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.

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sPCMA Business Forum 2015 Agenda

Monday, March 16
9:00 am – 9:30 am

General Session

The Unprecedented Changes Occurring in Drug Management  

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Bill Martin, Vice President, Pharma Strategies, Business Development and Account Management, Express Scripts

Pharmacy benefit management tools have been evolving since the industry began in the 1980’s. The last few years, however, have seen unprecedented change as compared to the previous 25. New market dynamics are fueling this rapid transformation of the PBM industry. The new drug pipeline, public payer growth, and cost and affordability will be among the factors that continue to drive the changes in the way PBMs manage drug therapy and benefits. During the session, Everett Bill will explore what is happening now, when this rapid change might end and what it means for the business strategies of PBM affiliated companies and industries.

9:30 am – 10:00 am

General Session

Formularies and Specialty Tiers in 2015 and Beyond

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

Ian Spatz, Senior Advisor, Healthcare Industry, Manatt, Phelps & Phillips, LLP

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

The advent of the Affordable Care Act and its creation of Qualified Health Plans and Medicaid Alternative Benefit Plans, along with the growing dominance of managed care in delivering Medicaid services, has reignited a discussion on whether and how to regulate formularies — their scope, content, and cost sharing. In addition, the growing prominence of specialty drugs has led to an increased focus on the use of specialty tiers and the impact they have on health plan premiums and beneficiary costs. At the state and federal levels, in legislatures and agencies, drug companies, health plans, PBMs and patient advocates are debating the proper role of competition and regulation in ensuring access to affordable medicines. Kristin and Ian will discuss current developments in these areas and look into their crystal balls to project the path and pace of change.

10:15 am – 11:00 am

Breakout Session 1 of 2

Latest Developments to the 340B Drug Program and Implications for Pharma and Payers

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Marcus Farbstein, Director, Public Policy and Government Markets, Medivation

Adam Fein, President, Pembroke Consulting, Inc.

Moderator: David Galardi, Worldwide Managing Director, Apogenics

This session will address the current 340B realities including the latest Health Services Resources Administration (HRSA) guidance and the role of regulators, and emerging marketplace trends such as a growing health system/SP model and collective bargaining. During this session, the panelists will discuss the implications of these trends for the various parties involved, tactics for working in this controversial space, lessons learned over the past several years and why the audience should be paying attention to these developments.

By attending this session, you should be able to:

  • Identify the conflicting interpretations of the 340B drug pricing program;
  • Explain crucial ways in which the 340B program’s growth is affecting managed care;
  • Summarize the challenges that the 340B contract pharmacy networks pose for PBMs and manufacturers; and
  • Explain the likely changes to the 340B program to be detailed in forthcoming guidance from HRSA.

10:15 am - 11:00 am

Breakout Session 2 of 2

How Payers Use Pipeline Data and Analysis to Make Decisions

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Farrah Wong, Manager, Pipeline and Drug Safety, OptumRx

This presentation goes beyond your typical pipeline session by offering a glimpse into how health plans analyze health plan data and model for future expenses. The first part of the presentation will include an overview of the “high impact” products coming to market in the next three years. Using Kalydeco as a case study, Dr. Wong will then explain how OptumRx uses data, modeling, and clinical information to help make plan benefit decisions.

By attending this session, you should be able to:

  • Identify at least two high impact pipeline drug trends; and
  • Outline how health plan data and clinical modeling influence formulary decisions

11:15 am - 11:45 am

Breakout Session 1 of 2

Where the Role of the PBM Evolves in Government Mandated Health Care

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Ellen Duffield, Senior Vice President & Chief Compliance Officer, Catamaran

Government, both state and federal, is the largest payer of health care in the U.S. and makes increasing regulatory and compliance demands of PBMs and payers. This session will take a look at how PBMs and their clients are responding to government demands and how these responses might impact their manufacturer partners. During this session, Ellen will discuss increased transparency requirements in Medicare, Medicaid and the exchange programs, and compliance considerations around integrating regulatory changes – the surveillance, ingestion and implementation of new data and processes.

By attending this session, you should you be able to:

  • List two ways in which the 2014 CMS final rule has changed compliance requirements for health plans and/or PDP sponsors; and
  • Outline how requirements affect Medicare star ratings and why this matters to payers, PBMs and manufacturers.

