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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PCMA Convenes Thought Leaders to Discuss High Price Drugs

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sPCMA Business Forum 2018 Agenda

Monday, March 5
6:30 am – 7:00 pm

Registration Open

7:00 am – 6:30 pm

Private Meeting Rooms Open

7:30 am – 9:00 am

Networking Breakfast &

Women’s Leadership Breakfast

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This breakfast program will offer our female attendees an opportunity to connect and share personal experiences as leaders in health care. Starting with a breakfast reception, attendees will have some initial time to network and converse. Then, a panel will share personal perspectives, career experiences, and discuss why supporting women in health care is important. The panel will speak for about 15 minutes, leaving time for audience Q&A and small group discussion. Themes that will be addressed include what does women’s leadership mean to you, effective communication styles, engaging career mentors or sponsors, and balancing work and personal goals.

 

Lida Etemad, Vice President, Pharmacy Management Strategies, E&I and C&S, UnitedHealthcare

Sandy Loreaux, Senior Vice President, Market Access and Commercial Operations, Valeant

Moderator: Betty Nguyen, Anchor & Journalist, NBC News & MSNBC

 

Breakfast Agenda

7:30 am – Breakfast Reception

8:00 am – Discussion

8:15 am – Audience Q&A

8:30 am – Small Group Discussion

8:45 am – Breakfast Ends

9:00 am – 9:30 am

Breakout Sessions (two concurrent)

 

Outcomes-Based Contracting in Integrated Health Delivery: Addressing Affordability and the Evidence Gaps

Bethanie Stein, Vice President, Trade Relations, Humana Pharmacy Solutions

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As our experience has grown with value-based contracting, we need to apply our knowledge while keeping affordability of the healthcare system at the core. Shifting our strategy to address uncertainty, coupled with a strong focus on the drug pipeline should define the road to success of value-based contracting.

By attending this session you should be able to:

  • Review one payer’s perspective on the best arrangements for value-based contracting; and
  • Outline three types of value base contracts that address uncertainty and provide a feedback loop to formulary decisions.

 

How Health Care Companies are Using Data and Predictive Algorithms to Identify and Address the Opioid Crisis

George Van Antwerp, Senior Manager, Deloitte Consulting LLP

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As the opioid crisis remains a front page issue, companies across the ecosystem are constantly evolving the role they play.  This session will look at the key questions being asked about how to address the opioid crisis and share real-world examples of how data and analytics are being used to address these problems.

By attending this session, you should be able to:

  • Describe at least two data sources being integrated to evaluate this issue; and
  • List at least two real-world examples of how data has been applied to answer questions such as:
    • What are the “hot spots” of abuse and where are focused efforts needed?
    • Who is at risk?
    • Which intervention is appropriate?

9:30 am - 9:45 am

Break

 

9:45 am - 11:45 am

General Sessions

 

9:45 am – 10:15 am: Current and Future Trends in Specialty Pharmaceuticals

Doug Long, Vice President, Industry Relations, IQVIA

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This session will explore trends impacting the U.S. pharmaceutical market.

Topics addressed will include:

  • How biologics’ entry into traditional space is shifting business from retail to PBMs, IDNs, and others;
  • Impact of the latest biosimilar innovations;
  • Current market growth compared to 2014 and 2015 – the state of the market and impact of a few high impact products;
  • Brand price inflation and generic price deflation; and
  • Deductible accumulators and other activity impacting adherence.

 

10:15 am – 10:45 am: Components of Success in Value-Based Purchasing

Amy Bricker, President, Supply Chain, Express Scripts

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Value-based contracting and its ability to drive results for commercial payers, manufacturers, and patients continues to be a critical and growing tool in the health care continuum. Learn more about real-world examples of how value-based contracting is being utilized and how PBMs and manufacturers partner together to improve patient care while bringing down the cost of treatment.

