5,1 million inhabitants 4 health regions 21 Health enterprises 80 Hospitals

Transkript

1 Norway is an elongated and scarcely populated country 5,1 million inhabitants 4 health regions 21 Health enterprises 80 Hospitals

2 Drug procurement cooperation - LIS Drug procurement cooperation organization Drug procurement cooperation results Drug procurement cooperation Key success factors

3 Drug procurement cooperation Established January employees administrates contracts for 2015

4 The purpose of the Drug procurement LIS-regulations - 1 cooperation (LIS) is to prepare the basis and specifications for purchase and delivery agreements of pharmaceuticals in cooperation with the state owned hospitals, and thereby reduce the costs.

5 Participants in LIS and the annual fee All health regions and all public hospitals in addition to Lovisenberg and Diakonhjemmet. Each participant pays an annual fee for operation of the LIS. The annual fee is distributed among the participants in relation to participants' share of the total procurement of medicines.

6 RHF S-Ø RHF V RHF M RHF N LIS-Board S-Ø, V, M, N LIS Working Committee Specialists croups; Cancer, X-ray, MS, TNF LIS-Contact

7 Working Committee Specialists with medical, pharmaceutical and purchasing-technical background Gustav Lehne chairman, dr.med. specialist in pharmacology and oncology, Oslo University Hospital, Actively contribute with relevant questions and answers about drugs and drug use in the hospitals If necessary specialist groups can be established

8 LIS Contact persons 1 person from each Health enterprises who: Contributes to the cost-effectivenes use of drugs in the hospital Insures that the hospital drug purchases are in accordance with laws and regulations Implement the chosen substances in the hospital and in the pharmacy Insure loyalty to contract suppliers Insure regular contact with the drug committee and other groups in the hospital concerning pharmaceutical use

9 Contracts General agreement per Health enterprises: the agreements are binding for both the supplier and the buyer In case of medical reasons other pharmaceuticals than agreed on in the contract can be utilized The general agreements are not of hindrance for clinical testing of pharmaceuticals or research

10 Drug supply chain Industry/suppliers Parallel importers Alliance NMD Apo Private pharmacies Hospital pharmacies Hospital A Hospital B

11 Offer Paclitaxel Max AIP Tilbudt AIP Volum Sum Max AIP Sum tilbudt AIP % rabatt % dyrere Accord 5ml 997,38 39, ,8 16,7ml 3 331,27 101, ,0 25ml 4 986,92 198, ,0 50ml 9 973,85 214, , ,2 51,9 Actavis 5ml 997,38 30, ,9 16,7ml 3 331,27 70, ,9 25ml 4 986,92 106, ,8 50ml 9 973,85 158, , ,07 3,4 Farmaplus 5ml 997,38 49, ,0 16,7ml 3 331,27 118, ,4 25ml 4 986,92 247, ,0 50ml 9 973,85 338, , ,3 98,4 Fresenius 5ml 997,38 42, ,7 16,7ml 3 331,27 97, ,1 25ml 4 986,92 146, ,1 50ml 9 973,85 218, , ,5 31,7 Hospira 5ml 997,38 30, ,8 16,7ml 3 331,27 71, ,9 25ml 4 986,92 97, ,1 50ml 9 973,85 149, , ,14 Teva 5ml 997,38 52, ,4 16,7ml 3 331,27 125, ,2 25ml 4 986,92 167, ,6 50ml 9 973,85 313, , ,4 94,9

12 Price trends as a result of the annual competition and patent expiration, Paclitaxel 50 ML Max AIP Generic compitition from LIS-AIP

13 Price trends as a result of the annual competition and patent expiration, Ondansetron 700,00 600,00 592,24 500,00 400,00 300,00 200,00 100,00 0,00 292,25 397,56 16,72 11,39 Maksimal AIP LIS AIP Patente expiration 2005, generic competition 2007

14 Price trends as a result of the annual competition and patent expiration, Docetaxel Maksimal AIP LIS AIP Expected generic competition 2010

15 The National System for the Introduction of New Health Technologies (methods) within the Specialist Health Service in Norway.

