2017 Agenda Below. Our 2018 agenda is in production.

October 2017 Speaker Presentation
Thursday, October 5, 2017



Chairman's Opening Remarks

George Van AntwerpSenior Manager Deloitte Consulting LLP


Opening Address

What's New in Specialty Pharmacy & One Health Plan's Forward Strategy

What does the expanding specialty drug market really mean for health plans? During this session, Sheila Arquette, Executive Director of NASP and former Pharmacy Director at Independent Health will examine the growth predictions of specialty pharmaceuticals, and the challenges and opportunities it presents for health plans. Topics to be addressed:

  • defining specialty and other advocacy issues
  • impact of manufacturer limited distribution dispensing programs
  • Independent Health's deep dive patient and provider education plan
  • Independent Health's collaboration with retail pharmacies
  • Independent Health's Specialty Pharmacy Center of Excellence program

Sheila Arquette, RPHStrategic Pharmacy Projects Advisor, Independent Health Executive Director, National Association of Specialty Pharmacy (NASP)


Innovation in Specialty Trend Management Strategies

As specialty trend continues in the double-digits for the foreseeable future, it is imperative that health plans identify opportunities to decrease spend. In this session, we will discuss a variety of strategies that can be utilized to control trend. In addition to more traditional channel management and site of care tactics, we will also explore innovative approaches in leveraging:

  • Copay Assistance Programs
  • Formulary
  • Utilization Management

Meghan Pasicznyk, PharmD, MBADirector of Specialty Market Development,Accredo Health Group An Express Scripts Company


Panel Session: Weighing the Value of Specialty Drugs Against Cost

The continued rise of specialty drug costs is putting more pressure on health plans to ensure that the medications that are prescribed to members are medically necessary and appropriately used. It is forcing tough conversations around what value certain specialty medications bring and at what cost. Our panelists will share their viewpoints on value vs. cost, and discuss how each of their organizations are addressing this challenge.


Sheila Arquette, RPHStrategic Pharmacy Projects Advisor, Independent Health Executive Director, National Association of Specialty Pharmacy (NASP)


Bruce Rogen, MD, MPH, FACP,Medical Director,Cleveland Clinic Health Plan

Melissa Skelton Duke, PharmD, MS, BCPS,Senior Director, Specialty and Home Delivery Pharmacy ServicesBanner Health

Steven G. Avey, RPh, MS, FAMCPVice President, Specialty Programs, MedImpact Healthcare Systems, Inc.


Networking Refreshment Break


Controlling Specialty Drug Spend Through Innovative Benefit Design & Pharmacy Management

For most health plans the rising cost and utilization of specialty pharmaceuticals is one of the primary drivers of increasing costs. The Cleveland Clinic Employee Health Plan, a self- insured plan with 90,000 members, has implemented several innovative strategies to control specialty drug costs. These include specific benefit design changes, incentivized medication compliance, integrated population health management, rare disease management, and copay card initiatives. Through these, and traditional pharmacy management strategies (prior authorizations, step edits, quantity limits, narrow networks), the Cleveland Clinic Employee Health Plan has been able to mitigate some of the rapid increase in this area of health plan spend.

Bruce Rogen, MD, MPH, FACPMedical Director,Cleveland Clinic Health Plan

Jeffrey G Schmitt, RPh, BS, PharmD,Director, Pharmacy,Cleveland Clinic Health Plan


Impact of Biosimilars on Specialty Drug Market

Introduced into the market more than 30 years ago, biological products result from biologic material and encompass a wide range of elements such as hormones, vaccines, antibodies, proteins, polysaccharides, polynucleotides, growth factors, blood products, and live viral material; they differ greatly from chemical medicines. Biosimilars are medicinal products with a similar but not identical safety, efficacy and quality as the authorized reference (originator) biologic agents. They are composed of an analogous active substance but are large molecular- weight, complex molecules that are produced in living cells through genetic engineering.

The Biologics Price Competition and Innovation Act (BPCIA) defines biosimilar as a biological product highly similar to the reference product notwithstanding minor differences in clinically inactive components; and with no clinically meaningful differences between the biologic product and the reference product in terms of the safety, purity, and potency of the product. In this presentation, we will review the impact of different biosimilars into the US Market, address concerns with biosimilars in specialty pharmacies and discuss the worldwide situation of biosimilars focusing mainly on the United States (U.S.) laws, regulations and legislation pathways, pricing and challenging market access.