By attending this session, you should be able to:

  • Name two ways that value-based contracting is leveraged in the market;
  • Provide examples of how this is impacting patient care and health care costs; and
  • Outline metrics of success for value-based contracting.

 

10:45 am – 11:15 am: 2018 Thoughts Across the Rx Supply Chain: Disruption, Consolidation, Washington, DC, and Consumerism

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

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Wall Street analysts always offer our attendees a unique and thought provoking perspective of our industries. During this session, Lisa will share her thoughts on the most important trends impacting the intersection of PBMs and manufacturers.

Some of the ideas that will be addressed include:

  • Outlook for 2018 across the drug supply chain – Key themes and growth drivers
  • Industry disruptors – Amazon, Health Transformation Alliance, and the Berkshire Hathaway/J.P. Morgan/Amazon partnership
  • Implications of industry consolidation
  • Activity in Washington DC; and
  • Consumerism in health care.

 

11:15 am – 11:45 am: The Growth of Specialty Pharmacy: Key Trends to Consider

Alan Lotvin, Executive Vice President, CVS Specialty, CVS Health

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As specialty continues to grow, estimated to reach $280B by 2021, market dynamics will have wide ranging impacts on how cost-effective care is delivered. During this session, Alan will discuss key trends he believes are crucial for the specialty pharmacy industry to address.

  • The robust pipeline of specialty agents for higher prevalence disease states deliver great clinical promise, but also come with added cost pressure.
  • Transformative therapies, like high-cost CAR T-cell products, present a challenging economic proposition in a fragmented U.S. market.
  • Advances in oncology testing creates both complexity and opportunity for better patient care.
  • True generics and biosimilars are emerging as a significant factor in specialty management.

11:45 am - 1:15 pm

Networking Lunch &

Member Company Lunch Receptions: Aetna, Humana, OptumRx, Prime Therapeutics

These receptions promote business interactions between PBM members, drug manufacturers, and other industry partners. Attendees flow in and out of the concurrent receptions, whereas PBM members serve as hosts in their designated room during the reception time.

1:15 pm - 1:45 pm

Breakout Sessions (two concurrent)

 

Coupons, Copay Cards, and Conversion Programs

Lida Etemad, Vice President, Pharmacy Management Strategies, E&I and C&S, UnitedHealthcare

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Coupon and copay card programs have proliferated in recent years and have become a standard part of the drug commercialization process.  This session will provide a brief review of programs that lower member cost-share, how they work, and their implications, along with a payer’s viewpoint on these programs.

By attending this session, you should be able to:

  • Differentiate between various types of pharmaceutical manufacturer funded patient cost-share offset programs; and
  • Outline some of the diverse perspectives of the impact of these programs.

 

The Latest in Value Frameworks

Ed Pezalla, Payer Expert & Former Vice President and National Medical Director, Pharmaceutical Policy and Strategy at Aetna

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Over the past few years we have seen the introduction of multiple value frameworks. During this session, Ed will provide an overview of the value frameworks being used today – by whom and why. He will share insights related to new developments in the field – including PhRMA’s creation of their own value framework, and recent ISPOR guidelines related to economic evaluation. He will conclude with his thoughts on implications for this emerging and increasingly crowded space.

By attending this session, you should be able to:

  • Describe at least two value frameworks in the market today; and
  • Name as least one implication of the new ISPOR guidelines.

1:45 pm - 2:00 pm

Break

2:00 pm - 2:30 pm

Breakout Sessions (two concurrent)

 

Evolution of the P&T Committee: Moving from Drug Evaluation to Population Health Management

Jay McKnight, Vice President, Pharmacy Clinical Strategies, Humana Pharmacy Solutions

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Pharmacy and Therapeutics (P&T) Committees were introduced almost a century ago to provide rudimentary drug lists. In more contemporary times, they serve as a forum for the evaluation of drugs by clinical experts in varying disciplines. Today, P&T Committees must evolve to address the challenge of synthesizing the evidence base to develop coverage polices for complex pharmaceutical agents, many in disease populations where there have never been treatment options.

