Thursday, October 11, 2018

Registrations & Breakfast- Exhibits Open


Chairman's Welcome & Opening Remarks


Panel Discussion

Top Trends In Specialty Drug Management

  • Escalated Spending on Specialty
  • "Generic Wave" of new generic entries as an alternative
  • Bulging Pipeline
  • Targeted Therapies
  • Health Care Reform- Legislative and regulatory activity
  • Emergence of Biosimilars
  • Growth of Co-pay Programs targeting patients with commercial coverage
  • The Next Big Things: Adherence, Medical Benefit Management & the demand for demonstrated value

Sheila Arquette,Executive Director,National Association of Specialty Pharmacy- Health Care Reform- Legislative and regulatory activity


Defining The Value & Role In Therapy For Specialty Pharmaceuticals

  • Discuss the mechanism of action, indications, efficacy, and safety of new and emerging specialty medications
  • Report the likely effect of new specialty medications on the managed care market

Panel Discussion

Identify Critical Challenges For Plan Sponsors In Projecting The Impact Of Specialty Drugs

  • Specialty pharmacy may hurt providers and patients because the impact of high-priced specialty drugs could be patient financial insolvency and lack of medication adherence
  • In order to encourage more overall positive patient care experiences, plans are in an endless search to determine the most economical methods to deliver clinical expertise
  • Plan executives expect persistent movement from medical benefit to pharmacy benefit in order to improve control and availability of real-time data but the patient's out-of-pocket costs greatly increase
  • Biosimilars were once promised to reduce annual costs but plans lack the ability to conduct step- therapy or mandate substitutions with new follow-on biologics or biosimilars so the annualized savings are lower than predicted regarding follow-on options
  • Plan executives are averse to dissatisfy providers who are critical to their networks by eliminating spread revenue using buy-and-bill model

Tracey Davis,Director of Pharmacy,Amerihealth Caritas

Patrick Sorgen,Manager, Specialty Pharmacy,Indiana University Health


Networking Break - Exhibits Open


Panel Discussion

Navigating The Specialty Drug Lexicon

  • Service level specifics and offerings (of specialty pharmacy providers, manufacturers, etc.)
  • Drug delivery mechanisms; how they affect benefit design access and approvals
  • Distribution channels are inconsistent in product design, payment structure or geography
  • "Special Handling" requirements
  • Authenticating service capabilities
  • Qualifications a company needs to be considered a specialty pharmacy provider

Sheila Arquette,Executive Director,NASP


Panel Discussion

How To Effectively Integrate Specialty Pharmacy Into Your Formulary

  • Specialty Pharmacy Criteria to consider:
    • Complex therapy for complex disease
    • Specialized patient training and coordination of care (Services, supplies or devices) requires prior or therapy initiation and/or during therapy
    • Unique patient compliance and safety monitoring requirements
    • Unique requirements for handling, shipping and storage
    • Potential for significant waste due to high cost of drug

Rushabh Shah,Pharmacy Director Associate, Specialty Pharmacy,University of Kentucky

Robie Keefer,Manufacturer Relations,Aetna Specialty Pharmacy


Current PBM Business Models & Analyzing Shifts In Primary Sources Of Profit

  • "Spread margins" on top of retailers' own margins and lately, direct and indirect reimbursement (DIR) fees are collected from retail pharmacies in return for being included in their networks
  • Claims processing and data fees
  • Rebates given by Pharma on small molecule brand drugs in return for preferred status on formularies
  • Rebates given by Pharma on specialty drugs in return for preferred status on formularies
  • Profit margins on 90-day generic Rx filled by captive mail order operations

Networking Lunch


Panel Discussion

Cost Control Strategies For Greater Impact On Cost Reductions

  • Overview of Cost Drivers
    • Drug Mix
    • Degree of provider reimbursement
    • Member Benefit Design
    • Distribution channel
    • Utilization Management
    • Operational impact in paying claims appropriately
    • Formularies & cost sharing, including 2018 Formulary List
    • Formulary Rebates
    • Step therapy
    • Prior authorization
    • Price Contracting
  • Aggressive Price Contracting
  • Increasing member copays
  • Mandating specialty pharmacy providers
  • Maximizing formulary rebates
  • Implementing effective evidence based prior authorization

Rushabh Shah,Pharmacy Director Associate, Specialty Pharmacy,University of Kentucky

Tracey Davis,Director of Pharmacy,Amerihealth Caritas


CareFirst Case Study:

