The sPCMA Business Forum hosts payer-aligned specialty pharmacies and their business partners – payers, PBMs, drug manufacturers, and others.  Speakers are among the specialty pharmacy industry’s top thought leaders and the Business Forum hosts the most specialty drug management decision makers of any industry conference.

Conference Program Book

Business Forum 2014 Agenda

Wednesday, March 12
8:30 am – 9:30 am

General Session

Welcome Remarks

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Mark Merritt, President & Chief Executive Officer, PCMA

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

PCMA Board Member Executive Panel – How PBMs are Competing in the Specialty Market

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Eric Elliott, President & Chief Executive Officer, Prime Therapeutics

Dirk McMahon, Chief Executive Officer, OptumRx

Jon Roberts, Executive Vice President & President, CVS Caremark Pharmacy Services, CVS Caremark

Moderator: Adam Fein, President, Pembroke Consulting, Inc. & Chief Executive Officer, Drug Channels Institute

As we are all aware, payers are highly focused on the rising specialty drug spend. Spending for specialty drugs continues to grow at 15% to 20% annually. CVS Caremark and Prime Therapeutics project that specialty drugs will account for 50% of total U.S. drug spending within five years. The specialty market’s projected growth is drawing many companies into the channel. This panel, representing some of the largest PBMs, and the largest specialty pharmacies, will offer insight around specialty pharmacy channel competition and what differentiates their companies’ services from others in the marketplace, specialty drug trend management, including medical benefit and site of care management. They will provide recommendations for manufacturers looking to interact with different parts of their organizations, and will share their thoughts on the likely winners and losers in the current specialty pharmacy battles.

9:30 am - 10:15 am

General Session

Pharma Strategies for 2020 – Preparing Today for a Specialty Drug Driven Marketplace

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Eddie Williams, Senior Vice President, Biopharmaceuticals, Novo Nordisk

Gary Zieziula, Chief Commercial Officer, EMD Serono

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

As is evident in every corner of the pharmaceutical marketplace, the primary focus and conversations are on specialty pharmacy and the drug products associated with this rapidly growing segment of the industry.  Manufacturers and benefit managers alike continue their focus on primary care, but must also contend with the complex and numerous challenges and opportunities of the specialty segment.   During this session, the panel will discuss industry strategies, market trends, and collaboration opportunities for the evolving primary care segment, as well as the growing specialty segment.   This includes the importance of maintaining a patient-centric focus, the evolving reimbursement landscape and pressures it has places on manufacturers, and the growing need for manufacturers and payers to move beyond transactional relationships into more collaborative partnerships.

10:30 am – 11:15 am

Breakout Session 1 of 2

** ACA, ACOs, and Specialty – How Will New Coverage, Payment, and Delivery Models Impact Specialty?

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Leigh Ann Bruhn, Director, Reimbursement, Avalere Health

Matthew Eyles, Executive Vice President, Avalere Health

The ACA is significantly evolving the coverage, payment and delivery environment for specialty pharmaceuticals.  New coverage and benefit design features under health insurance exchange plans will impact patient access to specialty drugs.  Moreover, changes in the payment and delivery system with the advent of accountable care organizations (ACOs) and other new models of coordinated care where providers assume greater risk for the financial and health outcomes of patients will affect how and when specialty drugs are prescribed.  This session will address the key changes in the coverage, payment and delivery environment that could have the greatest impact on specialty medicines today and in the future.

By attending this session, you should be able to:

  • Outline how specialty medicines are treated in the new exchange plans;
  • Discuss the factors behind the movement toward  accountable care/ ACOs and other emerging payment and delivery models;
  • Identify the anticipated impact of payment and delivery system changes on specialty drugs;  and
  • Describe how specialty pharmacies and specialty manufacturers may evolve their evidence generation or services to deliver value in an era of accountable care/ACOs.

