Expanding Utilization
1 1
2
1
2
1
Alferon Campath Humira Rebif Rituxan Xolair
Number of Current FDA Indications
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30 2007 Express Scripts, Inc. All Rights Reserved.
New Indications Are Expanding Utilization
1 1
2
1
2
1
4
3
4
5
4
2
Alferon Campath Humira Rebif Rituxan Xolair
Number of Current FDA Indications Number of Indications Under Investigation
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31 2007 Express Scripts, Inc. All Rights Reserved.
The Routes of Administration Are
Growing More Complex
0
10
20
30
RA MS Hep C Crohn's Psoriasis
Unknown
IM
Sub Q
Intravenous
Injectable
Oral(Route
unknown)
ESI Pipeline Tracking database, Phase 2 or later
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32 2007 Express Scripts, Inc. All Rights Reserved.
What Do You Want?
![Page 33: Specialty Pharmacy: Today’s Prescription for a Better Tomorrow Steve Miller, MD Chief Medical Officer](https://reader035.vdocuments.mx/reader035/viewer/2022062800/56649de45503460f94adb7f6/html5/thumbnails/33.jpg)
33 2007 Express Scripts, Inc. All Rights Reserved.
What Do You Want?
• Improved clinical outcomes
• Improved compliance
• Improved patient satisfaction
• Increased reliability of distribution channel
• Decreased acquisition costs
• Consultation on benefit design
![Page 34: Specialty Pharmacy: Today’s Prescription for a Better Tomorrow Steve Miller, MD Chief Medical Officer](https://reader035.vdocuments.mx/reader035/viewer/2022062800/56649de45503460f94adb7f6/html5/thumbnails/34.jpg)
34 2007 Express Scripts, Inc. All Rights Reserved.
Superb Care Makes a Difference
82%
83%
86%
74%
72%
75%
65% 70% 75% 80% 85% 90%
More Satisfied
Rate staff asextremely skillful
Better Educated
Rheumatoid Arthritis Data
CuraScriptRetail0%
10%
20%
30%
40%
50%
42%42%33%33%
Self-ManagementSelf-Management
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35 2007 Express Scripts, Inc. All Rights Reserved.
CuraScript Patients Are More Adherent With Therapy
79%82%
84%87%
92% 92%
70%
75%
80%
85%
90%
95%
Rheumatoid Arthritis Multiple Sclerosis Hepatitis C
Retail CuraScript
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36 2007 Express Scripts, Inc. All Rights Reserved.
Natural History of HCV Infection High Level of Individual Variation
Reprinted with permission from Lauer GM, et al. N Engl JMed. 2001; 345:41-52. Copyright © 2001 Massachusetts Medical Society. All rights reserved.
NormalNormalliverliver
Acute Acute infectioninfection
Chronic Chronic infection infection develops develops in 80%in 80%
Chronic Chronic hepatitishepatitis
Cirrhosis Cirrhosis developdevelops in 20%s in 20%
Risk of Risk of carcinoma, carcinoma,
1-4% per 1-4% per yearyear
~20 years~20 yearsAlcohol use, co-infectionAlcohol use, co-infection
~30 years~30 yearsFemale sex, younger age at infectionFemale sex, younger age at infection
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37 2007 Express Scripts, Inc. All Rights Reserved.
Hepatitis C Impact On the Health System Today
Example: Liver Transplantation
• 1,000 per year in US
• $300,000-$900,000 each
Annual spend for HCV transplants in US is over $500,000,000
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38 2007 Express Scripts, Inc. All Rights Reserved.
Future Burden of HCV$830 Billion between 2010-
2019
190,000 additional deaths
![Page 39: Specialty Pharmacy: Today’s Prescription for a Better Tomorrow Steve Miller, MD Chief Medical Officer](https://reader035.vdocuments.mx/reader035/viewer/2022062800/56649de45503460f94adb7f6/html5/thumbnails/39.jpg)
39 2007 Express Scripts, Inc. All Rights Reserved.
Compliance Is Critical To Clearing Hepatitis Virus
0%
20%
40%
60%
80%
Non-Compliant Compliant
% o
f Pat
ient
s wi
th S
usta
ined
Vira
l Res
pons
e
10%10%
75%75%
Hepatitis C Type 1
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40 2007 Express Scripts, Inc. All Rights Reserved.
Value of Specialty Pharmacy
• More convenient
• Higher satisfaction
• Better educated
• More compliant
• Greater savings
• Safer
![Page 41: Specialty Pharmacy: Today’s Prescription for a Better Tomorrow Steve Miller, MD Chief Medical Officer](https://reader035.vdocuments.mx/reader035/viewer/2022062800/56649de45503460f94adb7f6/html5/thumbnails/41.jpg)
41 2007 Express Scripts, Inc. All Rights Reserved.
Optimal Recommendations
Comprehensive Communications
for all programs
Clinical ProgramsClinical Programs•Prior AuthorizationPrior Authorization•Drug Quantity ManagementDrug Quantity Management
Co-PaymentsCo-Payments• $25 more for non-formulary$25 more for non-formulary• $30 more for Retail$30 more for Retail
CuraScript Exclusive•CuraScript for all fills•Courtesy fills for “stats” only
CuraScript Exclusive•CuraScript for all fills•Courtesy fills for “stats” only
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42 2007 Express Scripts, Inc. All Rights Reserved.
