The PCMA Annual Meeting is the industry’s premier executive conference. The event provides an un-matched and ideal venue for senior executives from PBMs, specialty pharmacy, payer organizations, and pharmaceutical manufacturers to network, conduct business and learn about the most current issues impacting the industry.

The decision makers in attendance, educational insights and business connections made while on-site, are ultimately what make the Annual Meeting so successful. The high level interactions that take place at this event help to promote continued industry collaboration and dialogue.

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Annual Meeting 2014 Agenda

Monday, October 13
10:00 am - 11:00 am

Annual Meeting Welcome 

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Conference Moderator: Susan Dentzer, Senior Policy Advisor, Robert Wood Johnson Foundation

Federal and State Legislative and Regulatory Efforts to Control Patients’ Cost Burden

Lauren Barnes, Senior Vice President, Avalere Health

Kristin Bass, Senior Vice President, Policy and Federal Affairs, PCMA

Price and affordability of drugs have been two of the hottest issues this year, and will be discussed in depth during the next two days. During this session, Kristin Bass and Lauren Barnes will discuss how the price and affordability strategies in which pharma and payers are engaging are playing out in the regulatory and legislative arenas. They will discuss the specific initiatives on the state and federal level that aim to shape drug management practices, and how the market is likely to respond to them.

11:00 am - 11:30 am

PCMA Leadership Session – Strategic Insights and Priorities for the PBM Industry

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Mark Merritt, President & Chief Executive Officer, PCMA

Dirk McMahon, Chief Executive Officer, OptumRx

Jon Roberts, President, CVS/caremark & Executive Vice President, CVS Health

The head of PCMA, Mark Merritt, along with PCMA’s outgoing Board Chairman, Dirk McMahon, and incoming Chairman, Jon Roberts, will share their perspectives on the policy and market dynamics that have impacted the PBM industry during the last year and trends they are tracking for 2015.

Key issues the panel will discuss include:

  • Drug management strategies and solutions in a changed drug marketplace;
  • Specialty pharmacy innovation and evolution;
  • State legislative and regulatory maneuvers; and
  • The need for alignment strategies for PBMs and pharma.

11:30 am - 12:00 pm

Exchange Marketplace Report

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Peter Wickersham, Senior Vice President, Integrated Care and Specialty, Prime Therapeutics

Ahead of the next public exchange open enrollment season, increased attention is being given to utilization and costs associated with this population. Prime Therapeutics’ experience managing pharmacy benefits for more than 3.6 million individual market members (of which 1.4 million are public exchange members), allows Peter Wickersham to provide an insightful overview of demographic, drug cost, utilization and key spend categories of exchange members for the first six months of the year. This presentation will also include a look at how this population has utilized high-cost specialty medicines.

1:30 pm - 2:00 pm

Precision Medicine

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Roy Beveridge, Chief Medical Officer, Humana Inc.

Modern medicine has evolved into the false belief that spending more equates to better care. The result is that health care spending is out of balance. Treatment is not always aligned with the evidence and payment is based on volume as opposed to incenting quality outcomes. Spending is concentrated on medical services for treatment rather than being focused on the behavior choices that actually make us healthy. Reversing this trend will require diligence from all stakeholders to create a shift in focus to wellbeing that balances cost, treatment choices and outcomes evidence. Medicine at its core is about people as patients. Rebalancing health care spending can serve to close the gap between people and care.

Among the topics Dr. Beveridge will address are:

  • Contributors to out of balance health care spending and opportunities to rebalance;
  • The interrelationship between treatment guidelines, clinical evidence, and aligned incentives;
  • The population disease management risk continuum; and
  • Case study research addressing oncology quality management.

2:00 pm – 2:30 pm

The Evolution of the Rx Channel and What it Means for PBMs

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Lisa Gill, Managing Director, Senior Analyst, Equity Research, Healthcare Technology and Distribution, J.P. Morgan

Wall Street analysts always offer a highly informed perspective of our industries. During this fireside chat-style session, Lisa Gill will provide her perspective on various trends related to drug channel evolution including:

  • Public and private exchange implications;
  • Tightening payer and PBM controls — closed formularies, margins in the distribution channel, etc.;
  • Management of specialty; and
  • The future role of drug retail

Tuesday, October 14
8:30 am - 9:15 am

It’s All About Value

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Tim Wentworth, President, Express Scripts

With pharmaceutical manufacturers hiking costs for new drugs, payers facing increasingly difficult tradeoffs, and patients demanding unfettered access to treatments, we face an unprecedented challenge in how to pay for health care innovation. As fewer and fewer can afford innovation, we move ever closer toward an outcome no one wants: the government as a single payer for prescription drugs. Tim Wentworth will provide his perspective on why it is more important than ever to focus on the value of health care, and the specific actions stakeholders must immediately take to ensure better financial and health outcomes.

