The PBM industry is of the most dynamic in all of healthcare, always evolving and adapting to patient and client needs, as well as the innovative drug therapies they’re called upon to manage.  In this discussion, PCMA’s Chairman of the Board Ken Paulus is joined by fellow Board members John Prince and Tim Wentworth for a discussion that touches on priority issues such as value-based arrangements, patient affordability, vertical integration and aligned incentives, and modernizing Medicare Part D and B.

Speakers: 
-Ken Paulus, President and Chief Executive Officer, Prime Therapeutics
– John Prince, Chief Executive Officer, OptumRx
– Tim Wentworth, Chief Executive Officer, Evernorth

Moderator:
– Ian Spatz, Senior Advisor, Manatt Health, Manatt, Phelps & Phillips

Integration of medical and pharmacy care enables both improved patient care and outcomes, as well as a reduction in total cost of care.  During her presentation, Caroline Carney will highlight how this work takes place, and discuss the promise and possibilities of what’s to come by leveraging an integrated care model.

By attending this session, you should be able to:

• describe the concept of achieving total cost of care savings through advancing clinical programs;
• explain the importance of both pharmacy-based and gap-based programs in achieving total cost of care savings;
• outline several types of interventions used to achieve total cost of care savings;
• recognize the need for analytics to drive forward programs and measure financial, clinical, and satisfaction outcomes; and
• summarize the trajectory that a PBM can take in achieving total cost of care savings and improved member satisfaction.

Speaker:
– Caroline Carney, Chief Medical Officer, Magellan Health & Chief Medical Officer, MagellanRx Management

During this session, Tom and Brett discuss the origins of their successful VBA, factors for success, how the arrangement progresses to a “2.0” phase, and what companies should be considering when thinking about greater payer/PBM alignment thorough VBAs.

Speakers:
– Tom Peddicord, Head National Accounts Population, Health MSL Team, U.S. Pharma HE&OR and Medical Access, Novartis Pharmaceuticals Corp
– Brett Sahli, Senior Director, Value and Outcomes, Prime Therapeutics

The Biopharmaceutical industry has responded to COVID-19 with innovation for vaccines and treatments. Different groups throughout the supply chain have come together and collaborated to help patients receive treatment. We’re seeing this play out not just with vaccine administration, but with therapies as well.  This session brings together individuals with experience in a collaboration regarding monoclonal antibody treatment for patients from Lilly, UnitedHealth Group, and Optum Infusion Pharmacy.

Their discussion will highlight lessons learned for supply chain entities collaborating regarding patients with high-touch therapies such as the COVID-19 monoclonal antibody treatment with Lilly’s COVID-19 monoclonal antibody treatments.

Speakers:
– Derek Asay, Senior Director, Government Strategy, Lilly USA
– Deneen Vojta, Executive Vice President, Global Research & Development, UnitedHealth Group
– Mark Williams, Senior Medical Director, Covid-19 Platform Team, Eli Lilly and Company

Moderator: 
– Michael Zeglinski, Senior Vice President & Chief Executive Officer, Optum Specialty and Infusion Pharmacies, OptumRx

Biopharmaceutical innovation continues to deliver groundbreaking rare disease, curative and personalized gene therapies to meet unmet patient medical needs.  The therapies and vaccines developed in response to COVID-19 demonstrate the ability of this industry to collaborate with supply chain partners to deliver breakthrough medical treatments in incredibly short periods of time.

During this session, Patrik  and Ramona will discuss industry trends and priorities, as well as payer collaborations that are central to maintaining and supporting biopharmaceutical innovation in the future.

Speakers:
– Patrik Jonsson, Senior Vice President of Eli Lilly and Company, President of Lilly USA and Chief Customer Officer, Eli Lilly and Company
– Ramona Sequeira, President, US Business Unit and Global Portfolio Commercialization, Takeda Pharmaceutical Company

Moderator:
– Ian Spatz, Senior Advisor, Manatt Health, Manatt, Phelps & Phillips

Despite the promise of improved patient health outcomes at a lower price, the United States has been slow in its adoption of value-based care financing.  One of the major blind spots in these models is the exclusion of pharmacy, leading to misaligned incentives and missed opportunities.

