FEBRUARY 28 PHARMACOGENOMICS PRESENTATION - 2020 PHARMACY DEVELOPMENT SERVICES - RXGENOMIX
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
February 28
Pharmacogenomics
Presentation
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.
PDS & RxGenomix are happy to partner together today to
provide you with Non-PBM Revenue to benefit your patients!
Session goals:
Your speakers: • Learn how your pharmacy can become educated and find
revenue in PGx.
• Assist with mitigation of poor reimbursements through other
Brad Tice, PharmD, revenue.
MBA, FAPhA, • Determine WHY this is important to the future of pharmacy
President APhA services.
• Provide more opportunities for clinical services and Service-
Founder and CEO Based Pharmacy.
PDS Quadrant: GROWTH
Cari Lalande, PharmD PDS Trainings: CSPI, Professional Communications, Marketing
Director - Clinical PGx 360
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.
OUR MISSION:
To provide personalized
pharmacy care that gets
people on the path to
optimal health.
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.
82%
of Americans take at
50%
of medications
least one medication are ineffective or
minimally effective
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.
Polypharmacy – a
300% increase in 20
years…
From 14% to 42%
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.
“It is far more important to know
what person the disease has than
what disease the person has.”
– Hippocrates
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.
The Old Treatment Paradigm
Diagnose Disease, Treat Symptoms - Costly, Trial and Error Approach to Treatment
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.
Common Ineffectiveness
Common Medications Are Ineffective for Many
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.
The Benefits of PGx Testing
• Early Detection
• Rapid, Effective Treatment
• Improved Quality of Care
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.
PGx Essentials
For each PGx gene, an individual will fall into one of four categories:
Poor Intermediate Normal Ultra-rapid
metabolizer metabolizer metabolizer metabolizer
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.Impact of Metabolic Status
METABOLIC STATUS PRODRUGS ACTIVE DRUGS
Ultra-rapid May cause side effects
May lack efficacy
metabolizers or toxicity
Normal Presumed normal level Presumed normal level
metabolizers of drug activity of drug activity
Intermediate May cause side effects
May have reduced efficacy
metabolizers or toxicity
Poor May cause side effects
May lack efficacy
metabolizers or toxicity
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.“If it were not for the great
variability among individuals,
medicine might as well be a
science and not an art.”
– William Osler
often described as the Father of Modern Medicine
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.The Benefits of PGx Testing
• Maximize the intended use of the medication
• Speed time to therapeutic benefit
• Reduce medication cost
• Decrease chance of side effects and/or dependency
• Reduce adverse drug reactions (ADRs)
• Reduce additional healthcare costs by up to 15:1
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.Consumer Demand
65% interested if their employer
65% offered affordable, private testing
52% willing to pay up to $250 out of
52% their own pocket for genetic testing
Wamberg Genomic Consumer Survey, which queried 536 U.S. consumers from 26 to 64 years old with employer-sponsored health
insurance. Survey Sampling International (SSI) fielded the survey in October/November 2017.
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.Five Key Considerations
• Show me there are trained providers
• Show me the potential population for which
PGx testing is appropriate
• Show me that my population (the managed cohort)
is getting healthier (clinical improvement)
• Show me that we are getting a positive
return on our investment (ROI)
• Show me an ability to integrate and scale long-term
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.Increased Market Uptake
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.Increased Market Uptake
February 25, 2020
FDA Table of Pharmacogenetic Associations Released
“…believes there is sufficient scientific evidence to suggest that subgroups of patients
with certain genetic variants…are likely to have altered drug metabolism, and in
certain cases, differential therapeutic effects, including differences in risks of adverse
events.”
