PBMI National Conference

Technology is advancing to allow the prior authorization process to operate behind the scenes through electronic systems that are integrated with health plan information.

Changes to the methodology for how the Health Equity Index is assessed could see Medicare Advantage Star ratings — and payments to plans — drop.

Joseph Shields of TransparencyRx predicts there will be more lawsuits against self-funded employers alleging they’ve mismanaged prescription drug benefits through PBMs.

During an interview, Joseph Shields of TransparencyRx discusses the PBM legislation that is expected to move forward in Congress in the next few months.

Thompson, the president of the National Alliance of Healthcare Purchaser Coalitions, said if that 20% of the market changes way it deals with PBMs “it will change the market, it will change the conversation, it will change the practices of key players.”

Thompson, the president and CEO of the National Alliance of Healthcare Purchaser Coalitions, said rebates and pass through are just the “tip of the iceberg” of the misalignment between employers and PBMs that disadvantages employers.

Panelists at the 2023 PBMI Annual National Conference mentioned post-marketing studies and changing the mind-set about what a prescription entails.

Mike Steelman, vice president, Managed Markets, Dexcom presented on the pathways to implement non-prescription digital therapeutics at the 2023 PBMI Annual National Conference in Orlando. In this interview with Managed Healthcare Executive, Steelman suggests that creating "certainty in an uncertain world" in the digital therapeutic space could potentially open up doors for further use of these tools.

Mike Baldzicki, chief commercial officer, Premier Pharmacy Services, shared some takeaways from his presentation on the rare-ultra orphan disease market and its therapies at the 2023 PBMI Annual National Conference in Orlando.

There is a huge opportunity for savings from the recently launched Humira biosimilars and others expected to reach the market in the next few years. But plans and PBMs will need to step into the role that pharmaceutical manufacturers once did in supporting patients and prescribers.

At the 2023 PBMI Annual National Conference in Orlando, Ellen Feeney, director of Clinical Pharmacy Strategies at Highmark discusses how these new programs payers are using to control medication costs work, and shares how costs of the GLP-1s should be managed.

Ozempic (semaglutide) is second only to Humira (adalimumab) in sales, according to the IQVIA vice president of industry relations and a frequent speaker at conference. And for newly launched drugs, sales figures for Mounjaro (tirzepatide) are second only to what they were for Harvoni (ledipasvir and sofosbuvir), a hepatitis C antiviral, when the hepatitis C antivirals were new.

Payers are trying to figure out how to provide access to patients who would benefit from weight loss drugs such as semaglutide but also control costs.

As cell- and gene-based therapies become available for new and expanded indications with a higher incidence of patients, payers will be challenged to find ways to provide access to patients.

At the 2023 PBMI Annual National Conference in Orlando, Ellen Feeney, director of Clinical Pharmacy Strategies at Highmark shares the tools payers are using to control medication costs outside the traditional ones like utilization management. Feeney also talked about the new program that Highmark kickstarted in 2022 to help manage medication costs.

At this year's PBMI Annual National Conference in Orlando Ben Urick, principal health outcomes researcher at Prime Therapeutics, shared methods for medical cost savings through adherence improvement using integrated medical and pharmacy claims data.

Greg Baker, CEO of AffirmedRx, one of the many new, smaller pharmacy benefit managers (PBMs) challenging the status quo, listed the eight things that employers should know about their PBM. Baker planned to share six key points at the 2023 PBMI National Annual Conference in Orlando, but shared two more with conference goers.

Sampson Davis, M.D., an emergency medicine physician and best-selling author, says a tailored approach is needed.

Case and care management can help health plans cope with seven-figure cell and gene therapies, according to panelists at the Pharmacy Benefit Management Institute’s annual meeting.

PBM transparency and data reporting requirements are likely to be part of a larger healthcare bill that Congress will work on this fall.

The keynote speaker for the three-day meeting in Orlando is Sampson Davis, M.D., an emergency medicine physician in New Jersey, an inspirational speaker and co-author of three best-selling books.

The harm caused by weight-loss drugs have overwhelmed any benefit they may have. The repurposed diabetes drugs like Wegovy (semaglutide) have a strong safety profile, said presented at the annual Pharmacy Benefit Management Institute meeting.

Payers need to reframe how they view obesity as not just a health and wellness issue, but as a progressive chronic disease that needs medication, explained David Skomo, RPh, chief operations officer at WellDyne.

Timothy Mizak and Nicole Bulochnik of Abarca talked about how can PBMs help payers manage costs through a hybrid network model that leverages value-based and other innovative drug contracts at the Pharmacy Benefit Management Institute (PBMI) annual meeting in Orlando.

Executives at Arrive Health and OptumRx say they have ironed out many of the problems with real-time benefit checks, which delivers out-of-pocket cost and prior approval information at the time a prescription is being written.

Jeffrey A. Shaman, Ph.D., chief science officer at Coriell Life Sciences, talked about how pharmacogenomics can inform medication management.

Nicole Bulochnik, Vice President of Drug Pricing and Network Strategy at Abarca Health delivers her presentation, "PBM-Payer Partnerships: Insight into Alternative Cost Management Strategies Across Common PBM Levels," during this year's PBMI National Annual Conference in Orlando, FL.

Thus far, value-based contracts for prescription drugs has not been transformative because of the scalability challenge for payers, explained Gregory Warren, FSA, FCA, MAAA, partner and consulting actuary with Axene Health Partners.