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 2018 Agenda

Monday, March 11
7:00 am – 6:30 pm

Private Meeting Rooms Open

7:00 am – 8:45 am

Women’s Leadership Breakfast

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

Karen Hough, Founder & Chief Executive Officer, ImprovEdge                                              *Appearance is underwritten by Boehringer Ingelheim

Christine Marsh, Vice President, Market Access, Boehringer Ingelheim

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The breakfast program will offer female attendees an opportunity to connect with one another and learn about the importance of “presence” in both our professional and personal lives. Attendees will have time to network and converse before a 45-minute interactive workshop: “Presence: Impact and Influence,” led by Karen Hough, founder and chief executive officer of ImprovEdge. Karen will guide attendees through exercises that demonstrate how you can use the art of improvisation and your own authentic presence to build trust, impact, and influence. Attendees will learn simple communication techniques that are essential to building better relationships, examine different modes of influence — including effective questioning, and build awareness of influence based on perception and brain science.

Then, a panel will share their personal perspectives and experience with presence. The panel will speak for about 30 minutes during which there will be an opportunity for audience Q&A.

7:00 am Breakfast
7:30 am Presence: Impact and Influence
8:10 am Panel Discussion and Audience Q&A
8:45 am Breakfast Ends

7:00 am – 9:00 am

Networking Breakfast

9:00 am – 12:00 pm

General Sessions

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

 

9:00 am – 9:30 am

Welcome & Opening Remarks

JC Scott, President & Chief Executive Officer, PCMA

 

HHS’s Proposed Rebate Rule: Implications to the Drug Supply Chain

Ian Spatz, Senior Advisor, Manatt Health

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On January 31, 2019, the Office of Inspector General (OIG) released a proposed rule that amends the discount safe harbor regulation to eliminate protection for price reductions, including rebates, that are offered by pharmaceutical manufacturers to plan sponsors under Medicare Part D, Medicaid managed care organizations, or PBMs under contract with them.

If the rule is finalized as proposed, the current safe harbor protection for rebates would end on January 1, 2020. Simultaneously, the OIG proposes to create two new safe harbors effective 60 days after the publication of the final rule, the first of which would protect certain point-of-sale (POS) reductions in price offered by manufacturer, and the second that would protect certain PBM service fees. If finalized as proposed, the rule would have a major impact on current drug supply chain transactions, and could result in significant cost transfers in the Medicare and Medicaid programs.

During this session, Ian will discuss implications to the primary players in the supply chain if this rule were to be finalized.

 

9:30 am – 10:00 am

American Patients First Blueprint Discussion and Update

John O’Brien, Senior Advisor to the Secretary for Drug Pricing Reform, U.S. Department of Health and Human Services

Moderator: Kristin Bass, Chief Policy and External Affairs Officer, PCMA

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HHS continues to take action on the four strategies contemplated in the American Patients First Blueprint they released in May last year: increased competition, better negotiation, incentives for lower list prices, and reducing out-of-pocket costs. Most recently, the long-anticipated proposed rule for removing safe harbor protection for rebates involving prescription pharmaceuticals and the creation of a new safe harbor protection for certain point-of-sale reductions in price of prescription pharmaceuticals and certain PBM service fees has the potential to disrupt the entire pharmacy supply chain. Pharmaceutical and biotech manufacturers, pharmacy benefit managers, and other stakeholders in the market have indicated that they recognize the scale of disruption this would involve.

During this session John will discuss the proposed rebate rule, as well as other actions being taken by HHS as they continue executing priorities detailed in the Blueprint.

 

10:00 am – 10:45 am

The Future of PBM-Pharma Relations and Negotiations

Dave Moules, Vice President, U.S. Payer and Channel Access, Pfizer

Everett Neville, Executive Vice President & Chief Value Officer, Express Scripts

Brendan O’Grady, Executive Vice President, North America Commercial, Teva Pharmaceuticals

Kent Rogers, Senior Vice President, Chief Formulary and Procurement Officer – Industry Relations, OptumRx

Moderator: Ian Spatz, Senior Advisor, Manatt Health

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The rebate contracting system we know today has been an extremely effective tool for drug discount negotiations and cost management.  As the comment period draws to a close for the HHS proposed rule to remove the safe harbor protection for rebates in Medicare and Medicaid, we expect significant changes to the system. During this session, our panel will discuss the drivers of this change and how it will impact the supply chain.

 

10:45 am – 11:15 am

The Biggest Disruptor in Healthcare is…

Lisa Gill, Managing Director, Senior Analyst Equity Research, Healthcare Services – Technology, Distribution & PBMs, JPMorgan

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What will be the biggest disruptor to healthcare over the next few years? Amazon? Government? New Entrants? JPMorgan believes the biggest disruptor in healthcare services will be the consumer. Price, convenience, and quality will drive how and where healthcare services are consumed. Patients are more involved in healthcare decisions and how to allocate their healthcare dollars than ever before.