Ali McBride, PharmD, MS, BCPS,Clinical Coordinator of Hematology & Oncology,University of Arizona Cancer Center


Conclusion of Day One

Friday, October 6, 2017

Continental Breakfast


Chairman's Recap

George Van AntwerpSenior Manager Deloitte Consulting LLP


Outcomes of a Voluntary Site of Care Program: One Health Plan's Experience

Many health plans are challenged with discrepancies in reimbursement for infusible drugs based on site of service. In the fall of 2015, Highmark Inc. implemented a voluntary site of care program designed to encourage a shift in site of care from high cost sites of care to lower cost alternatives. In this session, we will discuss program outcomes and other aspects including:

  • Methods utilized
  • Drugs and populations targeted
  • Challenges observed
  • Success stories
  • Lessons learned
  • Looking forward . . . what's next for site of care?

Leah King, PharmD, JDManager, Pharmacy Strategy,Highmark Inc.


Best Practice Member Engagement Strategies (It Ain't Dog Food If The Dog Don't Eat It!)

Neal Sofian, Director of Member Engagement will discuss some of the successful strategies Premera is using to build relationships with their members. This session explores models that use personalization as a means to create a much better member experience, which will generate engagement across the full range of services that can be provided by a health plan. We'll explore the requirements of a true personal consumer experience; based on segments of one, what do we need to know about each person to do this and what data will provide us the insight to actually get people to do take action.

Neal Sofian,Director of Member Engagement,Premera Blue Cross


Exploring Value Based Contracting, Risk Sharing Agreements & Real-World Evidence

Dr. Gregory Daniel, Deputy Director of the Duke-Robert J. Margolis, MD Center for Health Policy and a Clinical Professor in Duke's Fuqua School of Business will discuss:

  • Policy efforts to improve uses of RWE and value-based contracting for drugs and devices to drive high-value innovation
  • Better uses of RWE to improve evidence development efficiency and better inform regulatory decisions, including labeling changes and new indications, with RWE and patient experiences
  • Emerging efforts to support better stakeholder engagement to improve risk-sharing and value- based arrangements that rely on outcomes and value measurement

Gregory Daniel, PhD, MPH,Deputy Director,Duke- Margolis Center for Health Policy, Duke University


Morning Networking Break


Deep Dive Case Study

Successful Strategies for Managing Multiple Sclerosis Drugs at Blue Cross Blue Shield of Michigan

Multiple sclerosis (MS) was a mystery to treat for over a century. Disease modifying therapies, which slow MS progression, have been available since the early 1990s, with many approved since then and more in the pipeline. However, the American Academy of Neurology (AAN) has not updated its MS disease modifying therapy guidelines since 2002, which leads to many questions on how to manage these drugs on both pharmacy and medical benefits.

This session will provide what a managed care pharmacist needs to understand about MS, including the major differences between treatment of relapsing and progressive forms of MS, an evaluation of the current medications, including the newly approved ocrelizumab, drugs in the pipeline, and the draft treatment guidelines proposed by the AAN. Strategies for management of these drugs on both medical and pharmacy benefits will be highlighted.

Elizabeth Saltzman, PharmD,Manager, Specialty Pharmacy Utilization Management,Blue Cross Blue Shield of Michigan


Achieving More Value in the Management of Chronic HCV Infection: Identifying and Minimizing Waste

Due to the rapid therapeutic developments and now numerous but costly treatment regimens, achieving value in the management of chronic HCV infection has become one of the most complex challenges facing health plans today. The balancing act between treating to cure and cost-effective management has led to a unique health care dilemma. Many will argue that the answer lies in value. Value is defined as the health outcome achieved per dollar spent. Achieving more value in the treatment of chronic HCV infection can be achieved with a strategic focus on identifying and eliminating waste.

A significant amount of waste continues to occur in the treatment of chronic HCV infection. Waste occurs when patients don't complete therapy. Waste occurs when the expected cure rate is not achieved. Waste occurs when high-cost therapies are used in place of equally effective, lower cost options. Because chronic HCV infection therapies are expensive, any waste occurring during treatment results in a rapid increase in overall cost. Identifying where waste is occurring allows health plans to identify opportunities and develop new strategies to address.