10:30 am – 11:15 am

Breakout Session 2 of 2

**Winners and Losers in Today’s 340B Drug Program

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Amanda Bartelme, Director, Reimbursement, Avalere Health

Drug makers, health insurers and payers, PBMs and specialty pharmacies, and many other industries have much to lose and gain as players in the 340B Drug Program. During this session, we’ll take a look at what industries and companies are playing in the space, and how that has evolved through the history of the program.

By attending this session, you should be able to:

  • Explain the origins of the 340B Drug Discount program, its purpose,  and its evolution over time;
  • Identify criticisms of the 340B program from a variety of stakeholders including manufacturers, government agencies, payers,  and eligible program participants;
  • Compare how  the program directly and indirectly influences various stakeholders, including who gains/looses under the current system; and
  • Recognize areas likely to be reshaped by impending 340B program guidance from HRSA, the program’s regulatory body.

11:30 am – 12:15 pm

Breakout Session 1 of 2

** Challenges in Specialty Pharmacy – Aligning Outcomes and Cost

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Steve Chick, Vice President, Leader of Comprehensive Health Insights, Humana Inc.

Moderator: Jerry Miller, Healthcare Industry Consultant

There is now more than ever a need for open dialogue around the cost of drugs and outcome-based contracting. This session aims to bring to the forefront the evolution of outcomes contracting in specialty pharmacy, current perceived challenges and issues, ways in which both industries should be looking at real world data differently, and real ideas for payer and manufacturer collaborations and new types of contracts.

By attending this session, you should be able to:

  • Discuss the evolution of outcomes contacting in specialty pharmacy – what were its roots, how has it evolved, what does it look like today, and what is the future trajectory;
  • List at least three perceived challenges to outcomes contracting in specialty pharmacy; and
  • Explain the general concept of evidence developed and contracting

11:30 am – 12:15 pm

Breakout Session 2 of 2

** Development in the Biosimilars Marketplace

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Thomas Felix, MD, Director, Research and Development Policy, Amgen

Ameet Mallik, Global Head of Biopharmaceuticals and Oncology Injectables, Sandoz

Moderator: Everett Neville, Chief Trade Relations Officer, Express Scripts

While further clarity is needed from the FDA on a pathway, biosimilar companies are building and strengthening relationships with payers and other stakeholders as they prepare their products for the U.S. market.  Our panelists will discuss the latest U.S. market dynamics.  Discussion topics will include pipeline expectations for the next 3-5 years, payer perspectives around naming, interchangeability, and the role of P&Ts, and economic realities around pricing and growth strategies.

By attending this session, you should be able to:

  • Name several biosimilar products in the U.S. market pipeline; and
  • Outline the pros and cons (at least one of each) of product interchangeability from the perspective of the manufacturer and from the payer.

1:30 pm - 2:15 pm

Breakout Session 1 of 2

**What’s Driving Formulary Exclusion Lists in Specialty?

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Patrick Gleason, Director, Health Outcomes, Prime Therapeutics

Moderator: Jerry Miller, Healthcare Industry Consultant

By 2018, it’s predicted that specialty medicines will account for 50 percent of all drug spend. As more specialty medicines arrive on the market with few generic alternatives, pharmacy benefit managers are beginning to exclude some specialty drugs from formularies. This session will discuss the advantages and disadvantages of formulary exclusion lists and the factors driving this trend.

By attending this session, you should be able to:

  • List at least two pharmacy benefit manager options available to control specialty drug expenditure growth;
  • Identify the three factors associated with specialty drug formulary exclusion list development;
  • Describe recent examples of pharmacy benefit managers adopting specialty drug exclusion lists; and
  • Discuss the advantages and disadvantages of specialty drug exclusion lists

 

1:30 pm - 2:15 pm

Breakout Session 2 of 2

**Paying for Specialty Drugs – Are Payers Hitting the Wall?

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Ed Pezalla, MD, Vice President & National Medical Director, Pharmaceutical Policy and Strategy, Aetna