 

11:15 am - 11:45 am

Breakout Session 2 of 2

Electronic Prior Authorization Adoption and the Role of ePA in Reducing Health Care Costs

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Perry Lewis, Vice President, Industry Relations, CoverMyMeds

During this session, Perry will discuss why electronic prior authorization matters and the various factors and stakeholders driving it. His presentation will address the following considerations and more.

  • What percentage of the market is implementing ePA and how accessible is it to prescribers and pharmacists?
  • How realistic is a national adoption scorecard? How real is adoption by all the stakeholders — by health plans, pharmacies, etc.?
  • How are state regulations driving adoption and what are the implications for stakeholders?

By attending this session, you should be able to:

  • Name one thing that the pharma industry values with regard to ePA, i.e. why does it matter to them;
  • Name one thing that payers value with regard to ePA, i.e. why does it matter to them;
  • Identify the percentage of the market that has implemented ePA; and
  • List two lessons learned by engaged stakeholders.

1:15 pm – 2:00 pm

General Session

The Political Outlook of Health Care

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Joe Scarborough, Co-Host of MSNBC’s Morning Joe

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

Joe Scarborough and Mika Brzezinski have been widely applauded for bringing something new and different to morning television with MSNBC’s Morning Joe. They created a format that is substantive, informative and entertaining. Anyone who is anyone in politics, or cares about politics these days is plugged into the program and Morning Joe does particularly well among Washington’s power players.

Balanced by his Democratic co-host and flanked by diverse guests, Scarborough navigates the political environment with an insider’s perspective and a no-nonsense attitude. Pulling from his experience as an influential player in Republican politics, Scarborough leads candid discussions about the important issues facing America each day.

During this session, Scarborough will address national politics, including the 2016 Presidential race, and how politics are playing out in the health care debate.

2:00 pm – 2:45 pm

General Session

Remarks from PCMA

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Mark Merritt, President & Chief Executive Officer, PCMA

PBM and Pharma Leadership Panel

Mark Alles, President & Chief Operating Officer, Celgene

Eric Elliott, President & Chief Executive Officer, Prime Therapeutics

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

Moderator: Adam Fein, President, Pembroke Consulting, Inc.

Pharmaceutical industry revenues will continue shifting from traditional brand name drugs to specialty drugs over the next few years. By 2018, specialty drugs will account for 50% of total U.S. drug spending. This growth is accompanied by controversy, especially over the pricing of innovative specialty drugs. Specialty drug trend is expected to remain in the 15% to 20% range. Higher prices and the commercialization of new therapies are driving these drug trend increases.

In addition, a growing number of pharmacies are vigorously competing to dispense specialty therapies. Pharmacies dispensing specialty drugs are operated by such organizations as PBMs, retail chains, health plans, pharmaceutical wholesalers, physician practices and hospital systems. There are also many independent specialty pharmacies.

During this session, Dr. Fein will lead the panel in a discussion around three main topics — drug pricing and valuing innovation, the specialty pharmacy boom and channel considerations, and future challenges and evolving PBM-pharma partnership opportunities.

3:00 pm – 3:30 pm

Breakout Session 1 of 1

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

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Trip Hofer, President, Accordant, a CVS Health Company

Specialty pharmacy is growing in both cost and complexity for both patients and providers, especially for those patients with rare conditions. These patient and providers have an even greater challenge as impactful management demands more than medication, side effect and adherence management. A holistic approach must also address co-morbidity support, symptom and self-care management, and other non-medication related areas. Trip will discuss ways that specialty pharmacies and care management programs must integrate in a seamless manner for improved outcomes in both health and overall costs.

By attending this session, you should be able to:

  • Review key trends in specialty pharmacy and rare diseases;
  • List focus areas for specialty pharmacy and care management teams;
  • Describe collaboration possibilities for specialty pharmacies and care management teams; and
  • Outline key health and cost savings outcomes that can be affected by collaborative efforts.