Medicare Advantage + Part D plans (MAPD) are a fully integrated financing model that breaks down these silos and allows for focus on managing primary care risk.  This leads to lower overall costs, improved medication adherence, and health outcomes.

By attending this session, you should be able to:

• outline the current structure of Medicare and the disincentives in the system due to pharmacy carve-out;
• explain the rationale for integrating pharmacy costs into primary care; and
• identify practice improvement opportunities related to pharmacy in MAPD.

Speaker:
– Will Shrank, Chief Medical and Corporate Affairs Officer, Humana Inc.

The specialty drug pipeline represents significant advancements in drug therapy for some of the most challenging disease states. While these new advancements such as orphan and gene therapies offer new hope, they also represent a significant challenge of affordability to payers. The healthcare system will require additional tools and collaboration ensure appropriate therapy access and predictable affordability. This session will discuss areas of common ground to address these unique challenges across the healthcare ecosystem.

By attending this session, you should be able to:

• describe evolution of drug management over the last decade;
• describe challenges faced by payers, patients and providers; and
• describe areas of common ground for a more simple, affordable and predictable healthcare system.

Speaker:
– Harold Carter, Vice President, Pharma Strategy, Contracting and Wholesale Markets, Express Scripts

The COVID-19 pandemic has been a significant disruptor to patient care across the health care system.  Patient visits with physicians have declined, prescription drug prescribing and utilization has been significantly impacted, and a new “normal” has emerged.  Doug long will break down the data to highlight the pandemic’s impact on pharmaceutical care and discuss what the new normal may look like.

By attending this session, you should be able to:

• recognize where the US Pharmaceutical market growth has been and near-term forecast for growth;
• summarize the performance of the various sectors of the dispensing side;
• describe the performance of Brand, Generic and Specialty products; and
• identify which factors will affect future growth.

Speaker:
– Dong Long, Vice President, Industry Relations, IQVIA

Regulatory action and executive orders are an often-used mechanism for policy makers to influence drug pricing and overall prescription drug management in both public and commercial business.  Our panel of insiders will discuss the recent Medicare rules, Medicaid reforms including best price changes to accommodate value based arrangements, as well as coupon and accumulator aspects of the rule, future CMMI initiatives, and how rebate reform and MFN pricing proposals might play out.

Speakers:
– Tom Barker, Partner, Co-Chair, Healthcare Practice, Foley Hoag
– Tim Dube, Vice President, Regulatory Affairs, PCMA
– Stephanie Dyson, Vice President, Head of Government Affairs & Public Policy, Biogen

Moderator:
– Ian Spatz, Senior Advisor, Manatt Health, Manatt, Phelps & Phillips

During this presentation, we will examine the current patient journey to access specialty therapies and identify how modifying patient access services to be designed with the patient at the center can significantly impact the patient journey while delivering value across stakeholders.

By attending this session, you should be able to:

• identify challenges patients face when accessing specialty therapies;
• recognize how a patient-centric solution impacts the patient journey;
• demonstrate how building value around the patient enables benefits for all; and
• discuss insights and trends that can be examined and applied to drive innovation in patient support services.

Speaker:
– Erica Conroy, Vice President, Specialty Business, CoverMyMeds

As predicted a decade or more ago, Specialty/Orphan products continue to be approved by the FDA in record numbers. What was not predicted is the strong preference of the manufacturers to commercialize via Limited Specialty Pharmacy Networks and the current trend of vertical integration between Payers and Dispensing entities. Attend this session to hear how others have maximized a new product launch or have recently optimized a currently available specialty product.

By attending this session, you should be able to:

• recognize the “typical” distribution strategy employed to successfully launch a Specialty Product;
• review the primary drivers of Specialty Pharmacy Network Design;
• discuss the various types of traditional Specialty Pharmacies as well as emerging Specialty Dispensing Entities;
• summarize the pros and cons of working with various types of dispensing entities; and
• review the nuances of Specialty Pharmacy Network Inclusion.