 

11:15 am – 12:00 pm 

Specialty Pharmaceuticals: Trends & Outlook

Doug Long, Vice President, Industry Relations, IQVIA

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This session will explore trends impacting the U.S. specialty pharmaceuticals market.

During the session Doug will:

  • Provide an overview of market trends including single digit growth, implications related to the hepatitis C and pain categories, and the impact of less brand inflation and more generic price deflation;
  • Expand on differences between invoice and net and explain where rebates are going for Medicare, Medicaid, commercial plans;
  • Review key market access trends including formulary exclusions, more burden on the patient, price transparency, vertical integration, IDNs and ACOs; and
  • He will offer an update on biosimilars and other innovations in the pipeline.

12:00 pm - 1:30 pm

Networking Lunch & 

Member Company Lunch Receptions: Humana Pharmacy Solutions & Prime Therapeutics

These receptions offer excellent opportunities for interactions between PBM and SP members, drug manufactures, and other industry partners. Attendees flow in and out of the concurrent receptions while members serve as hosts in their designated room during the reception time.

1:30 pm - 2:00 pm

Breakout Sessions (two concurrent)

 

Medicare Part B Step Therapy: The Evolution of Evidence Based and Patient-Centered Medication Management

Bethanie Stein, Vice President, Strategic Contracting, Purchasing, and Analytics, Humana Pharmacy Solutions

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Medicare Advantage (MA) drug policy has changed and beginning  January 1, 2019,  health plans can apply step therapy guidelines for physician-administered medications covered by MA plans. Step therapy requires beneficiaries to use evidence based  and condition-specific preferred medications before using more expensive drugs which allows health plans to provide beneficiaries with value based medication access.

By attending this session you should be able to:

  • Describe Medicare Advantage (MA) plan options for addressing evidence based Part B drug utilization management;
  • Outline 2019 CMS guidance on plan application of step therapy for Part B drugs and possible flexibilities that may be finalized for plan year 2020; and
  • Explain MA plan strategies for advancing market based solutions to manage Part B drugs.

Activity Type: Knowledge-based (K); Target Audience: Pharmacists (P); CEUs: 0.050; UAN: 0841-0000-19-001-L04-P

 

What’s Trending for Pharmacy?

Farrah Wong, Senior Director, Commercial Formulary Contracting Strategy, OptumRx

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This session will explore the trends and upcoming pipeline agents that will be moving the market in the upcoming few years. Farrah will offer a sneak peek into key pharmacy trends, products that are anticipated in the next few years, she will discuss underlying factors on key cost drivers, and she will provide examples of what payers are doing to outpace these challenges.

By attending this session, you should be able to:

  • Identify at least two high impact pipeline drug agents; and
  • Outline how health plan data and modeling influence drug management strategies.

Activity Type: Knowledge-based (K); Target Audience: Pharmacists (P); CEUs: 0.050; UAN: 0841-0000-19-002-L04-P

2:00 pm - 2:15 pm

Break

2:15 pm - 2:45 pm

Breakout Sessions (two concurrent)

 

Optimizing Healthcare Value in the U.S. – Can it be Done?

Kjel Johnson, Vice President, Specialty Strategy and Client Solutions, CVS Health

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This session will discuss the U.S. interest in measuring healthcare value – how it works, who does it, and what is  happening in the U.S. versus outside the U.S. Kjel will touch on the Administration’s work to improve value in specialty including their Part B proposal and initiatives related to Part B stepped care and biosimilars. He will also review value-based contracting across the system and what various stakeholders are doing.

By attending this session, you should be able to:

  • Describe the best ways to measure healthcare value;
  • List the current Medicare value efforts; and
  • Develop a strategy to improve healthcare value.

Activity Type: Knowledge-based (K); Target Audience: Pharmacists (P); CEUs: 0.050; UAN: 0841-0000-19-003-L04-P

 

A Novel Approach to Linking Pharmaceutical Pricing and Value Assessments to Evolving Evidence

Larry Blandford, Executive Vice President, Customer Solutions, Precision Value & Health

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With the continued escalating pressure on pricing of biopharmaceuticals, activity in more formally assessing their value has grown in the U.S. While several entities have proposed or implemented different methodologies for value assessment, rarely are these assessments updated as evidence evolves. The session proposes a novel approach for dynamically updating value assessments as new evidence becomes available by applying modified versions of accepted methodologies often incorporated into health technology assessments used around the world. The output can then be leveraged for both pricing decisions by biopharma companies, pre- and post-launch, as well as for payers to formalize the basis for informing initial and ongoing coverage decisions. With ICER’s intent to report on products whose price increases are not supported by evidence, and governmental inquiries into the rationale for price increases, the approach provides a method for both biopharmaceutical companies and payers to achieve more accurate and current value determination under their own terms rather than to have product value dictated by others.