3:45 pm – 4:15 pm

Breakout Session 1 of

How High Touch Needs of Patients, Providers and Payers are Driving Specialty Pharmacies to Become More Clinical

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George Van Antwerp, Senior Manager, Deloitte Consulting LLP

The business of specialty pharmacy is becoming more personalized to address the complexity of conditions. The need is not only about controlling costs but about managing a patient towards better outcomes. Managing therapy for clinical outcomes is increasingly falling on specialty pharmacies with pressure from patients, payers and providers. This has opened the opportunity for small specialty pharmacies that focus on a specific therapeutic category, although applying the typical mail order or PBM model which derives value through economies of scale can be a challenge with this model. This session will review the paradigm shift specialty pharmacies are facing and provide examples of strategies that some stakeholders are considering to address the challenges.

By attending this session, you should be able to:

  • Name at least two therapeutic categories that focused specialty pharmacies are supporting;
  • Outline one reason why it would be difficult for smaller specialty pharmacies to operate with significant scale; and
  • Describe three strategies stakeholders are considering to address the mentioned specialty pharmacy challenges.

3:45 pm – 4:15 pm

Breakout Session 2 of 2

Integrated Delivery System Evolution and a Shift in Influence and Control – Payer and PBM Roles in the New Model

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Matt Aubin, Senior Principal, Precision for Value

Rachelle Wan, Senior Vice President, Strategic Services & Lead of Pharmacy Benefit and Contracting, Precision Advisors

As the integrated delivery systems continue to grow in sophistication, integration, control and size, are PBMs and payers continuing to develop their capabilities to become ideal partners to integrated delivery systems? During this presentation, Matt and Rachelle will share the latest market developments, and they will discuss control and influence in integrated delivery system models.

By attending this session, you should be able to:

  • Describe ongoing market developments which impact all stakeholders today;
  • List two upcoming changes within the marketplace; and
  • Outline the importance of assessing current business development strategies.

Tuesday, March 17
9:00 am – 9:30 am

General Session

Managed Markets Hot Topics Discussion

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Jim Meyers, Senior Vice President, North America Commercial Organization, Gilead Sciences

Robyn Peters, Vice President, Market Access and Reimbursement, Biogen Idec

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

During this session, our lineup of managed markets veterans will discuss three core issues that PBM and pharma executives are grappling with in the age of specialty.  How these issues play out in the months and years to come will have a significant impact on the way our industries conduct business.

  1. Affordability and Value
  • High cost has led to increased focus on value by payers and patients alike
  1. Copay Assistance and PAPs
  • What place do these have in specialty pharmacy?
  • What role do they play in patient care?
  • Where are manufacturers’ and payers’ objectives aligned, and not?
  1. Manufacturer Collaboration with Payers/PBMs
  • Pre-market launch period
  • Commercialization
  • Full product lifecycle
  • Product pipeline and trends

9:30 am – 10:15 am

General Session

Overall Complexity of the U.S. Biosimilars Market – Patent Design, Commercialization, FDA Approval and Research

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Mike Castagna, Vice President, Global Biosimilars Commercial Lead, Amgen

Denny Lanfear, President, Chief Executive Officer & Chairman, Coherus BioSciences

Sophie Opdyke, Vice President, Commercial Development, Biosimilars, Pfizer

Moderator: Bill Martin, Vice President, Pharma Strategies, Business Development and Account Management, Express Scripts

Even though the pace of U.S. biosimilars filings is accelerating and approvals are nearing, many questions remain. Multiple strategies exist among the numerous brand and generic manufacturers. This panel discussion will explore the complexities of four critical areas within the U.S biosimilars market — patent design, FDA approval, commercialization and research. The panel will discuss these factors, and how the different market segments will need to prepare for this highly competitive and emerging market.

10:30 am – 11:00 am

Breakout Session 1 of 2

The U.S. Pharmaceutical and Specialty Markets – Looking Back and Looking Ahead

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Doug Long, Vice President, Industry Relations, IMS Health

The U.S. pharmaceutical market returned to double digit dollar growth in 2014, led by the strong growth in specialty drugs and few patent expiries of branded drugs. Specialty sales exploded in 2014, with the introduction of two breakthrough Hepatitis C therapies and strong growth in autoimmune and MS drugs. At the same time, drugs like Nexium and Copaxone were supposed to go generic in 2014 but did not.