https://www.fda.gov/medical-devices/precision-medicine/table-pharmacogenetic-associations
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.Advanced Analytics
17,000 lives – 65% had a potential PGx-related opportunity
Overall patients for whom PGx is likely appropriate Most common PGx drugs
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.PGx and Behavioral Health
Have a genetic mutation that would affect the
50% efficacy of at least one class of antidepressants1
% of U.S. adults have a prescription
17% for a behavioral health medication2
12.7% Persons 12+ who took an antidepressant in the past month3
1
CYP2C9, CYP2C19, CYP2D6
2
HHS, Agency for Healthcare Research and Quality 2013
3
CDC, National Center for Health Statistics © 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.PGx and Behavioral Health
Major Depressive Disorder in a 10,000 Life Group
• 700 (7%) could be expected to have MDD1
• 53% expected to respond to first-line antidepressant – 371
• 47% would need trial and error prescribing – 329
1. Neuropsychiatr Dis Treat. 2018; 14: 225–230.
2. Winner J.G., et al Journal of Translational Psychiatry 2013, 3:e242
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.PGx and Behavioral Health
47% 53% treatment resistance
2nd 3rd 4th 5th
8 - 12 weeks per failure
Total Cost of Treatment = $9,100,000 2
1. Neuropsychiatr Dis Treat. 2018; 14: 225–230.
2. Winner J.G., et al Journal of Translational Psychiatry 2013, 3:e242
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.PGx and Behavioral Health
Cost of PGx-guided treatment-resistant
therapy = $7,393,148 2
47% 53% PGx 2nd 3rd 4th 5th
$1,706,852
Savings realized with PGx testing2
1. Neuropsychiatr Dis Treat. 2018; 14: 225–230.
2. Winner J.G., et al Journal of Translational Psychiatry 2013, 3:e242
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.The RxGenomix Hub
Pharmacist
› RPh orders PGx test through RxGenomix portal
› After first test is done, RPh pings database for
genetic risk of new medications
Risk-stratified list of patients
onboarded to RxGenomix Data
Warehouse
Lab Partner
Provider & Patient
› Processing of PGx sample
› Provider and patient collaborate to
determine optimized medication regimen › Delivery of SNPS/geneCNVS transmission
› Provider pings RxGenomix database for › CLIA/COLA/CAP accredited
genetic risk of new medications › QA/QC of PGx report
Pharmacist Lab Data Interpretation
› Pharmacist works within the Hub to › Interpretation of raw genomic data
create a personalized Action Plan
› PGx report generation
› Pharmacist consults with provider and
patient on needed therapy changes › Clinical decision support
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.Testimonials
“I now consider it unethical not to test every one of our members.”
Dr. George Brett, Medical Director – PACE Programs
“This information is incredibly beneficial and may help identify areas
that could be addressed with the simple change of a medication.”
Beth Bryant, Pharmacist – GrandView Pharmacy
“The test was directly responsible for providing what I believe was
life-saving information.”
Dr. Janet Campbell – University Hospital of Missouri
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.PAYMENT MODELS
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.PGx Payment Landscape
Medicare/Medicaid Third Party Direct Contract Direct Pay
By Region –
Increasing recognition Contract directly
generally seeing Cash-based model
and payment with employers
~ $600-$1,000/sample
• United Healthcare
• Paid to the lab • Fee for Service
• InterMountain
• Requires “Aggregators” (FFS)
Healthcare
ICD-10 codes • Concierge
• Benecard
Consulting with provider Can bill for consulting
payment available – must with the patient under Avoid direct
work through Stark and PDS’ Service-Based to Consumer!
Anti-kickback regulations Pharmacy Program
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.PGx Payment Landscape
Medicare/Medicaid Third Party Direct Contract Direct Pay
By Region –
Increasing recognition Contract directly
generally seeing Cash-based model
and payment with employers
~ $600-$1,000/sample
• United Healthcare
• Paid to the lab • Fee for Service
• InterMountain
• Requires “Aggregators” (FFS)
Healthcare
ICD-10 codes • Concierge
• Benecard
Consulting with provider Can bill for consulting
payment available – must with the patient under Avoid direct
work through Stark and PDS’ Service-Based to Consumer!
Anti-kickback regulations Pharmacy Program
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.PGx Payment Landscape
Medicare/Medicaid Third Party Direct Contract Direct Pay
By Region –
Increasing recognition Contract directly
generally seeing Cash-based model
and payment with employers
~ $600-$1,000/sample
• United Healthcare
• Paid to the lab • Fee for Service
• InterMountain
• Requires “Aggregators” (FFS)
Healthcare
ICD-10 codes • Concierge
• Benecard
Consulting with provider Can bill for consulting
payment available – must with the patient under Avoid direct
work through Stark and PDS’ Service-Based to Consumer!