Debbie Stern, President, Rxperts

This session will provide an overview of the most current and aggressive payer management strategies. Our speakers will then provide context related to these and future management including:

  • Value-based benefit design
  • Outcomes contracting
  • New methodology to conduct formulary review based on value and outcomes
  • Physician engagement and member empowerment

By attending this session you should be able to:

  • Outline key challenges facing payers related to the coverage of specialty drugs;
  • Identify tactics currently used by payers to manage the coverage and reimbursement of specialty drugs; and
  • Describe potential new strategies related to clinical evaluation, patient engagement and shared risk programs

1:30 pm - 2:15 pm

Breakout Session 1 of 1

**The Increasing Depth and Reach of the Patient/Pharma Relationship

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David Galardi, Worldwide Managing Director, Apogenics, Inc.

As the specialty pharmacy marketplace grows and evolves, a manufacturer’s role and the services it provides are also changing. Through various support programs, manufacturers are taking on the role of pseudo-providers, assuming more services that are traditionally provided by the prescriber, pharmacy or benefit manager. A patient is no longer solely the patient of providers and a health plan member. Patients are increasingly engaged in relationships with the manufacturer. This session will discuss implications of these programs on payer or pharmacy operations and considerations manufacturers should be making when developing support programs.

By attending this session, you should be able to:

  • Provide an example of an ancillary manufacturer service-offering to a patient;
  • Understand how manufacturers monitor their service provider operations;
  • Outline two reasons why manufacturers are building their services to reach patients directly; and
  • Discuss the implications of some manufacturer support programs on payer operations.

2:30 pm - 3:15 pm

Breakout Session 1 of 3

**Specialty Pharmacy 2020 – Convergence with the Individual Market

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William Fleming, President, Humana Pharmacy Solutions, Humana Inc.

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

Currently, the individual insurance market provides coverage to more than 19 million people who purchase health insurance on their own. As legislative and market forces encourage more people to enroll in the individual market, payers are increasing their focus on the patient. Payers are trying to understand which attributes attract the individual to a particular plan or to a particular pharmacy benefit. This session will address the forces behind and implications around this “patient centric” market shift.

By attending this session, you should be able to:

  • Explain the general concept of the evolving retail-ization of health care;
  • Outline some of the evolving specialty pharmacy market macro trends; and
  • Describe a few opportunities and challenges of the convergence

2:30 pm - 3:15 pm

Breakout Session 2 of 3

**State Legislative and Regulatory Focus on Specialty Pharmacy

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Eric Douglas, Senior Director, Government Affairs, CVS Caremark

Jonah Houts, Vice President, State Government Affairs, Express Scripts

Moderator: Jerry Miller, Healthcare Industry Consultant

Specialty pharmacy issues have moved to the top of the health care agenda in the states. Current legislative and regulatory efforts stand to impact all players within the specialty pharmacy space.  Battle lines have been drawn, and we’re underway on several hotly contested proposals. Our panelists will discuss state issues such as Any Willing Pharmacy/Specialty, biosimilars, tiering and cost sharing, and oral chemo parity.

By attending this session, you should be able to:

  • List several states with AWP legislation moving through the legislature;
  • Outline two contrasting arguments around biosimilar legislation; and
  • Name at least three players (adversaries and/or allies) advocating for biosimilar legislation in the states

2:30 pm - 3:15 pm

Breakout Session 3 of 3

**A Deeper Dive into the 340B Drug Program – What’s Hot Now and what’s on the Horizon

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Bill Sarraille, Partner, Sidley Austin

Following up on Amanda Bartelme’s session discussing “The Winners and Losers in the 340B Drug Program,” this session will take a more in-depth look a number of key issues under the 340B program.  This session will discuss recent trends and developments in 340B audits and enforcement—including HRSA audits of covered entities, manufacturer audits, congressional oversight efforts, and 340B-focused activities by the HHS Office of Inspector General. In addition to key details of ongoing 340B program integrity and enforcement efforts, this session will cover forthcoming action expected from the Health Resources and Services Administration (HRSA), including topics that may be addressed in the impending 340B “mega-rule” that HRSA expected in June, as well as possible programs and initiatives that HRSA might develop or enhance with its new 340B funding under the FY 2014 omnibus. Hot topics such as 340B guidance and implications for limited distribution and limited supply products, patient definition, contract pharmacy arrangements, hospital eligibility requirements, the future of the program, and others, will be woven into the discussion.

