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Drug Review Process April 12, 2016
| Date post: | 18-Jan-2017 |
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Drug Review Process
April 12, 2016
2016 Drug User Group 2
Overview 1. Define private payer priorities for new drugs 2. Outline the TELUS Health Drug Review process 3. Highlight opportunities for collaboration
2016 Drug User Group 3
Enhanced Pharmacy Benefit Management
§ Canada’s largest provider of complete and integrated solutions for the transmission, adjudication and administration of drug benefit claims.
§ Flexible, efficient, and cost-effective drug benefit plans integrating three (3) key aspects:
2016 Drug User Group 4
13M Canadians use the TELUS Health Assure Card
9K pharmacies are enrolled in the TELUS Health Assure Claims Service
Scope of our solutions
Online interactions to link patients, providers and insurers:
2016 Drug User Group 5
Private Payer Priorities
Patient Access
§ Timely decisions on coverage
§ Accurate classification of drugs, e.g. hospital
Drug Cost Effectiveness
§ Formulary Committee Assessment
§ 3rd Party Reviewers
Appropriate Prescribing
§ Prior Authorization Criteria
2016 Drug User Group 6
Private Payer Drug Plan Designs
Traditional § Comprehensive
§ Includes: any DIN that requires a prescription, including fertility, smoking cessation, OTC, etc…
§ Excludes: Hospital drugs § Restrictive
§ Includes: any DIN that requires a prescription and only life-sustaining OTC , e.g. insulin
§ Excludes: Hospital drugs and any combination of fertility, smoking cessation
Targeted § Includes: Specific therapeutic classes, e.g. Generic
drugs only § Excludes: Hospital drugs
Managed (TELUS Health – National Formulary) § Health care professional committee that focuses on
most appropriate therapeutic choices and managing costs § Includes: Dependent on decision § Excludes: Dependent on decision
2016 Drug User Group 7
Formulary Committee
§ Comprised of TELUS Health pharmacists & industry experts with a wide range of experience
§ Leverages standardized processes to ensure a balanced, cost-effective approach
§ Utilizes standardized templates to ensure accuracy and consistency on decisions
2016 Drug User Group 8
Formulary Committee Assessment
Carrier Communication [TELUS Health]
Final Listing Decision [TELUS Health] Tier 1 Tier 2 Exclude
Formulary Committee Meeting [TELUS Health]
Drug Assessment & Prior Authorization Criteria [TELUS Health]
Product Submission Consensus Conferences
Published Evidence and Opinions
Pharmacoeconomic Modelling / Studies
Provincial Formulary / CADTH
Recommendations 3rd Party Expert
Reviewers
New Drug Submission [Manufacturer]
Drug Pipeline Tracker [TELUS Health] 1
2
3
4
5
6
2016 Drug User Group 9
Formulary Committee Assessment - Timing
Drug Assessment (6-9 months post NOC)
Formulary Committee Meeting (minimum 12 times/year)
Prior Authorization Criteria (3-4 weeks post NOC)
Notice of Compliance (NOC)
Carrier Communication [TELUS Health]
Final Listing Decision [TELUS Health] Tier 1 Tier 2 Exclude
Formulary Committee Meeting [TELUS Health]
Drug Assessment & Prior Authorization Criteria [TELUS Health]
New Drug Submission [Manufacturer]
Drug Pipeline Tracker [TELUS Health] 1
2
3
4
5
6
2016 Drug User Group 10
Drug Submission Requirements Executive Summary
Health Canada NOC
§ English & French Product Monograph
§ Intake documentation, as required by TELUS Health for database input Product Summary
§ PMPRB 7 Pricing Pricing
§ Summary of key features of the drug, as required by TELUS Health Fact Sheet
§ Key clinical and comparative studies § Place in therapy summary Clinical Summary
§ Perspective: Third Party Payer Budget Impact Analysis
§ Perspective: Third Party Payer Pharmacoeconomic Analysis
Additional Information
2016 Drug User Group 11
Opportunities for Collaboration
[Manufacturer] Submit clinical documentation pre-NOC • Provides context for Prior Authorization criteria
development • Shortens Drug Assessment timelines
[Manufacturer] & [Public Payer] • New developments in pricing agreements across
stakeholders
Carrier Communication [TELUS Health]
Final Listing Decision [TELUS Health] Tier 1 Tier 2 Exclude
Formulary Committee Meeting [TELUS Health]
Drug Assessment & Prior Authorization Criteria [TELUS Health]
New Drug Submission [Manufacturer]
Drug Pipeline Tracker [TELUS Health] 1
2
3
4
5
6