Anti-kickback regulations Pharmacy Program
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.PGx Payment Landscape
Medicare/Medicaid Third Party Direct Contract Direct Pay
By Region –
Increasing recognition Contract directly
generally seeing Cash-based model
and payment with employers
~ $600-$1,000/sample
• United Healthcare
• Paid to the lab • Fee for Service
• InterMountain
• Requires “Aggregators” (FFS)
Healthcare
ICD-10 codes • Concierge
• Benecard
Consulting with provider Can bill for consulting
payment available – must with the patient under Avoid direct
work through Stark and PDS’ Service-Based to Consumer!
Anti-kickback regulations Pharmacy Program
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.Models for Payment
Model Initial Fee Ongoing Fees
Fee for Service Recommended: Recommended:
$399: $309 for test/$90 for $2-$3/minute of consult
pharmacist consult ~ $45/consult
Concierge 1 $309 at point of sale $9.99 per month
Concierge 2 $99 at point of sale $24.99 per month
*reduces price sensitivity
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.FOCUS ON
SELLING YOUR VALUE
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.Focus On Selling Your Value
Question:
Do you believe you provide value to your patients
(or could provide)?
Do you believe you save them money on their healthcare?
Do you believe you make their life better?
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.Focus On Selling Your Value
Question:
Do you ENJOY selling your services to your patients?
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.Conceptual Sales Territory
NOT
LOOKING
LOOKING
*Solution Selling, Michael Bosworth © 1995 © 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.Your Obligation
Your job, your OBLIGATION,
as a health care provider is to
move the patient from here… …to here.
Level 3:
Level 1: Level 2: Vision of a
solution tied
Latent Pain Pain to your
capabilities
*Solution Selling, Michael Bosworth © 1995 © 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.Vision Creation Prompter
Diagnose Reasons Explore Impact Visualize Capabilities
Tell me about it, what is Besides yourself, who else What is it going to take for
causing you to have this… is impacted by this (repeat you to solve this (repeat
Open (repeat pain)? pain), and how are they pain)?
impacted? Could I try a few ideas on
you?
Is it because? Is this (pain) also What if there were a way
causing…? If so, wouldn’t for you to …, would that
Control (title) be concerned? help? What if you were
also able to…?
So, the reasons for your From what I just heard From what I just heard, if
(repeat pain) are…? (repeat the who and how), you had the ability to..
Confirm this isn’t just your (repeat capabilities), could
problem, but a _____ You solve (repeat pain)?
problem?
*Solution Selling, Michael Bosworth © 1995 © 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.Vision Creation Prompter
I am confident we can offer you a solution
that will provide you with those capabilities.
Would you be willing to take a look?
*Solution Selling, Michael Bosworth © 1995 © 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.Vision Creation Prompter
Pain Identified
Patient takes multiple medications and is not
sure if they are really working well together.
*Solution Selling, Michael Bosworth © 1995 © 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.Vision Creation Prompter
Diagnose Reasons Explore Impact Visualize Capabilities
What is it going to take for you to
Tell me about it, what is causing you Besides yourself, who else is
solve this problem of taking so many
to have this problem of taking too impacted by this problem of taking
Open many medications and worrying if so many medications, and how are
medications and not knowing if they
are working?
they are all working? they impacted?
Could I try a few ideas on you?
1. Is it because you see several What if there were a way for you to
Is this issue with taking so many
different doctors and they all know if your medications are working
medications also causing difficulty in
prescribe different medications? specifically well for you? Would that
Control affording to take all of the
2. And is it because the condition help? What if you were also able to
medications and pay other bills? If so,
you are treating only seems to identify if it is possible to get off of
wouldn’t your children be concerned
get worse, so the doctors just some of your medications while
about you?
add more medications? making your condition better?