By attending this session, you should be able to:

  • Identify the purpose and structure of a Pharmacy & Therapeutics Committee
  • List the evidence types considered by Pharmacy & Therapeutics Committees when determining formulary coverage and policy; and
  • Identify examples of the evidence gaps in emerging therapeutics.

 

The Value and Use of Digital Therapeutics in Patient Care

Scott Honken, Senior Vice President, Payer Sales and Strategy, Voluntis

Caroline York, Senior Vice President, Operations, WellDoc

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Digital therapeutics (DTx) represent a new generation of healthcare that uses innovative, clinically-validated disease management and direct treatment applications to enhance, and in some cases replace, current medical practices and treatments. DTx products demonstrate safety and efficacy in clinical trials, receive regulatory clearance when used as a medical device, integrate into clinical practice, may be prescribed by healthcare providers, and tailor to patients’ clinical needs, goals, and lifestyles.

These clinically-validated solutions may be used as standalone interventions (i.e. replacing a medication therapy or filling a gap where no treatment exists today) or in association with other treatments (e.g. prescribed alongside a medication to extend the efficacy of the drug therapy) to engage patients and improve the overall quality, cohesion, outcomes, and value of healthcare delivery. Patients representing a wide spectrum of conditions — including respiratory, cardiovascular, endocrine, and mental health conditions — benefit from the use of digital therapeutics.

During this session, Scott and Caroline will provide an overview of digital therapeutics, including examples of existing products, demonstrated clinical outcomes, and successful reimbursement models. They will conclude by offering recommendations on how industry stakeholders can work together to ensure that these products are accessible to patients, prescribed by providers, and models that payers should consider to gain the value from this new generation of therapies.

By attending this session, you should be able to:

  • Describe two existing digital therapeutic solutions;
  • Differentiate digital therapeutics from general digital health apps; and
    Outline at least one reimbursement model for DTx products.

2:30 pm - 2:45 pm

Break

2:45 pm - 3:15 pm

Breakout Sessions (two concurrent)

 

Specialty Pharmacy Limited Networks: When and How to Re-evaluate

Phyllis Kidder, Senior Principal, Blue Fin Group

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Once a manufacturer has established a limited or exclusive specialty pharmacy network for a product, it can be tempting to leave it “as-is” if no obvious issues arise. During this session, Phyllis will discuss the rationale for a thoughtful and proactive, time-based approach for re-evaluating a manufacturer’s SPP network including what is a potential framework for re-evaluation, when and how often re-evaluation should occur, additional triggers for re-evaluation, developing criteria to evaluate potential new SPP partners, including the addition of IDN SPPs to your network, and managing the size of your network.

By attending this session, you should be able to:

  • Describe when and how often SPP network re-evaluation should occur; and
  • Outline criteria for evaluating new SPP partners.

 

Identifying Market Level Influences Driving Utilization Patterns of Specialty Products to Guide Intervention

Larry Blandford, Executive Vice President, Managing Partner, Precision Xtract

Ashwin Athri, Senior Vice President, Promotional Effectiveness, Precision Xtract

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This session will demonstrate how to leverage local market commercialization frameworks with multiple data sources to identify the primary drivers of product utilization influence. Larry and Ashwin will demonstrate how to use identified primary local market-based influencers across payers, health systems, and prescribers to inform strategies such as contracting, account prioritization, targeting, etc, for product utilization and network management. They will apply these methodologies for oncology products to highlight the variance in primary influencers by local market and the importance of considering payer, provider, channel, and tumor prevalence when projecting the utilization of new and existing treatments.

By attending this session, you should be able to:

  • Describe the impact of IDNs on oncology treatment in local markets;
  • Outline the variance that can occur in payer and provider relative control in local markets; and
  • Describe how treatment utilization can vary across provider types.