By attending this session, you should be able to:

  • List at least two issues that, according to recent statements from HRSA, are predicted to be addressed in the impending 340B “mega-rule” that HRSA plans to release by June 2014;
  • Describe two differences between HRSA audits and manufacturer-initiated audits of 340B covered entities; and
  • Outline the basic arguments for enhancing covered entity compliance programs.

3:30 pm - 4:15 pm

Breakout Session 1 of 3

**Specialty Pipeline – Forecasts, Implications and Priorities for Managed Care

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Sherry Andes, Manager, Pipeline and Trend Surveillance, Drug Intelligence, Catamaran

Moderator: Debbie Stern, President, Rxperts

The pharmaceutical industry recently completed a productive 2013, with at least 60% of FDA-approved drugs being specialty pharmaceuticals.  The patent cliff is largely over, pipelines are being replenished and new treatment categories are emerging, especially in the specialty market.  What does 2014 hold and how are reacting?  This session will provide an overview of key trends/forecasts relative to the specialty market, as well as a focused look at select therapeutic areas of the specialty pharmaceutical pipeline of greatest interest to managed care decision-makers.  It will also provide insights into key operational changes and clinical strategies that organizations like Catamaran are employing to ensure they are well-equipped to support clients in this high-profile area of focus.

By attending this session, you should be able to:

  • Understand key drivers of specialty drug trend and forecasts;
  • Identify the key specialty therapeutic areas (and key drugs) of greatest interest to managed care organizations in 2014 and why;
  • Articulate how P&T Committees are evolving in composition, training and drug evaluation procedures to meet this changing pharmaceutical landscape; and
  • Comprehend where organizations are investing resources to drive optimal value with new specialty drugs before, during and after launch.

3:30 pm - 4:15 pm

Breakout Session 2 of 3

**Utilization Management Guidelines for Specialty Drugs – A Closer Look at Prior Authorization and Medical Policy Guidelines

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Brian Solow, MD, Chief Medical Officer, OptumRx

Moderator: Jerry Miller, Healthcare Industry Consultant

With the approval of more and more biologics, prior authorizations have become the norm, but both payers and manufactures believe the process can be improved. There is a need to create not just PAs, but utilization management guidelines for specialty pharmaceuticals. This interactive session will provide insight into how medical policy pharmacy guidelines are derived and how they might affect the evolution of utilization management guidelines for specialty, will share data supporting contracting and clinical decision-making, and will discuss where manufactures and payers can take the conversation from here.

By attending this session you should be able to:

  • Understand why utilization guidelines are used for many specialty drugs;
  • List the sources used to create guidelines;
  • Outline how pharma can be a partner in establishing UM guidelines; and
  • Describe the steps manufacturers can take if there is a clinical issue with the guidelines.

3:30 pm – 4:15 pm

Breakout Session 3 of 3

**Oncology Landscape – 2014 & Beyond

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Kjel Johnson, Vice President, Global Oncology, IMS Health

This session will present the results of the IMS Institute’s first annual Oncology Trend Report. The report provides a global view of the oncology marketplace including pricing trends, launch successes (and failures), biosimilars, site of care, duration of therapy, approval endpoints comparison, forecasting and emerging markets. Kjel will summarize the report’s finding and provide provocative remarks on where he sees the market going.

By attending this session, you should be able to:

  • List the key oncology market drivers and challenges;
  • Describe the drivers of a successful oncology drug launch;
  • Develop a strategy to optimize market access; and
  • Outline the future of the oncology drug market.