Managing pharmacy budgets will become even more difficult with the specialty drug wave and the number of new specialty drugs in the pipeline. During this presentation, Doug will address market trends and considerations for the future including the importance of using medicines responsibly in the current environment, a need to focus on adherence and timely diagnosis and treatment, reducing medication errors, more appropriate antibiotic use, increasing the use of generics, and managing poly pharmacy for the elderly.

By attending this session, you should be able to:

  • Outline where the U.S. pharmaceutical market growth has been and summarize a near-term forecast for growth;
  • Identify at least two factors that will affect specialty growth in the future; and
  • List six ways in which the responsible use of medicines can save health care costs.

10:30 am – 11:00 am

Breakout Session 2of 2

Payers’ Biosimilar Strategies – How PBM and Payer P&Ts will Evaluate Biosimilars

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Brian Solow, Chief Medical Officer, OptumRx

Because biosimilars are new to the U.S. market, they present a great partnership opportunity for manufacturers to share their experiences from first generation biosimilar products in the E.U. with U.S. payers.  Sharing real clinical data from these products in Europe would inform payers as they evaluate the products within their own P&Ts and determine how they plan to manage biosimilars across their organizations.  During this session, Dr. Solow will review the hurdles biosimilars are facing to receive FDA approval.  He will also provide insight into how P&Ts will evaluate biosimilars, with considerations around one-time use versus chronic products, along with the various nuances associated with utilization management programs.  Lastly he will present a case scenario of a recent P&T biosimilar discussion.

By attending this session, you should be able to:

  • Outline the complexities faced by P&T committees in reviewing biosimilars;
  • Describe the clinical literature that is important for PBMs to review for these agents; and
  • List two ways in which pharmaceutical manufacturers can assist and partner with PBMs in this new market.

11:15 am – 11:45 am

Breakout Session 1 of 2

Next Generation Specialty Management

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Surya Singh, Corporate Vice President, Specialty Client Solutions, CVS Health

By 2018, specialty will represent half of all drug spend. A traditional management approach alone is no match for the changing marketplace. A holistic approach to patient care, coupled with traditional and innovative drug management levers, can have a significant impact on both clinical care and cost management.  During this session, Randy Dr. Singh will discuss approaches that make achieving such ambitious goals possible.

By attending this session, you should be able to:

  • Understand market place dynamics impacting the specialty landscape
  • Explain how applying medical benefit and claim management solutions can reduce cost of care
  • Understand why increasing patient convenience and access to specialty medications and clinical services is beneficial

11:15 am – 11:45 am

Breakout Session 2 of 2

Patient Adherence and Script Abandonment – Behavioral and Economic Influence

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Pamela Morris, Director, Syndicated Research, Zitter Health Insights

New research reveals unique insights into patient behavior based on real-time feedback from patients immediately after they have a point of interaction with a physician or pharmacist. By exploring their interactions with the doctor and pharmacist, as well as what the patient does in between those contacts, this research is uniquely poised to answer the question of why patients do not fill their prescriptions and how they adhere when they do fill their scripts.

As script abandonment and medication adherence is an issue that can ultimately impact patient outcomes, it is important to understand the full range of clinical, social, and economic reasons for this patient behavior. Additionally, as deductibles have risen dramatically over the past few years, particularly in the health insurance exchanges, Pamela will present research into the increasing costs facing patients through high deductibles and increasing use of coinsurance. Categories of focus will include rheumatoid arthritis, multiple sclerosis, hepatitis C, psoriasis, asthma, and diabetes.

By attending this session, you should be able to:

  • Outline when and why patients decide not to fill their medications;
  • Articulate the clinical, economic and social factors that influence patient fill behavior and medication adherence;
  • Identify which patient profiles best adhere to their medications and why; and
  • Classify patient cost burden based on benefit design.

12:00 pm – 12:30 pm

Breakout Session 1 of 1

Payers’ Specialty Management Strategies – Focus on the Medical Side of the Benefit

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Brian Seiz, Vice President & General Manager, Specialty Solutions, 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, payers are demanding aggressive management strategies to bring down the trend.  In this session, Brian will offer his perspective on management of the medical side of the equation.  He will highlight topics such as site of care management, oncology decision support and much more.