3:15 pm - 6:30 pm

Open time for private meetings

6:30 pm - 9:00 pm

Cocktail and Dinner Reception with Live Music

Live music, food stations and views of the golf course provide a relaxed and fun atmosphere — perfect for business networking — during this special reception and dinner.

Tuesday, March 6
7:00 am - 4:00 pm

Registration Open

7:00 am - 8:00 pm

Private Meeting Rooms Open

7:30 am - 9:00 am

Networking Breakfast &

Member Company Breakfast Reception: Magellan Rx Management

These receptions promote business interactions between PBM members, drug manufacturers, and other industry partners. Attendees flow in and out of the concurrent receptions, whereas PBM members serve as hosts in their designated room during the reception time.

9:00 am - 10:45 am

General Sessions

 

9:00 am – 9:15 am: Health Care: The Current Political and Policy Environment

Mark Merritt, President & Chief Executive Officer, PCMA

 

9:15 am – 9:45 am: Managing Specialty Costs by Improving Patient Care

Jon Roberts, Executive Vice President & Chief Operating Officer, CVS Health

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Effectively managing the cost of specialty care requires a focus on more than drug costs alone. In this PBM leadership session, Jon will discuss benefit management strategies aimed at improving health outcomes and simplifying the health care experience, and why they are key to lowering spending overall. These strategies also require working closely with multiple stakeholders, including patients, payers, and providers.

Areas of focus will include:

  • Management of drugs paid under the medical benefit;
  • Comprehensive care management to lower and prevent medical costs; and
  • Technology solutions to simplifying administrative processes for providers and reduce delays in care for patients.

 

9:45 am – 10:15 am: Scientific Relevance vs. Commercial Viability: The Bar for Innovation

Kent Rogers, Senior Vice President, Industry Relations, OptumRx

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During this session, Kent will explore some crucial questions related to the future of the pharmacy marketplace.

  • There is still a gap in knowledge exchange among pharma executives and payers. How can we address this and what are the implications if it continues?
  • Disruptive pricing strategies have taken aim at the current model. How has this been received and what are the implications?
  • Have payer and pharma rebate negotiations reached a tipping point? If so, what’s next?
  • Are value-based agreements the new world order? Is the market ready for this kind of change?

 

10:15 am – 10:45 am: Health System Vale-Based Purchasing

Will Shrank, Chief Medical Officer, UPMC Health Plan

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In this session, Dr. Shrank will discuss how health systems and IDNs are engaging in value-based purchasing. In doing so, he will draw upon his experience with the newly formed UPMC Center for Value-Based Purchasing of Pharmaceuticals.

Areas of focus will include:

  • Consensus-based, empirically-driven outcome measures;
  • Transparency, objectivity, and feasibility of measurement;
  • The role of the provider in contract development; and
  • Unique implementation opportunities in vertically integrated environments.

10:45 am - 11:00 am

Break

11:00 am - 11:30 am

Breakout Sessions (two concurrent)

 

Specialty Pipeline Trends, a Payer Perspective: How to Leverage Data for High Impact Drug Management Programs

Steve Johnson, Assistant Vice President, Health Outcomes, Prime Therapeutics

Rae McMahan, Vice President & General Manager, Enterprise Specialty Pharmacy, Prime Therapeutics

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With specialty drug spend on the rise and the pharmaceutical pipeline dominated by potentially high-cost gene therapies (such as CAR-T), as well as new biosimilar products, it is important for payers to proactively monitor novel specialty therapies to understand cost and benefit implications.

During this session, Steve and Rae will discuss how Prime watches and monitors the specialty drug pipeline and assesses new therapies under the pharmacy or medical benefit, and how Prime combines medical and pharmacy data to inform health plans of what’s to come. They will also cover how Prime collaborates with plans to implement strategies to leverage these innovative new therapies.