16 Status Technology Assessment autumn 2015 Under utredning Terapiområde Forventet ferdigs5lt ID2014_023 (Plegridy) MS aug ID2014_039 (Lynparza) OvarialkreJ aug ID2013_030 (Imbruvica KLL) KLL? ID2014_004 (Gazyvaro) KLL aug/sept 2015 ID2014_001 (Imbruvica MCL) Mantelcellelymfom jan 2016 ID2014_021 (Zydelig, KLL) KLL aug/sept 2015 ID2014_022 (Zydelig, lymfom) Lymfom aug/sept 2015 ID2014_037 (Entyvio) Ulcerøs koliz/chrons sykdom aug/sept 2015 ID2015_004 (Cosentyx) Psoriasis sept/okt 2015 ID2015_002 (Otezla) Psoriasis/psoriasisartriZ nov ID2014_036 (Opdivio malignt melanom) Malignt melanom nov ID2014_034 (Keytruda malignt melanom) Malign Melanom nov «Rullerende innlevering» ID2015_006 (Opdivo lungekrej) LungekreJ? «Rullerende innlevering» ID2015_009 (Humira) SveZekjertelbetennelse? "Rullerende innlevering"

17 Status metodevurderinger leveringer høsten 2015 Bes5lt, ikke startet enda ID2013_005_006 (Serelaxin)* ID2013_024 (Removab) ID2014_011 (Vintafolide)* ID2014_001 (Imbruvica MCL) ID2015_012 (Cyramza) ID2015_018 (Imlygic) ID2015_013 (Blincyto) ID2014_038 (Cotellic) ID2015_010 (Imbruvica Mb Waldenstøm) ID2014_041 (Keytruda lungekrej) ID2014_042 (Niraparib) ID2015_003 (Vargatef ) ID2015_005 (Kyprolis) Hjertesvikt Ascites ved kreg OvarialkreG Mantelcellelymfom VentrikkelkreJ Malignt Melanom Leukemi Malignt Melanom Mb Waldenstrøm LungekreJ BrystkreJ LungekreJ Myelomatose Forventet start Uavklart MT? Uavklart MT jul.15 aug.15 nov.15 des.15 des.15 Q ; Q sept.15 Avventer dokumentasjon Avklare omfang dok. mars.16

18 MS Drug cost All prices include pharmacy margin and 25 % VAT Annual cost 2008 Annual cost 2014 % discount Interferon beta-1b (Extavia ) Interferon beta-1b (Betaferon ) Glatirameracetat (Copaxone ) Interferon beta-1a (Avonex ) Interferon beta-1a (Avonex ) Interferon beta-1a (Rebif ) 44 mcg Rebi Smart Kr (2010 offer) Kr Kr ,2 % Kr Kr ,3 % Kr Kr ,1 % Kr Kr ,6 % Kr Kr ,1 % Kr % Natalizumab (Tysabri ) Kr (Max AUP 2009) Fingolimod (Gilenya ) Kr (Max AUP 2011) Kr ,7 % Kr ,6 %

19 LIS TNF Specialist Group

20 Sales anti-tnf in Norway Sales mill. euro Sales mill. euro Sales mill. euro Sales mill. euro

21 Norway spend the most on anti-tnf? Annually 50 euros per capita in 2014

22 LIS TNF/BIO tender (Jan 2011 Des 2014) DDD vs. Costs (3-month avg) (index, Feb'11=100; source: IMS) FEB11 MAR11 APR11 MAY11 JUN11 JUL11 AUG11 SEP11 OCT11 NOV11 DEC11 JAN12 FEB12 MAR12 APR12 MAY12 JUN12 JUL12 AUG12 SEP12 OCT12 NOV12 DEC12 JAN13 FEB13 MAR13 APR13 MAY13 JUN13 JUL13 AUG13 SEP13 OCT13 NOV13 DEC13 JAN14 FEB14 MAR14 APR14 MAY14 JUN14 JUL14 AUG14 SEP14 OCT14 NOV14 DEC14 DDD Costs Cost per DDD KILDE: IMS

23 Enbrel turnover vials special offer inj. subst 25 mg ,2 mill. euro discount for 25 mg inj. subst ,5 mill. euro discount for 25 mg inj. subst ,1 mill. euro discount for 25 mg inj. subst INJ. SUBST 25MG 4 PRE-FILL SYR 50MG 4 PRE-FILL SYR 25MG 4 INJ PENN 50MG 4

