Biotechnology Healthcare - July/August 2008 - (Page 52)

EMPLOYER TO EMPLOYER Under the Hood: GM’s Strategy For Making Biologics Accessible John Carroll, Senior Contributing Editor C ynthia Kirman is first and foremost a pharmasticker price of two or three new Cadillacs. cist. That’s a point she’s careful to make at the “We recognize that with biologics, there are now treatbeginning of a conversation; something you ments where there were none before,” says Kirman, using need to know to understand her real-world apmultiple sclerosis as an example. “Not long ago, patients proach to her job as pharmacy director at General Motors, had very limited options. Now, new options are keeping the largest private purchaser of healthcare services in the them out of the hospital, and we see these biologics as United States. [playing an] important” role in that. “But we have to make GM covers 1 million lives, from rank-and-file workers sure they’re getting the right diagnosis and the right dose, in plants to salaried staff — both working and retired — and that they are taking it at the right time during the and their families. The auto manufacturer spent course of their illness.” $1.3 billion on pharmacy benefits last year. In the To Kirman, the potential safety issues associface of that seemingly sky-high number, Kirman ated with off-label use cannot be ignored. “For strives to keep grounded through her training as every biologic on the market, we want to make a pharmacist — the person whose knowledge sure it’s used according to FDA-approved labelplays a critical role in making sure that the “right ing,” she says. When the U.S. Food and Drug Adperson takes the right drug at the right time,” as ministration first gave marketing approval to she puts it. erythropoiesis-stimulating agents, such as dar“That,” says Kirman — the pharmacy direcbepoetin alfa (Aranesp) and epoetin alfa tor — “is where we get the best value.” (Epogen), GM had processes in place to ensure “The level of That’s her perspective as she pours over uti- clinical conversa- that people were not being overtreated. In retrolization data for those persons whom GM cov- tion has grown,” spect, that decision appears almost prescient, ers. If you were to bring them all together, they says Medco’s given the safety issues reported in the last year would compose the 10th largest city in America, Robert Epstein, about patients who received higher-than-apjust behind Dallas. And if you were to look MD, who works proved doses. closely at their drug utilization data — which in- with GM. “Now, “We work to understand current drug treatclude a trend toward greater use of biologics — people are lookment and to understand the pipeline, and we try you would see patterns that may suggest a need ing at approprito gain in-depth clinical knowledge of medicafor initiatives that could improve safety and con- ateness, not just tions,” she says. “We look to our carriers like trol costs. PBMs (GM works primarily with Medco) to give unit price.” “The interesting thing about drug data is [you us guidance and clinical literature.” see] how people and doctors use these medications as opposed to how they’re approved,” says Kirman. That kind A DIFFERENT CONVERSATION of analysis can produce red flags for serious quality issues. That’s an ongoing discussion, says Robert Epstein, MD, Take, for instance, a drug that is approved for once-daily Medco’s chief medical officer, as he and Kirman sit down for one of their regular get-togethers to discuss drug strateuse but repeatedly appears in the data as being used twice gies. a day. “I’ve been at Medco for 13 years,” says Epstein, “and in “We saw that as a real quality-of-care opportunity, with recent years, because of the complexity of the drugs comsome cost savings” potential as well, says Kirman. ing into the market, the level of clinical conversation has From an employer perspective, eliminating misuse and grown. Now people are looking at appropriateness, not just waste improves safety and reduces costs. At GM, that has unit price. helped to keep a lid on drug expenses two years running. “I think we’ll see more and more clients very focused on That was important before biologics began to factor promithe biologic side of the drug spend,” he adds — and not just nently into the pharmacy budget. It’s even more important because of their cost, but because they want to know more now that the auto giant covers the lion’s share of the cost about efficacy, safety, and the potential for healthcare cost of some biologics that, on an annual basis, can equal the 52 BIOTECHNOLOGY HEALTHCARE · JULY/AUGUST 2008

Table of Contents Feed for the Digital Edition of Biotechnology Healthcare - July/August 2008

Biotechnology Healthcare - July/August 2008 Openers Contents Editorial/David B. Nash, MD, MBA Drug Track Health Plan Confidential Rheumatoid Arthritis A Decade of Trial, Error, False Starts, and Hope What Path Will Comparative Effectiveness Research Take? RA Therapies in Development: A New Generation of Relief Assessing the Full Impact of RA on Employers and Payers Stem Cells: Health Insurance You Can Bank On Specialty Pharmacy Employer to Employer Personalized Medicine Trends Clinical Briefs

Biotechnology Healthcare - July/August 2008

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