Strategies to improve efficiencies in the management of Hepatitis C with a resultant decrease in waste require a systematic approach to patient care management. A Center of Excellence model collects data and coordinates the efforts of physicians, pharmacist and patients. Center of Excellence best practices help physicians select the right therapy, mange utilization to increase appropriate use, and provide high-touch clinical outreach. Patients receive an individual approach to their care, resulting in improved adherence, reduction in side effects, and higher therapy completion rates. Each practice plays an important role in reducing waste, and thus increasing value in the management of chronic HCV infection. With the right approach, health plans can align the best financial outcomes (less waste) with the best clinical outcomes (the highest cure rates). Learning objectives for this session:

  • Discuss different ways to measure waste in the treatment of chronic HCV infection.
  • Identify how much waste continues to occur in the treatment of chronic HCV infection.
  • Explain how health plans can bring more value (health outcomes achieved per dollar spent) to the treatment of chronic HCV infection by minimizing waste.
  • Case study and its application to decrease waste in the treatment of chronic HCV infection among Health Plan patient populations

AJ Ally, RPh, MBA,Vice President, Clinical Strategy and ProgramsDST Pharmacy Solutions


Roundtable Session: Discussion Groups Driven by Audience Choice Issues

One week before the event we will hand pick topics of the audiences' choice to tackle during our roundtable session. Breaking into small groups, brainstorm and share strategies with your peers. Walk away with some fresh ideas that you can implement upon returning to the office. Possible topics of discussion include:

  • Impact of 340B and limited dispensing programs on payer organizations
  • Role of biosimilars in specialty pharmacy.
  • Leveraging data analytics for better decision making
  • Collaborating with industry stakeholders
  • Specialty MTM
  • Personalized medicine

Networking Luncheon


Panel Session: Leveraging Technology Tools to Improve Specialty Medication Education and Adherence

Hear how your peers are leveraging various technology tools for different aspects of their specialty medication strategy to improve patient literacy, engagement and outcomes. Topics open for discussion are using technology for:

  • More effective data gathering and analytics
  • Keeping members connected and engaged
  • Incentivizing behaviors and improving specialty adherence
  • Better coordination of care across the continuum


George Van Antwerp,Senior ManagerDeloitte Consulting LLP


Shelly Spiro, RPh, FASCP,Executive Director,Pharmacy Health Information Technology Collaborative

Victoria Rodino,Senior Manager, Virtual Health Programs,Children's Medical Center

Eric Sredzinski, Pharm.D., AAHIVP,EVP, Clinical Affairs & Quality Assurance Pharmacy Program Director,Avella Specialty Pharmacy


Improving Medication Adherence at Alignment Health Plan

Medication adherence is a major public health issue that costs the U.S healthcare system more than $300 billion annually. Improving medication adherence in patients with chronic disorders is an important part of CMS's star ratings. This presentation provides specific solutions and intervention examples that have proven to be successful in improving medication adherence at Alignment Health Plan.

Ruby Liu, BA, PharmD,Director of Pharmacy,Alignment Healthcare


Optimizing Specialty Drug Management by Shifting Medications to Pharmacy Benefit

Specialty drug spend continues to pose affordability challenges for all stakeholders. It's an increasingly complex landscape that is multifaceted including treatments covered through different insurance benefits, distribution channels, medical necessity requirements and drug administration competencies. These factors can cause confusion and frustration for providers who want to use specialty drugs for appropriate patient candidates. Several years ago, well before the trend, BCBSRI shifted many of its specialty medications over to the pharmacy benefit with successful results. Topics in this presentation will include:

  • Overview of BCBSRI's current specialty pharmacy program
  • Program gaps and opportunities for improvement
  • Planned program enhancements
  • Expected outcomes

Donna Paine, PharmD, MBA,Clinical Pharmacy Specialist,Blue Cross Blue Shield of Rhode Island


Closing Address : Behind the Numbers: A Look at Specialty Drug Pharmacy Claims, Medical Claims & Variations in Site of Care within Large Self Fund Employer Groups

PwC's Health Research Institute recently released a report titled, Medical Cost Trend: Behind the Numbers 2017, which takes a look at what steps employers are taking to manage specialty drugs. Our speaker, Greg Mansur, from PwC's Pharmacy Benefits Practice will share some of their research results, providing a lens into the challenges and issues employer groups are facing.

Specialty pharmacy and the impact of these medications are cost drivers in increase healthcare expenditures. The cost of these medications however is not limited to the price of the drugs and the associated inflationary increases, but also the channel of distribution Pharmacy vs. Medical. Further, within the Medical Channel the Outpatient Hospital, Infusion Center, and Home IV infusion channels vary in cost. This presentation will speak to the cost differences by channel and the clinical utilization management difference observed in large self-funded employer groups who have carved out their pharmacy benefit to a Pharmacy Benefits Management organization for administration. We will identify the lack of parity and discuss the gaps found, address impact of rebates, and give insights as to how to assist employers as the pipeline of specialty drugs continues to grow.

Greg Mansur, Principal, Global Human Resource Services,PricewaterhouseCoopers LLP


Conclusion of Conference