By attending this session, you should be able to

  • Outline the division of specialty drug spend on pharmacy and medical benefit;
  • Explain a few ways in which the patient, provider, the PBM, the specialty pharmacy and the drug maker can find common ground; and
  • Discuss strategies to create more aligned incentives for patient care

1:30 pm – 2:15 pm

Breakout Session 1 of 2

Incentives and Payment Structures in the Health Care Delivery Model

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Jon Maesner, Chief Pharmacy Officer, Cigna

John Fox, Associate Vice President, Medical Affairs & Senior Medical Director, Priority Health

Moderator: Debbie Stern, Senior Vice President, Strategy and Business Development, CareCore National / MedSolutions

Join three industry leaders for a discussion on new and innovative strategies that payers are deploying to align incentives and payment across network providers in a way that promotes value over volume, using oncology as an example.

By attending this session, you should be able to:

  • Describe how public and private payers are identifying opportunities for payment reform;
  • List at least two mechanisms for developing value-based reimbursement within a health plan;
  • Outline new drivers that incorporate personalized medicine, cost-effectiveness and quality of life into drug therapy management; and
  • Apply value-based health care principles to comprehensive oncology management.

1:30 pm – 2:15 pm

Breakout Session 2 of 2

The New Playbook for Hub and Pharmacy Interaction – How Market Forces are Changing the Dynamics

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Rob Osborne, Vice President, Business Development, Express Scripts

Moderator: David Galardi, Worldwide Managing Director, Apogenics

There have been major changes to the Patient Service Hub model in recent years and the new playbook is different now than in years past. As oral specialty medications enter the market, specialty pharmacies are increasingly working with payers and providers to support patients prescribed such therapy.  At the same time, regulations are changing the playbook and causing manufacturers to evaluate and update the design of many of their products’ market access models.

 

The role of the Hub is evolving into a reimbursement and financial assistance support center that plays an important role in reducing the burden of the patient.  During this session, Rob and David will address these trends and what they mean for various stakeholders.

By attending this session, you should be able to:

  • Outline why oral therapies have the ability to impact the marketplace more than other therapies;
  • Describe one way in which new regulations will impact patients;
  • Discuss new AE requirements that are appearing in some contracts; and
  • Explain one reason why this evolution is providing specialty pharmacies with an opportunity to re-engage manufacturers on their services.

2:30 pm – 3:00 pm

Breakout Session 1 of 2

Payer Demands for Value – Considerations around Risk

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Steve Avey, Vice President, Specialty Pharmacy Programs, MedImpact Healthcare Systems, Inc.

As specialty spend continues to grow, payers are demanding more evidence demonstrating the value of expensive specialty products. At the same time, manufactures need to better understand the value of the services specialty pharmacies provide to clients improving clinical outcomes. There is a growing level of interest from the two stakeholders around risk. During this session, Steve will outline what kind of risk sharing arrangements are possible and what therapeutic categories they might involve.

By attending this session, you should be able to:

  • Outline a few examples of risk sharing arrangements that are presenting in the specialty arena;
  • Describe outcomes reporting for specialty; and
  • List two key elements of the value equation for specialty medications.

2:30 pm – 3:00 pm

Breakout Session 2 of 2

Use of Integrated Technologies to Develop Patient-Centric Support Models in Specialty Care

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Rujul Desai, Vice President, Avalere Health

New technologies for patient engagement, care management and data integration are transforming health care delivery and care coordination.  This session will explore some of the key trends in health information technology and data analytics with a specific focus on creating improved patient support models in specialty care from a multi-stakeholder and 360-degree perspective.  The convergence of these technology trends, a more favorable regulatory climate, and an emphasis on innovation are creating the ability to develop and implement better support tools to drive actionable intelligence, real-time decision making, and maximum value for patients, providers, payers, pharmacies and PBMs.

By attending this session, you should be able to:

  • Describe how your organization can best leverage these technology trends for specialty care coordination, and how early adopters are leading the way;
  • Outline how the regulatory and policy climate is evolving to help foster innovation for patient centric support models; and
  • List at least one integration opportunity in EMR/EHR, real-time data, big data, choice optimization, visualization and mobility.