From what I just heard, if you had the
So, the reasons for your concern are
From what I just heard you having ability to know your medications
that you are taking so many
to take so many medications is not were working well specifically for you
Confirm medications and are not sure if they
just your problem, but a problem for and potentially get off of some of the
are working well together and you
your family as well and is causing a medications, could YOU solve the
have several doctors prescribing
lot of stress? problem of worrying about your
medications for you?
medications?
*Solution Selling, Michael Bosworth © 1995 © 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.Vision Creation Prompter
I am confident we can offer you a solution
that will provide you with those capabilities.
Would you be willing to take a look?
*Solution Selling, Michael Bosworth © 1995 © 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.Additional Key Points
You are not ready to sell until you are ready to walk
Multiple attempts/offerings
Be aware of the phases of shifting buyer concerns
(buyers will express more anxiety as they approach the buying decision)
Successful salespeople are not more charismatic or
quick-witted. They are one thing - PREPARED
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.Closing Thoughts
You provide value
You cannot continue providing value if you are not
compensated for it
You deserve to be compensated for it
PGx provides you an opportunity to establish new
compensation models with your patients
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.RxGenomix Training Program
in Pharmacogenomics
PDS SUPER
CONFERENCE
SPECIAL
$249
Register at:
www.rxgenomix.com/pds
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.RxGenomix Concierge Experience
for PGx in Community Pharmacy
READY TO ADD
PGX TO YOUR RxGenomix can help you:
PHARMACY’S • Promote an innovative service
SERVICES? • Integrate PGx into your existing workflow
• Streamline the entire process
• Increase revenue for your pharmacy
• Add to your value as a healthcare provider
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.“I’m not sure I can fit this
in my existing workflow.”
“I’m not sure our patients
can afford the service.”
“If PGx will drive
WHAT WE’VE volume and client
loyalty, we’re all for it”
“PGx would help us get
HEARD… to know our patients at
a deeper level”
“Pharmacogenomics is
the tool that pharmacists
“Our customers come to us need. It’s a no-brainer”
because we have invested in
their well-being. PGx would “How can this
only add to that.” program generate
revenue for our
pharmacy?
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.Elevating pharmacists to take action
and deliver actionable insights to
THE VALUE OF A patients in need.
CONCIERGE PGx PGx Benefits
PROGRAM Empowering pharmacists to understand and
interact with their patients at a deeper level
PGx Costs
Costs The costs of not knowing who your patients are,
and how medications are truly working for
Benefits them, will prolong time to therapeutic benefit
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.Concierge Packages
Package Price
PGx Prime
Marketing Starter Kit, Program Training, Technology $499.00
(Test and Member Fees
Access, Pharmacogenomic Reporting Not Included)
PGx Plus
Marketing Starter Kit, Program Training, Technology $999.00
(Test and Member Fees
Access, Pharmacogenomic Reporting, CE Program, Not Included)
and P2P Consultation
PGx Premium
Fully Customized Marketing Toolkit, Program $1,499.00
Training, Technology Access, Pharmacogenomic (Test and Member Fees
Reporting, CE Program, Onsite Training Support, and Not Included)
RxGenomix Pharmacist Consultation
Member Fees Test $309.00
Monthly Tech Fee $9.99
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.Concierge Services Fee Summary
Service Price
PGx Test
Point of Sale, PGx Test w/ lab processing and full $309.00
report
Membership Technology Fee
Pharmacogenomic Technology Platform –
Clinical decision support tool access for member’s
pharmacogenomic testing results. Data can be $9.99/month
accessed to review medication action plan and
evaluate medication risks prior to prescribing new or
changed medications.
*Membership Pricing Model* Example:
To alleviate upfront price sensitivity, pharmacy can Program Registration:
opt for a monthly membership program at a lower $99.00
per month rate
Monthly Membership
Rate: $24.99
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.COME SEE US AT BOOTH 281
www.rxgenomix.com/pds
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.Brad Tice, CEO (presenter)
Cari Lalande, Director of Clinical Pharmacogenomics (presenter)
Nathan Lankford, SVP of Business Development
Eric Johns, SVP of Business Development
Monty Lankford, Senior Account Executive
www.rxgenomix.com/pds
© 2 0 2 0 Phar m ac y De ve lopm e nt S e r vic e s.You can also read