4:30 pm - 5:15 pm

Breakout Session 1 of 2

**Management of Specialty Drugs in the Medical Benefit and Strategies for Regional Health Plans

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Rae McMahan, Vice President, Specialty Pharmacy Programs, Prime Therapeutics

As more conditions are treated with specialty medicines and more specialty medicines arrive on the market, specialty drug trend is growing by double digits every year.  This growth, coupled with the fact that most of the specialty spend is found on the medical benefit and not on the pharmacy benefit, make managing the medical benefit extremely important for a health plan and employer.

By attending this session, you should be able to:

  • List at least two disease classes that drive the most specialty drug spend and why;
  • Identify what management approaches work best to control specialty drug costs; and
  • List two changes in the payer landscape that will impact channel strategy decisions.

4:30 pm – 5:15 pm

Breakout Session 2 of 2

**Predicting Enrollment at the Disease State Level in the Health Insurance Marketplace

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Mark Zitter, Chief Executive Officer, Zitter Health Insights

Zitter Health Insights is conducting an ongoing syndicated study into the impact of the health insurance exchanges on multiple stakeholders. In this session, learn about the impact on consumers and how those with different diseases will enroll in the exchanges. Findings will be presented on recent research into 3,000 uninsured consumers to determine the number of patients expected to flow into each state’s exchange—across several specialty and non-specialty disease states. This will provide PBMs with the ability to gauge both volume of newly insured patients and their demographic profiles, cost-sensitivity, and desire to stay on prior medications.

By attending this session, you should be able to:

  • Quantify patient enrollment with regard to specialty and non-specialty disease states, to determine organizational impact;
  • Identify demographic profiles of consumers who are likely to enroll in the exchanges; and
  • Classify cost sensitivity of previously uninsured consumers within specialty and non-specialty disease states

Thursday, March 13
9:30 am – 10:15 am

General Session

Perspectives on the Emerging Specialty Pharmacy Landscape – Hot Topics, Trends, and What Matters Most

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Randy Falkenrath, Senior Vice President, Specialty Pharmacy, CVS Caremark

Kevin Host, Senior Vice President, Specialty Pharmacy, OptumRx

Albert Thigpen, Senior Vice President, Industry Relations and Pharmacy Operations, Catamaran

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

Building on the conference’s opening PCMA Board Member Panel, this group of sPCMA Board Members and specialty pharmacy thought leaders will provide their perspectives on even more issues impacting specialty pharmacy today.  Included in this session will be discussion around cost control measures spurred by the high cost of specialty drugs, the role of specialty pharmacy and SP services in adherence optimization , quality and consistency measures for specialty pharmacy accreditation , and biosimilars.

10:15 am – 11:00 am

General Session

**Oncology Drug Management, Distribution and Reimbursement Strategies

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Kevin Cast, Vice President, Strategy and Contracting, Pharma and Biotech, UBC: an Express Scripts Company

Mike Einodshofer, Senior Director, Specialty Strategy and Innovation, Walgreens

Burt Zweigenhaft, Chief Executive Officer, Onco360

Moderator: Lauren Barnes, Senior Vice President, Reimbursement, Avalere Health

Manufacturers continue to be heavily focused on oncology drug innovation.  Payers, PBMs, specialty pharmacies are preparing for this pipeline to come to market.  Today’s oncology market landscape will not look like tomorrow’s.  Bringing together diverse expertise from multiple corners of the oncology channel, the panel will share their insights around the pressure points, opportunities and drivers of change in this fluid and dynamic market.  Specific discussion topics will include specialty pharmacy services and deliverables, fair market value, limited distribution networks, cost, value and metrics for measuring quality, and challenges with managing products across the medical and pharmacy benefits.

By attending this session you should be able to:

  • List two ways in which management of oncology drug products has gotten or is getting more sophisticated; and
  • Describe a situation in which payers have to manage cost in drug classes with multiple products.

