Pharmacy benefit managers are at the forefront of implementing innovative contracting techniques that better align the cost of medications with their value. By offering additional tools to manage specialty drugs, including the use of specialty pharmacies, PBMs and payers are improving the quality and continuity of care patients receive, while ensuring they derive the greatest value from their medications. Over the next 10 years, PBMs and specialty pharmacies will save an estimated total of $654 billion on drug costs for health plan sponsors.

The PCMA PBM Policy Forum is designed for policy makers and staff from Capitol Hill and the Administration, as well as healthcare and drug industry advocates from think tanks, patient advocacy groups, and industry trade associations. The PCMA Policy Forum 2016 hosted almost 200 people from more than 100 companies, organizations, and government offices.

The 2016 Policy Forum focused on market-based solutions to lower the cost of prescription drugs, such as the use of biosimilars, specialty pharmacies, and value-based contracting, as well as managing costs in the medical benefit. The forum featured leaders from the FDA, CMS, the Hill, Cigna, CVS Health, Express Scripts, and OptumRx.

Conference Program

2016_PBM Policy Forum_Program Book

Conference Highlights

Policy Forum 2016 Agenda

Monday, April 11
12:15 pm – 12:20 pm

Welcome and Introductions

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Conference Moderator: Susan Dentzer, President & Chief Executive Officer, Network for Excellence in Healthcare Innovation and Senior Policy Adviser, Robert Wood Johnson Foundation

12:20 pm – 12:50 pm

Innovation, Competition, and Cost: Perspectives From Capitol Hill

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Mary Sumpter Lapinski, Health Policy Director, Senate Health Education Labor and Pensions Committee (Majority)

Emily Murry, Staff Director, Health Subcommittee, House Committee on Ways & Means (Majority)

12:50 pm – 1:05 pm

How Policymakers Can Leverage Competition to Reduce Rx Costs

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Mark Merritt, President & Chief Executive Officer, PCMA

PCMA President and CEO Mark Merritt highlighted one of the critical challenges in healthcare today: how to manage pharmacy costs and improve access in an era when high cost medicines are becoming a larger part of drug spending. Merritt outlined how PBMs are meeting this challenge by using innovative management techniques that increase choice and competition, while reducing costs

1:05 pm – 1:35 pm

Managing High Impact Pipeline Drugs: Evolving Payer Considerations

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Farrah Wong, Director, Pipeline and Drug Surveillance, OptumRx

PBMs require more outcomes data from manufacturers to ensure these treatments are safe, effective, clinically appropriate for patients, and can increase patient survival. Improved outcomes data and competition in the market will allow PBMs to identify the most effective treatments for patients while ultimately lowering costs.

1:35 pm – 2:05 pm

What Makes Specialty Pharmacies Special and Why They Are Crucial to the Future of Drug Cost Management

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Everett Neville, Senior Vice President, Supply Chain, Express Scripts

Compared to traditional pharmacies, specialty pharmacies are able to prove their cost containment abilities and implement more complex criteria for patients using specialty drugs. When specialty pharmacists guide patients through each step of their treatments and apply PBM tools to the process, these pharmacies continue to achieve markedly different impacts on clinical outcomes and cost reductions from unmanaged patient care, up to a 50% trend difference.

2:05 pm – 2:35 pm

Managing the Escalating Cost and Utilization of Medical Benefit Drugs

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

“By using a relatively non-aggressive prior authorization, it’s possible to take out 3% of the drug spend under the medical benefit. When applied to the Medicare population, this could save $1.3 billion. Without impairing or restricting care, it is possible to make a huge impact on the budget with a relatively small amount of work.”

2:35 pm – 3:05 pm

The Challenges of High Cost Drugs for Medicare

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Sean Cavanaugh, Deputy Administrator & Director, Center for Medicare, Centers for Medicare & Medicaid Services

“The Medicare Part D program is in great shape, with over 40 million beneficiaries receiving benefits, and premiums having been essentially stable since the passage of the Affordable Care Act. We have been touting the successes of the program and rightfully so, with many in this room having helped contribute to the success of this program, and we thank you.”

3:05 pm – 3:35 pm

Value-Based Contracting and How it Is Being Applied in the Commercial Marketplace for Savings

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Chris Bradbury, Senior Vice President, Integrated Clinical Solutions and Specialty Pharmacy, Cigna Pharmacy Management

As the industry progresses toward an explosion of innovation, patients and all stakeholders must be committed to managing the total affordability and sustainability of healthcare long-term. In the midst of these increasing expenditures, PBMs are asking manufacturers to stand by their products in the real world and rely on the support of specialty pharmacies to provide the right support to patients and providers.

3:35 pm – 4:05 pm

The FDA’s Role in Competition: Streamlining Approval Processes and Facilitating Biosimilars

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Rich Moscicki, Deputy Center Director for Science Operations, Center for Drug Evaluation and Research, Food and Drug Administration

FDA leaders prioritized the approval of backlogged applications based on public health priorities, including those classes with sole source drugs on the market. Although the FDA could not consider the cost of drugs as a prioritization factor, by prioritizing the application of sole source drug classes, the FDA succeeded in addressing competition in the market.