9:15 am - 10:00 am

Pharma Leadership Address – The Price and Value of Curative Hepatitis C Medications

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John Milligan, President & Chief Operating Officer, Gilead Sciences

The price and value of curative hepatitis C medications have inspired an interesting debate between payers, PBMs, government officials, the medical community and the biopharmaceutical industry in 2014. John Milligan will discuss Gilead’s history of developing innovative therapies that address unmet medical needs and how the company is transforming the treatment of hepatitis C with simple and cost-effective hepatitis C cures.

Among the topics John will address are:

  • The rapidly evolving field of chronic hepatitis C treatment;
  • How Gilead’s efforts in HIV/AIDS drug development have led to the first generation of single tablet regimens for hepatitis C;
  • The burden of hepatitis C on our health care system and the value of treating the disease, as well as the costs of not treating; and
  • The opportunity to transform patient lives with hepatitis C cures.

10:00 am - 10:30 am

Public Policy and the U.S. Health Care System

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Troy Brennan, Chief Medical Officer, CVS Health

Public policy plays an ever-increasing role in our health care market. The U.S. government’s role as both health care payer and regulator complicates the market. With health care outcomes, cost and coverage challenges ever increasing, we need to understand how public policy helps and hurts progress.

During this session, Dr. Brennan will frame the challenges by:

  • Articulating the burden of cost that we face;
  • Highlighting health care spending growth relative to the deficit; and
  • Discussing how the U.S. pays more for health care than countries with socialized medicine, without realizing nearly the same coverage or outcomes

10:30 am - 11:15 am

PBMs, Specialty Pharmacies and Pharma Program Alignment – Affordability, Adherence and Outcomes

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Duane Barnes, Chief Operating Officer, Prime Therapeutics

Mike Staff, General Manager, National Accounts, Integrated Managed Health Care, AbbVie

The PBM and pharma industries have always worked toward improved adherence and outcomes.   More recently our approaches have aligned as we pursue this mutual goal. During this session, Mike Staff and Duane Barnes will discuss how the thinking and programs – such as contracting, case management strategies, utilization management, care models and adherence and persistence approaches – are evolving in this space.

11:15 am - 11:45 pm

Payer Driven Specialty Management for the Future

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Alan Lotvin, Executive Vice President, CVS/specialty, CVS Health

During this session Dr. Lotvin will provide an overview of the current factors that are driving the accelerating growth of the specialty trend. He will discuss the more aggressive combination of traditional and novel management approaches that payers can implement to manage increasing utilization and cost, while still maintaining positive health outcomes.

1:00 pm - 1:30 pm

Advancing Clinical Care in Specialty – Aligned Incentives Between all Stakeholders

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Bill Martin, Vice President, Pharma Strategy and Account Management, Express Scripts

The cost of specialty medications is increasing so rapidly it will account for 50% of total drug spend by 2018. Given this unsustainable trajectory, it is more important than ever to rally distinct stakeholders around one common goal: improved patient care. Bill Martin will offer his unique perspective and experience balancing the needs of payers, pharmaceutical manufacturers, physicians and patients to keep costs under control while improving patient health outcomes.

Topics discussed will include:

  • Complex industry dynamics and stakeholder perspectives;
  • The division of specialty drug spend on pharmacy and medical benefit;
  • Finding common ground between the patient, provider, the PBM, the specialty pharmacy and the drug maker;
  • Strategies to create more aligned incentives for patient care; and
  • Accomplishing better overall patient outcomes.

1:30 pm - 2:00 pm

Medication Consumption

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Chris Burns, Vice President, Marketing, Catamaran

There are so many different voices involved in managing health care and a growing need for stakeholders to work together across the entire continuum of care in order to drive better overall outcomes for quality, cost and patient satisfaction. Whether it is the payer, the PBM, the pharmacy or specialty pharmacy, the provider, the hospital, the manufacturer or the patient, each stakeholder group controls some spheres of influence but no group has control over everything.

This presentation is meant to represent the perspectives of two pieces of the puzzle. Chris Burns will present primary market research which explores how payers think about the management of prescription spend and how patients think about their medication consumption. The findings from this myth-busting research is meant to help Catamaran better understand how and why payers and patients make certain choices so Catamaran can make more informed strategic decisions for providing a better overall payer and patient experience in the future.