24 PHARMACEUTICAL PURCHASED WITH LIS AGREEMENTS 2014 Maximum set price mill. euro Price reduc;one mill. euro Pricered. Purchase with LIS agreements ,0 % The amounts in million euro including 25% VAT

25 20 years history and experience with tenders Key success factors Wholesaler agreements Contracts giving delivery safety, financial burden on delivery failure Benefits for pharmacies standardization Specialist Groups with leading medical doctors and patient organization and physicians associations represented in the specialist groups Torfinn Aanes"

26 Key success factors Seminars with an academic approach, information regarding consumption and recommendations for use Pharmaceutical industry attending the seminars product presentations with competitors present ensures transparency, industry gets to know prices and participates in the discussions Media attending the seminars Professionals and hospitals share experiences Torfinn Aanes"

27 Key success factors The directors for the 4 RHF s has decided that the specialist TNF and MS group recommendations are an instruction for The Health Trusts This instruction means that the cheapest alternative shall be used in all equal treatments. Deviations from the instruction shall be documented in the patients journal.

28 Key success factors Started information about biosimilars in 2008 for the hospitals Recommendations presenting price overviews showing annual cost Ensured that economics is part of an assessment for new and replacement patients Torfinn Aanes"

29 Key success factors Recommendations from the specialist groups provide clinical acceptance Recommendations communicated to all hospitals, seminar participants and on associations websites Spreadsheets for calculating 1. and 3 years' costs Torfinn Aanes"

30 In September, I m on my first real bike ride in 26 years. Patient revmatologisk dep. Haukeland Hospital LIS agreements allowing us to treat more patients Utne Sørensen, revmatologisk dep. Haukeland Hospital

31 LIS TNF SEMINAR JANUAR 2015

32 Orion winner Hospira loser

33 Savings 100 % Remsima Martina Hansens Hospital AS Sykehuset i Vestfold HF Sykehuset Telemark HF Lovisenberg Diakonale Sykehus AS Sykehuset Østfold HF Revmatismesykehuset AS Sykehuset Innlandet HF Sørlandet Sykehus HF Akershus Universitetssykehus HF Oslo Universitetssykehus HF Betanien Hospital Skien Diakonhjemmet sykehus AS Vestre Viken HF 1% 8% 9% 9% 10% 12% 14% 18% 19% 20% 22% 25% 64% Kroner

34 Remsima share of infliximab in volume 100% Helse Nord RHF Helse Vest RHF Helse Midt-Norge RHF Helse Sør-Øst RHF Norge 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

35 Mørke farger: 2014 Lyse farger: juni % 90% 80% Helse Nord RHF 89% 80% Remsima share of infliximab per health trust 83% 100% Helse Vest 93% RHF 87% Helse Midt-Norge RHF 78% Helse Sør-Øst RHF 75% 87% 88% 70% 60% 61% 68% 67% 61% 60% 67% 64% 67% 57% 70% 58% 57% 69% 50% 40% 30% 20% 10% 0% 51% 42% 36% 32% 30% 30% 28% 26% 24% 22% 20% 19% 17% 18% 16% 14% 15% 14% 12% 10% 8% 8% 9% 10% 8% 9% 6% 22% 20% 4% 1% Finnmarkssykehuset HF 7 Helse Bergen HF 13 Helse Møre og Romsdal HF 19 Sykehuset Innlandet HF 25 Mar;na Hansens Hospital AS 2 Universitetssykehuset Nord- Norge 8 Helse Førde HF 14 Vestre Viken HF 20 Sykehuset ØsVold HF 26 Ikke fordelbare kostnader 3 Nordlandssykehuset HF 9 Haraldsplass Diakonale Sykehus 15 Lovisenberg Diakonale Sykehus AS 21 Sørlandet Sykehus HF 27 Oslo Universitetssykehus HF 4 Helgelandssykehuset HF 10 Haugesund Sanitetsforenings Revma;smesykehus AS 16 Betanien Hospital Skien 22 Sykehuset i VesVold HF 5 Helse Stavanger HF 11 St. Olavs Hospital HF 17 Diakonhjemmet sykehus AS 23 Sykehuset Telemark HF 6 Helse Fonna HF 12 Helse Nord- Trøndelag 18 Akershus Universitetssykehus HF 24 Revma;smesykehuset AS