Specialty Growth Continues to Outpace Traditional Drug Market
Source: Express Scripts analysis of IMS data.
![Page 43: Specialty Pharmacy: Today’s Prescription for a Better Tomorrow Steve Miller, MD Chief Medical Officer](https://reader035.vdocuments.mx/reader035/viewer/2022062800/56649de45503460f94adb7f6/html5/thumbnails/43.jpg)
43 2007 Express Scripts, Inc. All Rights Reserved.
Access to Lifesaving Medications Act
•Introduced in 2007
•Bicameral, bipartisan
•Express Scripts supporting with research and analysis
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44 2007 Express Scripts, Inc. All Rights Reserved.
ESI Estimate of Biogeneric Savings
Opportunity•Studied four classes of medications
•Very conservative assumptions
Disease Category Drug Group
Patent Expiration
Multiple Sclerosis
Interferons 2003/2007
Anemia Erythropoietin 2004
Growth Failure Growth Hormone
2003
Diabetes Insulin 2004
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45 2007 Express Scripts, Inc. All Rights Reserved.
$3.5 Billion SavingsIn 1st Year Alone
$2,004
$797
$678
$28
$0 $500 $1,000 $1,500 $2,000 $2,500
Erythropoietins
Insulin
MultipleSclerosis
GrowthHormone
$ Millions
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46 2007 Express Scripts, Inc. All Rights Reserved.
In the first ten years:
$71 Billion Savings
$3.5 $4.0$4.6
$5.3$6.1
$7.0$8.1
$9.3$10.7
$12.3
$0
$2
$4
$6
$8
$10
$12
$14
Year1
Year2
Year3
Year4
Year5
Year6
Year7
Year8
Year9
Year10
$Bill
ions
Inflation and prevalence driving trend in this model
![Page 47: Specialty Pharmacy: Today’s Prescription for a Better Tomorrow Steve Miller, MD Chief Medical Officer](https://reader035.vdocuments.mx/reader035/viewer/2022062800/56649de45503460f94adb7f6/html5/thumbnails/47.jpg)
47 2007 Express Scripts, Inc. All Rights Reserved.
An
nu
al S
ale
s $
Bill
ion
Biologic Drugs Losing Patent Protection
0
10
20
30
40
$11 $11.2 $11.4 $11.7 $12.1
$15.6
$20.1
$29.8
$33.5$35.4
$37.5
Residual New
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
![Page 48: Specialty Pharmacy: Today’s Prescription for a Better Tomorrow Steve Miller, MD Chief Medical Officer](https://reader035.vdocuments.mx/reader035/viewer/2022062800/56649de45503460f94adb7f6/html5/thumbnails/48.jpg)
48 2007 Express Scripts, Inc. All Rights Reserved.
Contact Your Elected Officials
![Page 49: Specialty Pharmacy: Today’s Prescription for a Better Tomorrow Steve Miller, MD Chief Medical Officer](https://reader035.vdocuments.mx/reader035/viewer/2022062800/56649de45503460f94adb7f6/html5/thumbnails/49.jpg)
49 2007 Express Scripts, Inc. All Rights Reserved.
Contact Your Elected Officials
www.therightprescription.org
![Page 50: Specialty Pharmacy: Today’s Prescription for a Better Tomorrow Steve Miller, MD Chief Medical Officer](https://reader035.vdocuments.mx/reader035/viewer/2022062800/56649de45503460f94adb7f6/html5/thumbnails/50.jpg)
50 2007 Express Scripts, Inc. All Rights Reserved.
Contact Your Elected Officials
![Page 51: Specialty Pharmacy: Today’s Prescription for a Better Tomorrow Steve Miller, MD Chief Medical Officer](https://reader035.vdocuments.mx/reader035/viewer/2022062800/56649de45503460f94adb7f6/html5/thumbnails/51.jpg)
51 2007 Express Scripts, Inc. All Rights Reserved.
Contact Your Elected Officials
![Page 52: Specialty Pharmacy: Today’s Prescription for a Better Tomorrow Steve Miller, MD Chief Medical Officer](https://reader035.vdocuments.mx/reader035/viewer/2022062800/56649de45503460f94adb7f6/html5/thumbnails/52.jpg)
52 2007 Express Scripts, Inc. All Rights Reserved.
It’s Easy.
Just visit the ESI Outcomes Website: http://www.express-scripts.com/
ourcompany/news/
outcomesconference
Follow the link to: http://www.therightprescription.org
![Page 53: Specialty Pharmacy: Today’s Prescription for a Better Tomorrow Steve Miller, MD Chief Medical Officer](https://reader035.vdocuments.mx/reader035/viewer/2022062800/56649de45503460f94adb7f6/html5/thumbnails/53.jpg)
53 2007 Express Scripts, Inc. All Rights Reserved.
Conclusions
• Specialty spend is increasing
• It is just not about covering the medication but assuring appropriate use
– Right drug, dose, route and care
• There is much you can do now
– Put in plan designs that support goals
– Support biogeneric legislation