11:15 am – 12:00 pm

Breakout Session 1 of 2

** Member Engagement Strategies in Specialty

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Andrea Marks, Vice President & Chief Analytics Officer, Catamaran

The ability to achieve high quality health outcomes, coupled with effective management of drug expenditures within specialty pharmacy, remains one of the most daunting challenges facing health care payers today.  Due to the significant costs of specialty pharmaceuticals, and a robust pipeline likely to drive even higher uptake of these agents, it is more critical than ever to ensure that specialty drug recipients are effectively engaged in their overall health care.  This session will provide an overview of the complexities of the typical specialty pharmacy patient, including a look at the various comorbidities and concurrent therapies often tied to their specialty care.  It will also provide insights into key Big Data analytic and clinical strategies that companies like Catamaran are bringing forth to ensure that these patients are better educated and empowered to take a more active role in their care, and enhance the likelihood for desired outcomes.

By attending this session, you should be able to:

  • Explain how Big Data and new analytical methods can be used to better engage specialty patients in their care;
  • List a few therapeutic complexities that specialty patients endure;
  • Describe how attitudes and beliefs of the specialty patient will impact engagement approaches on care; and
  • Restate some unique approaches that leading companies are taking to ensure effective and enduring patient engagement.

 

11:15 am – 12:00 pm

Breakout Session 2 of 2

**A Wall Street Perspective on Market Evolution and Consolidation Trends

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Tom Gallucci, Managing Director, Healthcare Services, FBR Capital Markets & Co.

Moderator: Jerry Miller, Healthcare Industry Consultant

This session will explore the changing world in which the drug channel finds itself. Despite representing a number of distinct businesses, drug channel sector dynamics intersect in many ways and are becoming increasingly connected through vertical integration and formal partnerships. Looking specifically at the PBM, specialty pharmacy, retail and distribution channels, this session will explore some of market fundamentals, trends, and themes.

By attending this session, you should be able to:

  • List three reasons why stock prices for companies in this channel have risen meaningfully;
  • Outline two ways in which the “world is changing” and list implications for a few channel stakeholders;
  • Discuss three deals which have taken place that have driven benefits from the aggregation of generic purchasing power; and
  • Describe in some detail the macro market strategy of the major PBMs.  

1:00 pm – 2:00 pm

General Session

Remarks by Former Secretary of State Hillary Rodham Clinton

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Hillary Rodham Clinton served as the 67th U.S. Secretary of State from 2009 until 2013, after nearly four decades in public service. Her “smart power” approach to foreign policy repositioned American diplomacy and development for the 21st century. Clinton played a central role in restoring America’s standing in the world, reasserting the United States as a Pacific power, imposing crippling sanctions on Iran and North Korea, responding to the Arab Awakening and negotiating a ceasefire in the Middle East. Earlier, as First Lady and Senator from New York, she traveled to more than 80 countries as a champion of human rights, democracy, and opportunities for women and girls. Clinton also worked to provide health care to millions of children, create jobs and opportunity, and support first responders who risked their lives at Ground Zero. In her historic campaign for President, Clinton won 18 million votes.

2:15 pm – 3:00 pm

Breakout Session 1 of 2

** Fair Market Value – A Manufacturer’s Considerations

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Dave MacLeod, Vice President, Program Development, inVentiv Health Patient Access Solutions Group & Executive Advisor, Campbell Alliance

Tony Lanzone, Senior Vice President, Campbell Alliance

This presentation is designed to provide a clear definition of Fair Market Value. The speakers will offer an example of the methodology, analysis and potential tools that can be used to determine FMV for manufacturer products and programs.

By attending this session, you should be able to:

  • Define Fair Market Value and outline clear criteria for it;
  • Outline the framework manufacturers should use to calculate FMV; and
  • Review key market considerations manufacturers should use to develop FMV estimates.