By attending this session, you should be able to:

  • Discuss new specialty therapies in the pipeline, and their importance from a payer perspective;
  • Identify some of the factors that go into the analysis of these new products, and
  • Outline how health plans leverage real world data and analytics to make drug management program decisions.

 

Evolution of the Health Care Economic Information Exchange and Implications of Recent Legislation and Policy Updates

Laurent Carter, Vice President, U.S. Strategic Payer Marketing, Bristol-Myers Squibb

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This session will discuss the genesis of Health Care Economic Information Exchange (HCEI) communication between manufacturers and payers and will review basic tenets of FDAMA section 114, which first enabled manufacturers to share HCEI. The session will also outline recent updates from the 21st Century Cures Act and FDA draft guidance as it relates to real world evidence communication between pharmaceutical companies and payers.

By attending this session, you should be able to:

  • Outline the evolution of policy governing  pharmaceutical communication of HECI;
  • Discuss the four key tenets which guide HCEI communication per the 21st Century Cures Act, section 3037 and FDA draft guidance; and
  • List at least two implications of increased volume and evaluation of quality HCEI communications utilizing these industry standards.

11:30 am - 11:45 am

Break

11:45 am - 12:15 pm

Breakout Sessions (two concurrent)

 

Leveraging Advancing Technologies to Drive Innovation in Health Care

Todd Lord, Vice President, Magellan Method, Magellan Rx Management

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The rapid evolution of the healthcare industry can be, in part, attributed to advancements in technology. Technological breakthroughs both in and outside of our industry are revolutionizing the way healthcare is being delivered and monitored. Learn more about how developments in blockchain, machine learning, genomics, and cognitive and digital therapies are challenging the status quo and driving innovation.

By attending this session, you should be able to:

  • Provide three examples of new technologies that are changing healthcare;
  • Summarize how information technology can enhance efficiency and improve member engagement; and
  • Name at least two potential barriers for implementation.

 

Real World Evidence Driving Insights on Value of Care

Brian Solow, Chief Medical Officer, Optum Life Sciences

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This session will explore what is new and strategic in the real world evidence/data space. As with the current scramble for value/outcomes-based contracting, everyone seems to be anxiously trying to capture RWE for their products. But the question remains – do payers find this information valuable? Will it have impact at a pharmacy and therapeutics level? Will it have impact in the contracting arena? During this session, Brian will delve into these questions and other pertinent topics surrounding RWE.

By attending this session, you should be able to:

  • Describe at least two advantages of RWE;
  • Outline designs of RWE studies that will be best used in the payer environment; and
  • Name at least two current strategies used by PBMs regarding the use of RWE.

12:15 pm - 1:45 pm

Networking Lunch &

Member Company Lunch Receptions: CVS Health and Express Scripts

These receptions promote business interactions between PBM members, drug manufacturers, and other industry partners. Attendees flow in and out of the concurrent receptions, whereas PBM members serve as hosts in their designated room during the reception time.

1:45 pm - 2:15 pm

Breakout Session 

 

Rare Diseases: Not So Rare

Harold Carter, Senior Director, Clinical Solutions, Express Scripts

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Innovative new products recently launched along with a robust drug pipeline represent a rapidly evolving rare disease landscape that requires both improved patient care and unique management. Despite few patients suffering from complex and costly rare diseases, these steadily growing number of Americans represent a significant challenge to the overall healthcare system. During this session, you will learn more about the rare disease pipeline, recent drug launches, and how managing these products requires different lenses.

By attending this session, you should be able to:

  • Name at least two products in the rare disease pipeline;
  • Outline the impact of recent drug launches on overall spend; and
  • Provide examples of unique management opportunities, including specialized care and value-based purchasing.

 

2:15 pm - 8:00 pm

Open time for private meetings

8:00 pm - 10:00 pm

Cocktail and Dessert Reception

Swing by the lobby lounge for dessert, cocktails, and conversation with colleagues and industry peers at this after-dinner reception.