  • How CareFirst continues to improve their processes while reducing their costs

Arif Khan,Pharmacy VP, TCCI Program Oversight,CareFirst Blue Cross Blue Shield


Networking Refreshment Break- Exhibits Open


Panel Discussion

Impacts Of Utilization Management Reform & Practices

  • Clinical Appropriateness
  • Clinical Validity
  • Continuity of Care
  • Transparency & Fairness
  • Improving the above through prior authorization
    • Technologies
    • Improving clinical validity, continuity of care and administrative costs
    • How commercial payers are managing patient concerns

Panel Discussion

Designing & Implementing A Successful Medical Benefit Drug Management Plan

  • Utilization & Clinical Management
    • Prior authorizations & Benefit Design
  • Network Management
  • Site of Care Management
  • Reimbursement Management
  • Spending control
  • Nationally recognized, evidence-based guidelines that offer transparency, dose checks, and competent clinic dialogue
  • Evidence-based insights: Measurable outcomes and integration with latest approved clinical data
  • Benefit design efficiency: Plan provider capabilities & ensuring appropriate "best practice" metrics
  • Strong clinical support that acknowledges unique patient characteristics
  • Administered utilization management that mimics physician, clinical, and operational workflow, while minimizing management burdens

Robie Keefer,Manufacturer Relations,Aetna Specialty Pharmacy

Tracey Davis,Director of Pharmacy,Amerihealth Caritas


Panel Discussion

Medical Benefit vs. Pharmacy Benefit

  • Can PBM's or Specialty Pharmacies play a role in Medical Benefit Drug Management?
  • Inclusion of practicing subspecialists is the answer to any effective medical or drug benefit management process

Matthew Pond,System VP, Pharmacy Services,MemorialCare Health System

Neil Shah,Clinical Pharmacist Specialty Pharmacy,Blue Cross Blue Shield of North Carolina


Networking Cocktail Reception- Exhibits Open

Friday, October 12, 2018

Breakfast- Exhibits Open


My Patient Too: Pharmacy Ownership Of The Prescription Prior Authorization Process

Jason Poquette,Specialty & Outpatient Pharmacy Director,St. Vincent Hospital


Panel Discussion

Biosimilars Update: Actively Tempering Your Medication Spend

  • Biosimilars in Europe are stronger bet than the USA. Why?
  • How will they affect future drug prices?
  • What changes are necessary to increase uptake?
  • Recent approval of specific biosimilar: Renflexis

Ali McBride,Clinical Coordinator, Hematology/Oncology,University of Kentucky

Neil Shah,Clinical Pharmacist Specialty Pharmacy,Blue Cross Blue Shield of North Carolina


Managing Rare Conditions With The Ascent Of Orphan Drugs

  • In 2017, almost 50 orphan drugs were approved to treat the rarest disorders; offering alternative treatment to patients and increased cost per patient
  • Understand the present regulatory backdrop, current treatment options and utilization management strategies

Gene Therapy Pipeline - Impacts & Opportunities

  • Navigating the Gene Therapy Pipeline
  • Gene therapies defined
  • Approved and in-development Gene Therapies
  • CAR T-Cell Therapies: A discussion
  • Patient considerations
  • Payor considerations
  • Longer-term gene therapy pipeline

Networking Break- Exhibits Open


Panel Discussion

Innovative Strategies To Improving Adherence

  • Using Behavioral Coaching to improve adherence
  • Online hub- medication arrives quicker
  • Therapy Management
  • Utilizing Technology
    • Bi-directional interactive text messaging
    • Video conferencing consultations (BriovaRx created this concept; could be a potential sponsor opportunity)
      • Between patient and pharmacist
      • Support during "unboxing" phase
      • Education of proper usage, dosage and storaget
      • On-going support and encouragement throughout program
  • Smart Technology Devices
    • Smart Pill Bottles
    • Ingestible sensors and smart pills
    • Microneedle pills
    • Specialty Therapy Software Solutions

Austin Tull,Pharmacist,Cherokee Custom Script Pharmacy

Neal S. Sofian,Former Director of Member Engagement,Premera Blue Cross


Panel Discussion

Seizing Key Opportunities In Specialty Lite

  • Design a comprehensive and effective services program to ensure patient adherence and improve health outcomes utilizing the following stratagems:
    • Patient Assistance Programs
    • Reimbursement services hub
    • Alternate specialty pharmacy fulfillment providers

Rushabh Shah,Pharmacy Director Associate, Specialty Pharmacy,University of Kentucky


Analyzing Top Specialty Drug Growth Categories & Strategies To Balance Costs vs. Outcomes


  • Antineoplastic Drugs
  • Diabetes
  • Disease-Modifying Anti-Rheumatic Drugs (DMARDs)
  • Hematopoietic Drugs
  • Hepatitis C Virus (HCV)
  • Immune Globulin
  • Immunomodulatory Agents
  • Vaccines

Health Plans

Conference Concludes