By attending this session, you should be able to:

  • Describe factors driving a need to link pricing with evolving evidence;
  • Explain ways in which existing value assessment methodologies are effective and yet lacking in supporting pricing and coverage decisions;
  • Identify reasons why linking dynamic evidence assessments with pricing decisions would be beneficial to a biopharmaceutical company; and
  • Identify reasons why linking dynamic evidence assessments with coverage decisions would be beneficial to a benefit manager or health plan.

Activity Type: Knowledge-based (K); Target Audience: Pharmacists (P); CEUs: 0.050; 0841-0000-19-004-L04-P

2:45 pm - 3:00 pm

Break

3:00 pm - 3:30 pm

Breakout Sessions (two concurrent)

 

Value Based Contracting: Did We Accomplish What We Set Out To Do?

Lisa Carman, Vice President, Value Based Contracting, Optum Life Sciences

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This session will offer a strategic recap of where the industry is with regard to value based contracting (VBC). As every company in the health care continuum scrambles to develop value contracts, questions remain – are we accomplishing what we set out to do? During this session, Lisa will provide an overview of some of the goals of VBC and review regulatory and other challenges. She will discuss parts of  VBC beyond design and whether VBC can ever be a valid formulary tool. She will present a case study and explore lessons learned from pilots and mistakes. And she will explore what’s next, specifically opportunities related to rare disease and gene therapy.

By attending this session, you should be able to:

  • List two challenges related to value based contracting;
  • Describe the parts of a value based contract; and
  • Outline opportunities for rare disease and gene therapy applications of value based contracts.

Activity Type: Knowledge-based (K); Target Audience: Pharmacists (P); CEUs: 0.050; UAN: 0841-0000-19-005-L04-P

 

The Use of Evidence Platforms and AIML to Follow Specialty Populations

Ken Park, Vice President, Real-World and Analytic Solutions, Offering Development, IQVIA

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Given the need to demonstrate value in specialty pharma where disease populations are increasing become niche, this session will address how pharma and biotech companies should build appropriate data assets and find appropriate patient populations.

By attending this session, you should be able to:

  • Define an evidence platform and list three possible sources of data for evidence platforms; and
  • Describe two benefits of AIML for finding rare disease populations.

Activity Type: Knowledge-based (K); Target Audience: Pharmacists (P); CEUs: 0.050; UAN: 0841-0000-19-006-L04-P

3:30 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 an outdoor ambiance provide a relaxed and fun atmosphere — perfect for business networking during this evening reception.

Tuesday, March 12
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 Receptions: Magellan Rx Management & OptumRx

These receptions offer excellent opportunities for interactions between PBM and SP members, drug manufactures, and other industry partners. Attendees flow in and out of the concurrent receptions while members serve as hosts in their designated room during the reception time.

9:00 am - 11:30 am

General  Sessions

 

9:00 am – 9:30 am

Pharma Executive Session

Duane Barnes, President, Head of U.S. Operations, UCB

Moderator: Jim Hill, President, Pharma Strategy Group

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During this fireside chat-style session, Duane and Jim will discuss key issues facing the biopharmaceutical industry today. The conversation will touch on some of the other themes addressed at the conference including the future of PBM-pharma negotiations, affordability, access, and the evolving dynamics of value.

 

9:30 am – 10:00 am

PBM Executive Session

John Prince, Chief Executive Officer, OptumRx

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PCMA’s Chairman of the Board will share his thoughts on the current business and political landscape for PBMs.

 

10:00 am – 10:45 am

Specialty Pharmacy Industry Landscape Discussion

Jon Gavras, Senior Vice President, Chief Medical Officer, Prime Therapeutics

Bill Martin, Vice President/General Manager & Chief Commercial Officer, Accredo

Moderator: Dean Erhardt, President & Chief Executive Officer, D2 Consulting

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As specialty continues to grow, market dynamics will have wide-ranging impacts on how cost-effective care is delivered. This panel will discuss market dynamics and key trends they believe will impact the specialty pharmacy industry over the next few years.

 

 

10:45 am – 11:30 am

Ensuring Value in Paying for Ultra Expensive, Gene and Curative Therapies

Jim Clement, Partner, Coeus Consulting Group

Gina Guinasso, Senior Vice President, Commercial and Medicare Formulary Contracting Strategy, OptumRx

Rich O’Neal, Vice President, Market Access, Regeneron

Moderator: Tom Knox, President, Fathom Healthcare

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From cures for Hepatitis C, to complex CART-cell therapies, to gene therapies with one-time administration, breakthrough therapies are delivering tremendous value to patients. These products have the potential to fundamentally change the way we treat diseases, but upfront costs, durability of response, and other considerations present pricing and market access challenges. The health care system will need to evolve to be able to support the availability of these medical breakthroughs. PBMs and manufacturers are focused on value as they explore new and unique payment and delivery models to accommodate these new therapies.