36 Biosimilar Inflix market Unit developments 72 % 90 % Remsima price EUR % Remsima price EUR % Remsima price EUR Remsima price EUR 176.-

37 TNF området DDD utvikling P- 12 Change % YTD YTD- 1 Change % MAT MAT- 1 Change % Row Labels P CIMZIA 68311,19 10,6 % ,7 42,3 % ,1 72,2 % ENBREL ,5-7,4 % ,7-6,5 % ,2 % HUMIRA ,6-10,2 % ,1-6,2 % ,9 % INFLECTRA - 100,0 % - 100,0 % ORENCIA 4628,47 44,5 % 30622,58 37,4 % 48016,64 29,9 % REMICADE 88373,31-45,8 % ,4-34,3 % ,5 % REMSIMA ,6 395,4 % ,8 % ,4 % SIMPONI 50902,8 8,2 % ,8 0,8 % ,7 1,1 % STELARA 22082,48 33,2 % ,8 % ,3 57,4 % Grand Total ,4 % ,4 % ,4 % DLI DDD Month Month % change YTD YTD % change MAT MAT % change Stelara ,89% ,10% ,03% Simponi ,65% ,73% ,55% Remsima / / /0 Remicade ,28% ,36% ,04% Orencia ,97% ,96% ,62% Cimzia ,28% ,04% ,21% Enbrel ,82% ,96% ,81% Humira ,22% ,32% ,36% Totalt ,76% ,69% ,27% Growth % Growth % Growth % vs. MTH DDD vs. YTD DDD vs. MAT Brandname incl. DDD PI 7/2015 7/2014 YTD 7/2015 7/2014 MAT 7/2015 7/2014 HUMIRA (FI) , , ,64 REMICADE (FI) , , ,97 ENBREL (FI) , , ,71 INFLECTRA HOSPIRA 51 (FI) , , ,80 SIMPONI (FI) , , ,27 CIMZIA (FI) , , ,70 REMSIMA (FI) , , ,92 Total , , ,17 MTH MTH vs. MTH (%) YTD vs. YTD (%) MAT vs. MAT (%) Produkt DDD YTD MAT Enbrel , , ,44 Remicade , , ,09 Remsima Inflectra Humira , , ,81 Cimzia , , ,48 Simponi , , ,33 Total , , ,81

38 Forside regnearket

39 INDIKASJON Ulcerøs colitt Anbefalte hjemmebehandlinger Kostnad 1. år normaldose 2015 Simponi (Ferdigfylt sprøyte.) kr PASIENTENES VEKT (i kg) 70 Simponi (Ferdigfylt penn.) kr Humira (ferdigfylt sprøyte/penn) kr TAS INFUSJONSKOSTNADENE MED? Nei DOSEINTERVALL (i antall uker) - Infliximab 8 DOSEINTERVALL (i antall mnd.) - Mabthera 6 Anbefalte sykehusbehandlinger Kostnad 1. år normaldose 2015 Remsima kr Inflectra kr Remicade kr

40 Denmark vs Norway Hospital price DK 2014 LIS hospital price 2014 Diff i % Humira kr ,50 kr ,09-40 % Remicade kr ,48 kr ,96-30 % Mabthera kr ,51 kr ,12-25 % Lucentis kr ,00 kr ,10-25 % Gilenya kr ,00 kr ,78-8 %

41 Denmark versus Sweden Hospital price Average offer Diff i % DK 2014 price Sweden 2014 Humira kr ,50 kr ,43-1 % Remicade kr ,48 kr ,07-3 % Mabthera kr ,51 kr ,54-2 % Lucentis kr ,00 kr ,25-2 % Gilenya kr ,00 kr ,23 14 %

42 LIS price reductions annually and accumulated 1,6 Billion per year 1,4 1,2 1 0,8 0,6 0, Billion accumulated 0, Per år Akkumulert

43