PBMI National Conference

Employers are shopping around, according to panelists at a session at the 2025 PBMI meeting in Orlando. Transparency and a "true partnership" are among the attributes they are looking for.

Joe Boyle shared proactive compliance strategies for PBMs at PBMI 2025, highlighting the need to adapt to evolving regulations for sustainable growth.

PBMs navigate increasing regulatory demands for transparency, as Joe Boyle stressed the need for robust data management and strategic compliance at PBMI 2025.

At the PBMI 2025 Conference, ClearFile president Joe Boyle encouraged PBMs to attend NAIC meetings, stressing that showing up and maintaining relationships with regulators is critical for long-term success.

Vertically integrated health plans are starting to fall by the wayside due to their limited flexibility, while modular health plans are gaining traction, according to Scott Rossignol, senior director of Drug Value Strategy at Abarca Health.

At the PBMI annual meeting, experts warned that soaring prices for new cancer therapies require greater data sharing, precision medicine and value-based contracts to ensure patients get access to effective treatments without overwhelming costs.

IQVIA’s Scott Briggs forecasts increased GLP-1 drug spending, limited biosimilar savings and patient adherence hurdles for novel therapies at the Pharmacy Benefit Management Institute’s annual meeting in Orlando.

Employers face rising healthcare costs and specialty drug challenges, prompting a shift towards strategic partnerships with PBMs for better solutions, according to Karen van Caulil, Ph.D., president and CEO of the Florida Alliance for Healthcare Value, who chatted with MHE in the final installment of a two-part video interview.

Act 624 and ambiguous ERISA policies are some of the biggest issues faced by pharmacy benefit leaders today, according to Robyn Crosson, vice president of government relations, Navitus Health Solutions.

Employers are demanding more transparency and partnership from pharmacy benefit managers (PBMs), according to Karen van Caulil, Ph.D., president and CEO of the Florida Alliance for Healthcare Value, who spoke with MHE ahead of her remarks at the Pharmacy Benefit Management Institute’s annual meeting in Orlando.

New approaches are needed to manage the costs, access and adherence issues related to the GLP-1 drugs, say panelists at the Pharmacy Benefit Management Institute’s annual meeting in Orlando.

Pharmacy and medical benefit programs have traditionally operated separately, despite having similarities. Nishi Goel, Pharm.D., vice president of customer experience, Agadia, is trying to change that.

The growing trend of at-home drug administration emphasizes the need for integrated medical and pharmacy reviews, according to Nishi Goel, Pharm.D., vice president of customer experience, Agadia.

The IQVIA vice president of industry relations and his talks featuring rapid-fire delivery of voluminous slide decks is a familiar figure in managed care circles. He is retiring in May 2025.

The IQVIA vice president and frequent speaker at pharmaceutical and managed care meetings shares some insights after he delivered the keynote talk at 2024 PBMI Annual National Conference held last week in Orlando, Florida. Long, a well-known figure in managed care circles, announced at the PBMI meeting that he is retiring in 2025.

Kerri Tanner, Pharm.D., chief pharmacy officer of PayerAlly, discusses the dynamic pricing models of Waltz Health and Free Market Health as a way for independent specialty pharmacies to compete.

Digital technology, AI and other tools will allow for many specialty infusion therapies to be administered in ambulatory centers, allowing payers to customize programs.

Kerri Tanner, Pharm.D., the chief pharmacy officer of PayerAlly, says payers are looking for ways to rein in the escalating costs of specialty pharmacy drugs beyond the traditional techniques used by pharmacy benefit managers.

Patrick Cooney, president of The Federal Group, says elimination of spread pricing is one of the three key elements of the PBM legislation that he believes is likely to pass during the lame-duck session of Congress after the Nov. 5 election.

Greg Baker, CEO of AffirmedRx, did not hold back in criticizing CVS Caremark, Optum Rx and Express Scripts and their group purchasing organizations today at the PBMI Annual National Conference.

Patrick Cooney, president of The Federal Group, a Washington, D.C., lobbying firm says prospects for legislation passing this year, albeit during the post-election lameduck session, are good partly because the PBM legislation would produce Medicare savings that could be put toward other uses.

The IQVIA vice president and frequent speaker at pharmacy and managed care meetings said he will retire in May 2025.

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.