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HPN PharmacyManagement
Bahar Davidoff, Vice President Pharmacy Management
Heritage Provider Network
Date, 06/18/2016
Agenda
• Heritage Provider Network Overview
• Specialty Pharmacy Driving Costs
• Heritage Approach to Managing Pharmacy Costs
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HPN – “Our purpose is to better every life we touch through the way we care…”
• Caring for more than one
million members
• Largest Physician-Owned
Network: More than 4,000
primary care physicians, more
than 30,000 specialists
• Breakthrough therapies
• New molecular entities – Average 18 per year
Source: 2014 CVS Caremark Drug Trend Report, 2013 data
Specialty Drug Costs continue to Skyrocket
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FDA Expedited Programs
• Fast Track Designation
• Breakthrough Therapy Designation
• Accelerated Approval
• Priority Review Designation
New Molecular Entities
• Innovation
• Treatment for Rare diseases
• High cost of Research and Development
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• Site of Care Optimization:
• Hospital
• Physician offices
• Ambulatory Infusion Network
• Home Administration
• Improved Claims processing:
• Cost Analysis
• Strategic planning
Today’s pharmacy management requires multiple interventions in varied settings…
• What are Biosimilars
• Biosimilars are not Generics
• Potential cost savings
• BPCIA
Prior Authorization
Therapeutic Interchanges
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Standardizing Treatment Approach
• Clinical controls using evidence based guidelines
• Step therapy
• Appropriate medication
• Correct dosage
• Chronic disease management
Questions?
