Payers and PBMs have evolved their demands and expectations for pharmaceutical products during the last several years.   Clinical outcomes and evidence data that did not exist ten years ago, is now a primary factor for decision making by payers and PBMs.  Pharma understands the motivations and rational behind this.  At the same time, Payers and PBMs are committed to maintaining profit motivation for pharma by rewarding innovative products that deliver new value.  However, our industries continue to have differing perspectives on what constitutes value. 

During this session, our panel will attempt to answer the question posed in the session’s title by discussing the past, present, and future of payer expectations for pharmaceutical products. 

Learn the latest information regarding the proliferation of copay offset programs.  Mark Zitter will present brand new research that presents the most comprehensive look at the over 500 offset programs in the market today. The  Zitter Group’s Copay Offset Monitor data include a landscape analysis showing programs by drug category and manufacturer, details on benefit designs and amounts, contrasts between biologics and non-biologic offerings, physician and pharmacist perspectives on copay programs, and more.

Steve Willoughby will then offer an insightful perspective on the future state of the programs, how they are being received and reacted to by the market, and other strategic considerations for PBMs and Pharma. 

Wall Street analysts always offer a highly informed and outside perspective of our industries.  During this session you will learn what three leading analyst believe to be the critical issues impacting our industry today and in the future.   They include:

• Healthcare reform – ACO, Exchanges, payment bundling, etc.
• Industry consolidation
• The evolution of the PBM customer
• Drug pipeline effects on the management of the benefit
• Rationalization of R&D budgets.
• Therapeutics substitution trends. 
• Patent cliff implications
• The lessening of competition in new drug classes
• Pricing and inflation in drug pricing

In what has become a recurring session format at PCMA conferences, we once again have assembled a panel of leading executives from pharma/PBM relations and contracting to discuss what they believe are challenges and opportunities that are most impacting the business we engage in.  Their discussion will explore the following:

• Evidence models for pharmaceuticals
  • CER
  • Decision processes for coverage and reimbursement
• Patient migration
  • Shifting lives through ACA, ACOs, and acquisitions
• Affordability and its impact on adherence
  • Biosimilars, generic patent cliff
• The repositioning of pharma – from primary care to specialty
• Healthcare Reform
  • How is pharma reacting/responding?

As healthcare moves into and through reform, new challenges appear and new solutions are developed.  Where do the consumers fit in the healthcare equation?  What are we doing right, and what can we do better.  Changing behavior becomes critically important to PBMs and other healthcare players.  Do we know enough about the consumer to influence outcomes?  William will discuss:

• Today’s healthcare problems are apparent, do we have any solutions?
• Can transparency and clarity influence the behavior of providers and consumers?
• How does the way you ask the question influence the response?
• What steps can be taken to encourage consumers to embrace lifelong well-being?

Legislative and regulatory action at the state and federal level is greatly impacting the pharmaceutical supply chain. The drug manufacturing and PBM industries have been, and will continue to be, affected both collectively and exclusively. Many of these regulations are currently unfolding on a weekly basis. Staying current, and to the extent possible, ahead of the curve is top of mind for us all. During this session you will learn about what matters most in this arena.   Topics discussed will include:

• Health Reform Implementation: Key issues and opportunities including: Legal challenges, the evolutions of the exchanges, essential health benefits, accountable care organizations, Medicaid expansions and IPAB and PCORI

•  FDA Legislation and Regulation: drug shortages, PDUFA, biosimilars

• Possible regulations of PBM practices including transparency

Session Details:

• Healthcare reform and the weak economy is changing everything
  • Efficiency efforts/cost-cutting by Medicare and Medicaid are unprecedented
  • Commercial payers will resist cost-shifting
  • With reduced cash flow, healthcare sector can respond by downsizing
• Do not underestimate impact of structural changes from healthcare reform
  • Exchanges will bring Part D dynamics to commercial  world
  • Hospital-physician consolidation and ACOs mean current pharma/device model seen as an outsider
  • Irony:  Pharmacoeconomics seen as weak evidence in finance-focused world