Biotechnology Healthcare - July/August 2008 - (Page 53)

EMPLOYER TO EMPLOYER “We have to look at the science behind the medication and [its] value and try to understand where it fits in the scheme of things,” says Kirman. tradeoffs. “We’re seeing clients take a stronger stance on appropriate use and the appropriate time frame for use.” When a new biotech drug makes it to market, Kirman says it’s up to GM to make sure the therapy is available. “Enbrel is an important medication for us,” she says, seizing on an example. “We have employees who have rheumatoid arthritis. If the literature supports the use [of Enbrel], we want to get that person on Enbrel. If you can make sure that drug is going to the right person at the right dose, that’s really our focus. Whatever medical condition you have, you want to make sure it’s treated in the optimal way. It’s really about appropriate use.” That requires some careful review of the literature. “I do an awful lot of reading of primary journals,” says Kirman, drawing in data from a variety of sources to come up with a “widespread understanding of the current marketplace and what’s coming up.” But there are limits to anyone’s expertise. “We make cars and trucks,” she says. “Our PBM’s primary job is to be an expert on drugs, so we look to the PBM to provide expertise. We look to the PBM to come back to GM and say, ‘Here are your options. This is what we’ve learned from clinicians and the P&T committee.’” roadblocks, why pharmacists or physicians chose not to use a generic.” GM also made an effort to dispel misunderstandings among retirees, teaching them about generic equivalents and how the FDA approves them. “The staff put together a communications plan that was very, very comprehensive,” she recalls. There were messages about generic drugs printed on pay stubs. Retiree meetings included presentations on generics. Fliers reminded pharmacists about the push and GM signed on to Medco’s “Generics First” program. And, says Kirman, “It worked. “We saw the use of generics slowly go up,” she adds, and now every time a blockbuster medication goes generic, GM encourages physicians and enrollees to talk. The thought of generics brings to mind another conversation that GM — and Kirman — would particularly like to encourage: prospects for follow-on biologics. “We believe that would put more competition in the marketplace,” says Kirman. In Washington, GM has done a lot of lobbying for the creation of a biosimilar regulatory pathway. For now, GM continues to find ways to make biologics available to those who would benefit in ways that don’t bust the budget. “As a pharmacist, I see 40 to 50 drugs come out every single year. We used to think that $40 was expensive for a medication, so there’s always something coming out that is considered higher cost compared with [existing] therapies. It’s happened every single year. Now it happens that the higher-cost drug is a biologic. “But my job isn’t any different. It’s really the same concept. There will always be lower-cost and higher-cost medications. We have to look at the science behind the medication and the value [of the drug], and try to understand where it fits into the scheme of things.” THE GENERICS STRATEGY Traditionally, GM has had one of the richest benefits packages of any employer in the country, the legacy of an era when it dominated the U.S. auto market and was willing to make large promises to keep workers off picket lines. In recent years, management has fought for — and won — new policies that have shifted more expense to employees. But when held up against most private-sector workers, GM employees still receive comparatively rich coverage. GM has been able to keep its overall drug spend level over the past two years, thanks in part to its ability to drive utilization of generic drugs. Every 1 percentage-point inJohn Carroll is a freelance writer and is the editor of crease in the use of generics, where it offsets use of brandFierce Biotech. name medications, can save GM $20 million — thus explaining Kirman’s enthusiasm for a multipronged effort to encourage people to use, and physicians to prescribe, generics whenever appropriate. Those proEmployer to Employer grams have helped to achieve generic utilization as high as 98 percent in some classes. Perhaps A regular column for healthcare purchasers even more importantly, this push has helped to Case studies of how employers, coalitions, and other puroffset costs incurred with higher spending for bichasers approach the challenges of managing biologics. Send ologics. your story to Mike Dalzell, editor, at mdalzell@medimedia.com. “This was something we started 10 years ago,” says Kirman. “We started trying to understand the JULY/AUGUST 2008 · BIOTECHNOLOGY HEALTHCARE 53

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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