Speakers:
– Dave MacLeod, Head of Patient Services and Specialty Pharmacy Operations, Amylyx Pharmaceuticals
– Amy Ruiz, Head of Specialty Pharmacy Trade Relations, Acadia Pharmaceuticals Inc.

Moderator:
– Kevin Cast, Partner, Archbow

The PCMA Diversity, Inclusion, and Women’s Leadership Initiative was created to cultivate an environment within PCMA’s professional network to promote diversity and support the inclusion and leadership of underrepresented minority groups, including women.  The Initiative provides opportunities for all to join the conversation and support diversity and inclusion throughout their careers. This session hopes to drive the Initiative’s mission forward – to go beyond the conversations to action. Hear how experts in the space have taken action in their organizations by creating safe spaces for vulnerable conversations, supporting diversity hiring and promotion practices, and create programs to promote workplace structures of Inclusion & Belonging.

By attending this session, you should be able to:

• Identify and understand terminology that is often heard associated with discussions about Diversity & Inclusion initiatives and programs;
• Create and implement specific programs that go beyond creating diverse environments to creating environments of Inclusion & Belonging; and
• Encourage and inspire others in your organization to create workplace environments of Inclusion & Belonging.

Initiative Co-chairs:
– Anita Alamshaw, Executive Director & General Manager, US. Value and Access, Amgen
– Bethanie Stein, Vice President, Supply Chain and Analytics, Humana Inc.

Speakers:
– Eloiza Domingo-Snyder, Executive Director and Head Engagement, Diversity & Inclusion, Astellas
– Rob Perez, Operating Partner, General Atlantic

Moderator:
– Aashi Arora, Principal & Executive Coach, iRise Executive Coaching

Value-based arrangements (VBA) are gaining real traction in the market thanks to a number of factors including PBM industry integration, aligned incentives, and access to better data.  Our panel will discuss why the oncology and rare disease categories are ideal for VBAs, and how PBMs and drug makers can structure success deals.

Speakers:
– Adam Kautzner, Chief Pharma Trade Relations Officer, Express Scripts
– Gary Loeber, Executive Vice President Pharmaceutical Contracting and Purchasing, CVS Health
– Patrick Moss, Vice President, Specialty Distribution & Payer Access, Sarepta Therapeutics
– Jen Norton, Vice President, Head of U.S. Value & Access, Amgen

Whole-person care goes beyond just health and integrates social, behavioral, and physical health. Integration beyond the health sector to include coordination of a broad range of behavioral and social services holds promise for achieving improved health outcomes. This session will address the various components and guiding principles of whole-person care and provide use case programs for incorporation within PBMs and collaborations with industry and community partners.

By attending this session, you should be able to:

• define whole-person care;
• describe social determinants of health impact on health;
• discuss guiding principles of innovative whole-person clinical programs; and
• describe innovative clinical programs incorporating whole-person care.

Speaker:
– Lilian Ndehi, Associate Vice President, Patient Safety and Pharmacy Stars, Humana Inc.

Patients, caregivers, and clinicians have faced unprecedented challenges this past year. Given the global need to address growing mental health concerns, provide remote care for patients with chronic conditions, and enhance healthcare delivery processes, it is important to address increasing gaps in care by providing patients with access to appropriate evidence-based digital therapies in their home environments. Digital therapeutics (DTx) deliver medical interventions to patients using evidence-based, clinically evaluated software to treat, manage, and prevent a broad spectrum of diseases and disorders.

By attending this session, you should be able to:

• describe the current state of the DTx industry;
• propose ways to provide access to patients (e.g., wellness, pharmacy, medical benefit);
• recognize the need for harmonized coverage requirements; and
• discuss the current digital therapeutic pipeline.

Speakers:
– Mark Bini, Chief Patient Experience Officer, Evernorth
– Mike Pace, Vice President & Global Head, Market Access and Value Evidence, Pear Therapeutics

Moderator:
– Megan Coder, Executive Director, Digital Therapeutics Alliance