2:15 pm – 3:00 pm

Breakout Session 2 of 2

** How the Medicare Part D Proposed Rule Will Upend the Program

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

Moderator: Jerry Miller, Healthcare Industry Consultant

In January CMS released proposed rule changes for the Medicare Part D drug program.  Within the nearly 700 page document are dozens of rule changes, many of which are very problematic to PBMs, specialty pharmacies and drug makers engaged in the program. During this session you will learn about the sweeping changes being proposed by CMS, with a special focus on those changes impacting the specialty space, such as new rules for limited networks and mail service.

By attending this session, you should be able to:

  • Name at least three of the proposed rule changes; and
  • Explain why payers and others believe this rule moves Part D toward traditional Medicare and will undermine the program.

 

2:15 pm – 3:00 pm

Breakout Session 1 of 1

** The Role of the Manufacturer’s Channel Strategy in Commercial Success

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Kent Rogers, Principal Consultant, Blue Fin Group

The rapidly evolving specialty pharmacy marketplace is causing manufacturers to re-evaluate their channel strategies.  This session will explore the optimal approach to any channel strategy utilizing the 4 P’s: Provider, Patient, Payer and Pharmacy, with recommendations for integrating product attributes to achieve commercial success.  Considerations that will be discussed include the importance of the patient and provider journey, the changing payer landscape through vertical integration with the provider, and the role of the specialty pharmacy and support services in optimizing a consistent approach.

By attending this session, you should be able to:

  • Discuss the interplay between the patient/provider journey and a successful channel strategy;
  • List two changes in the payer landscape that will impact channel strategy decisions;
  • Identify at least one risk and one benefits of two or more structures of specialty pharmacy networks and patient support services ; and
  • Describe how to effectively build a channel strategy that includes an emphasis on the 4 P’s (patient, provider, payer, pharmacy).

3:15 pm – 4:00 pm

Breakout Session 1 of 2

**A Better Model – Specialty Pharmacy and Care Management Collaborations for Improving Health and Overall Costs

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Eric Wan, Vice President, Product Development, Accordant, a CVS Caremark Company

Moderator: Debbie Stern, President, Rxperts

Specialty Pharmacy is growing in both cost and complexity for both patients and providers, especially for patients with rare conditions.  Providers face an increasingly growing challenge because true management requires both management of the medication, side effects and adherence as well as co-morbidities, self-care and other non-medication related areas.  This session will discuss ways that specialty pharmacies and care management organizations can collaborate for improved outcomes in both health and overall costs.

By attending this session, you should be able to:

  • Identify at least two key trends in specialty pharmacy and rare disease;
  • Delineate focus areas for specialty pharmacy and care management teams;
  • Define collaboration possibilities for specialty pharmacies and care management teams; and
  • Describe key health and cost savings outcomes that can be affected by collaborative efforts.

3:15 pm – 4:00 pm

Breakout Session 2 of 2

**The PBM’s Role in the Health Insurance Marketplace

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Susan Fox, Director, Business and Product Development, US Script

Although the Health Insurance Marketplace (HIM) has been live for only a few months, early market experiences combined with strategies from Medicaid Managed Care Rx management demonstrate unique opportunities for PBMs to impact the success of these market offerings. What have we learned from this new market and the role the pharmacy benefit plays in influencing member satisfaction and as an indicator of health status? This session focuses on the importance of the pharmacy benefit in delivering a robust, member-centric HIM program. Results derived from our expansive Managed Medicaid population have enabled US Script to successfully leverage PBM tools to help manage the overall effectiveness of the HIM pharmacy benefit.

By attending this session you should be able to:

  • Define the Health Insurance Marketplace (HIM) Rx benefit requirements;
  • Discuss how Managed Medicaid Rx management strategies influence HIM preparedness;
  • Discuss how the pharmacy benefit can be uniquely leveraged in HIM to improved member understanding of their health status; and
  • Evaluate how prescription drug claims can provide early insight into enrollee health status.