Our panel will discuss the market players and forces that will impact the solutions that are being utilized now and are emerging for the future to ensure value in paying for ultra-expensive, gene, and curative therapies.

11:30 am - 11:45 am

Break

11:45 am - 12:15 pm

Breakout Sessions (two concurrent)

 

Navigating the Patient Journey

Candice Michaelson, Vice President, Supply Chain Strategy, Express Scripts

Matt Perlberg, Vice President, Supply Chain Strategy, Express Scripts

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PBMs help plan sponsors and patients save money and improve health outcomes. In this session, Candice and Matt will look at the complicated patient journey, the ways that PBMs help coordinate different stakeholders along that journey, the tools and resources they deploy to keep patients on the right path, and how it involves collective responsibility on both the medical and pharmacy side to do the right thing for the patient in a scalable way.

By attending this session you should be able to:

  • Identify current frameworks to keep patients on the right path;
  • Recognize two disease states in which there has been financial and clinical success; and
  • Describe two future market opportunities.

Activity Type: Knowledge-based (K); Target Audience: Pharmacists (P); CEUs: 0.050; UAN: 0841-0000-19-007-L04-P

 

Trends and Considerations in a Consumer Engagement World

Dean Erhardt, President & Chief Executive Officer, D2 Consulting

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Patients today are being much more directive in their care. Rather than going to a physician’s office and being told what to do, patients oftentimes research a condition before an appointment and ask for a specific treatment, acting as much more active consumers of care than ever before. Payers and other healthcare industry stakeholders are exploring the best ways to channel these captive and engaged patients and improve overall healthcare. During this session, Dean will discuss the challenges and opportunities related to consumer engagement today. He will review ways in which patient engagement trends are impacting payers, providers, and patients, and he will discuss the consumer’s response to these strategies and which are most effective for certain types of outcomes.

By attending this session, you should be able to:

  • Name at least one opportunity for payers in improving consumer engagement; and
  • List at least one challenge with regard to collecting more patient data.

Activity Type: Knowledge-based (K); Target Audience: Pharmacists (P); CEUs: 0.050; UAN: 0841-0000-19-009-L04-P

12:15 pm - 1:45 pm

Networking Lunch &  

Member Company Lunch Receptions: CVS Health & Express Scripts

These receptions offer excellent opportunities for interactions between PBM and SP members, drug manufactures, and other industry partners. Attendees flow in and out of the concurrent receptions while members serve as hosts in their designated room during the reception time.

1:45 pm - 2:15 pm

Breakout Sessions (two concurrent)

 

Medical Versus Pharmacy Review of Specialty Conditions: Costs, Utilization, and Focus on Oncology and HIV

Rochelle Henderson, Senior Director, Research, Express Scripts

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During this session Rochelle will offer an analysis of national data that combines pharmacy spend and medical spend for specialty medications. She will explore the division of medically billed specialty drug spend by site of care and percentage increase of medical drug spend in the outpatient hospital setting by region. Attendees will hear more about specialty medication trend and spend in the areas of oncology and HIV.

By attending this session, you should be able to:

  • Identify the top conditions for which specialty medications are dispensed by spend;
  • List two drugs that are typically billed to the medical benefit and two that are typically billed to the pharmacy benefit;
  • Describe at least one implication of moving a product from the medical to the pharmacy benefit.

Activity Type: Knowledge-based (K); Target Audience: Pharmacists (P); CEUs: 0.050; UAN: 0841-0000-19-008-L04-P

 

Five Digital Trends That Will Transform the Pharmacy Business

Harry Travis, President & Chief Executive Officer, etectRx

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During this session, Harry will review the definition of various digital technologies – digital health, digital medicine, digital therapeutic, and digital drug, – and he will explore five digital trends that will transform the pharmacy business. These trends include:

  1. The Internet of Things is powering a tsunami or digital medication adherence tools;
  2. Digital therapeutics are heralding a new way to treat disease;
  3. Digital medications will change pharma contracting forever;
  4. eCommerce comes to the drug store; and
  5. When will Apple make its move.

By attending this session, you should be able to:

  • List at least four digital medication adherence tools;
  • Define a digital therapeutic; and
  • Discuss the impact of digital medications on value-based contracting.

Activity Type: Knowledge-based (K); Target Audience: Pharmacists (P); CEUs: 0.050; UAN: 0841-0000-19-010-L04-P

2:15 pm - 8:00 pm

Open Time for Private Meetings

8:00 pm - 10:00 pm

Cocktail and Dessert Reception

Join your peers for dessert, cocktails, and conversation with colleagues at this after-dinner reception.