Investor Conference. Health Net Pharmaceutical Services

Transcription

1 Investor Conference Health Net Pharmaceutical Services John Sivori President, Health Net Pharmaceutical Services December 13, 2006

2 Health Net Pharmaceutical Services: What We Do HNPS (HNT s PBM) manages all pharmacy benefits for Health Net health plans HNPS negotiates with manufacturers, builds retail networks and collaborates with health plans on benefit designs HNPS outsources commodity functions to achieve low cost administrative structure Claims processing Mail order 2

3 Health Net Pharmaceutical Services Provides Enterprise Value HNPS provides efficient, low-cost and highly effective pharmacy benefit management exclusively to Health Net plans with integrated health care management Low cost administrative structure - by outsourcing commoditized utility functions (e.g., claims processing, mail order fulfillment) Operational consistency - by leveraging standardized operational processes (financial analysis, actuarial, clinical operations, etc.) Functional integration - leveraging skills to develop and execute operational strategies Competitive benefit cost advantage - leading the industry with effective cost trend management 3

4 Health Net Pharmaceutical Services Provides Enterprise Value (continued) HNPS provides a range of pharmacy products at appropriate price points that meet customers local market needs: Flexibility in benefit design options leveraging experience in diverse markets Offering members choice with aligned incentives Effective cost trend management providing best value across benefit options Differentiated value is driven by consistent execution of these levers 4

5 Background Drug Spend Under Management Estimated $1.7 Billion Under Management for 2006 ($ in billions) Specialty Pharmacy (including medical injectables) $0.3 (18%) State Programs Pharmacy $0.1 (6%) Commercial Pharmacy $0.7 (41%) Federal Programs Pharmacy $0.6 (35%) $1.7 billion represents 42% increase over 2005 levels as a result of Part D expansion Source: 2006 projections based upon Health Net Pharmaceutical Services internal numbers. 5

6 Management Performance Cost Trends 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% 16% 7% 13% 6% 4% 10% e HNT Industry Average 9% 8% Sources: PBM averages based upon reported trends of PBM competitors; 2006 industry estimates based upon projections in multiple reports from PBM competitors, analysts and industry consultants. HNT: Based upon internal reports and projections, normalized for the impact of Medicare members treated as commercial in % 7% Cost Trends: HNPS has managed cost trends to the single digits and well below the PBM industry average range over the last 5 years Levers utilized include: Benefit designs with aligned incentives Aggressive strategic formulary design Prior authorization (generics and formulary compliance) Promotion and incentive programs (members, providers, employers) Network ownership The industry has migrated to tighter managed products and trends have decreased as a result Focusing on a lowest net cost strategy, including leveraging generic releases, Health Net is expected to achieve pharmacy trends at the low end of the industry range over the next 4 years 6

7 Management Performance Generic Penetration Generic Penetration Generic penetration has been on the rise as drug classes have matured and blockbuster drugs have lost patent protection Health Net has remained ahead of industry averages by utilizing all available levers Generic penetration is expected to increase into the future as more drugs lose patent protection, helping to reduce overall drug cost trends Health Net is expected to remain ahead of the industry averages by aggressively leveraging opportunities with the lowest net cost strategy 7

8 Management Performance: Leveraging the Generic Environment $120 $100 Ingredient Cost/Rx and Generic Penetration Increase in generic penetration helped mitigate average ingredient cost per Rx trend. 52% 53% 53% 54% 55% 57% 57% 59% 70% 60% $80 50% 40% $60 30% $40 20% $20 10% $0 0% Q4 Q Brand Ingr. Cost/Rx Ingredient Cost/Rx Q Q3 Q Generic Ingr. Cost/Rx Percent Generic Rx's Q Q Q Source: Health Net Pharmaceutical Services internal numbers for commercial fully-insured membership 8

9 Continued Lower Rx Trends Expected More generics leveraging generic blockbusters Continued roll-out of tested management techniques across markets (Northeast) Provider programs further development Current events: Wal-Mart generic awareness Network opportunities (CVS/Caremark, AWP) Execution on the basics 9

10 Specialty Pharmacy Management HNPS utilizes all available levers to manage specialty drugs Certain HNT plans have shifted risk for specialty pharmacy management to qualified provider groups 2006 specialty drug trends have been managed to the low teens utilizing this approach 10

11 Solid History of Execution Managing cost trends focused on lowest net cost for Health Net Leveraging generics Solid benefit designs which drive performance Solid and active benefit management tools and processes 11

12 Investor Conference Health Net Pharmaceutical Services