The PCMA Annual Meeting is the industry’s premier executive conference. The event provides an un-matched and ideal venue for senior executives from PBMs, specialty pharmacy, payer organizations, and pharmaceutical manufacturers to network, conduct business and learn about the most current issues impacting the industry.

The decision makers in attendance, educational insights and business connections made while on-site, are ultimately what make the Annual Meeting so successful. The high level interactions that take place at this event help to promote continued industry collaboration and dialogue.

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Annual Meeting 2016 Agenda

Monday, September 19
Tuesday, September 20
Monday, September 19
9:15 am – 9:45 am

How PBMs Deliver Clinical Value through Specialty Pharmacy

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Alan Lotvin, Executive Vice President, CVS/specialty, CVS Health

Pharmacy benefits are first and foremost about helping patients manage their conditions. Specialty pharmacies and PBMs are applying their expertise and assets toward progressive solutions to help their clients support the clinical needs of patients while managing costs. All major specialty pharmacies offer many valuable solutions in regards to managing REMS, patient adherence, and drug delivery. However, patients and payers realize the most savings and clinical value when specialty pharmacies and PBMs combine.

This session will highlight the value payers and patients receive, such as indication-based solutions, managing utilization across benefits, and a robust approach to supporting patients beyond adherence, with a specialty pharmacy/PBM relationship. Combined, all of these approaches help support patient care and control overall specialty costs rather than a singular focus on drug costs or costs associated with specialty drug non-adherence.

9:45 am – 10:15 am

The World of Pharmacy and Pharmaceuticals in 2030

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Bill Roth, Founding Partner, Blue Fin Group

This session will explore a broad view of where our industries are headed in regard to innovation, the business models we’ll need to support it, and the importance of our alignment in order to balance society’s priorities. Combining the view of the cost of health care spiraling to $4.4 trillion by the end of the decade, with continued innovation on the way in the areas of proteonomics, genomics and precision medicine, biosynthetics, AI, and more, Bill will explore likely scenarios for how they could impact our own strategies as manufacturers, payers and consumers.

10:15 am – 11:00 am

Value-based Contracting: U.S. Landscape Realities

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Jim Clement, Executive Director, Cost of Care and Supply Chain Strategy, Aetna Pharmacy Management, Aetna

Mike Ryan, Senior Vice President, U.S. Value, Access and Policy, Bristol-Myers Squibb

Moderator: Tom Knox, President, Fathom Healthcare Solutions 

Though still in their infancy in the U.S. health care system, value-based risk sharing agreements are growing in popularity.  Market forces have been driving stakeholders to explore new types of financing and access, shifting risk towards value, indications, and/or outcomes-based arrangements.  These varying types of value-based arrangements have different goals and metrics for success. Some might allow a payer to minimize risk or manage risk differently; others allow manufactures to create product differentiation and to potentially obtain the full value of the product; while others still might allow for population versus patient management and improved data repositories and informatics systems.  Success depends on good contract design, availability of data, and administration.

During this session the panel will discuss the pros and cons of value-based contracts from their varying perspectives.  Some of the questions they will address include what’s driving the demand for these types of contracts, how are players looking at specialty versus non-specialty therapies as candidates for these arrangements, what are some of the barriers to doing value-based contracts in the current U.S. landscape, what are the manufacturer versus payer expectations of one another in engaging in these agreements, and finally, how do they see these arrangements evolving over time and with greater adoption.

11:00 am – 11:30 am

Policy Trends to Watch in 2017

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Larry Kocot, Principal and National Leader, Center for Healthcare Regulatory Insight, KPMG

Driven by the high cost of drugs, the prescription drug industry, including PBMs, is being discussed in Washington DC and State capitols at a level not seen in recent years.  New proposals for legislative and regulatory reform seem to come each day.  In this environment it can be difficult to decipher what legislative and regulatory policy actions are happening now and in the near future that will directly impact our business.

During this session Larry will discuss a number of policy trends that will impact healthcare markets in the next year, with specific implications for PBMs and pharmaceutical manufacturers.

11:30 am – 12:00 pm

The Business of BioPharma: Building a Healthy Future for Patients, Payers and Society

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George Scangos, Chief Executive Officer, Biogen

Moderator: Jerry Miller, President, J. Miller Consulting

The biopharma industry is currently in an historic period of innovation, with deep pipelines across many difficult-to-treat disease areas. However, there are numerous challenges that may impact whether promising drug candidates ever get to the patients who need them. As the CEO of Biogen and the current Chairman of PhRMA, Dr. Scangos has a unique view into the challenges of drug development, the current policy environment and the appropriate balance between innovation, access, and cost.

Tuesday, September 20
8:45 am – 9:45 am

PCMA Leadership Session

The Political and Policy Environment

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Mark Merritt, President & Chief Executive Officer, PCMA

The PBM/Pharma Relationship in the Era of High Price Drugs

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William Fleming, Segment Vice President, Humana Inc. & President, Humana Pharmacy Solutions

Tim Wentworth, President & Chief Executive Officer, Express Scripts

Moderator: Kent Rogers, Senior Vice President, Industry Relations, OptumRx

The high cost of drugs is an unavoidable subject for the PBM/payer and pharma industries today.  The drug pipeline of recent years has brought us breakthrough therapies that are delivering tremendous value to our health care system, albeit at high prices.  At the same time, we’re experiencing high costs associated with drugs offering little incremental value, and irresponsible pricing practices from bad actors in the industry.   These and many other factors are contributing to a business and political environment that threatens the ability to reward innovation in the pharma industry, and continue the use of free market solutions that our system has benefited from for so long.   Our industries share a common goal, the sustainability of the free market health care system that rewards innovation and improved outcomes and the lives of patients.

During this session, the outgoing and incoming PCMA Board Chairmen will share their views on industry trends, the PBM value proposition, and the evolving relationship between manufacturers and PBMs.

9:45 am – 10:30 am

Challenges Related to Outcomes Contracting in the U.S. and Solutions for Addressing Them

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Chris Bradbury, Leader, Integrated Clinical Solutions and Specialty Pharmacy, Cigna Pharmacy Management, Cigna

Claudio Faria, Senior Director, U.S. Health Economics Outcomes Research, Celgene

Pierre Leurent, Chief Executive Officer, President of the Management Board & Founder, Voluntis

Moderator: Eric Elliott, Chief Executive Officer, LMK Advisory & Chairman, Voluntis

During yesterday’s session we heard about the realities of the landscape for value-based contracts. While these types of contracts offer many opportunities, there are also significant difficulties in getting these contracts to the desired design and final stage. This panel will explore some of the biggest challenges and solutions for these contracting approaches – including the varying payer needs for an individual product, the high level of specificity needed, and data collection.

Helping to frame this conversation are three individuals, two from well-known companies with a clear view for how they could work and one from a company with capabilities and a business model to help solve one (hopefully last) hurdle on our way to extensive penetration of outcomes based contracts.

10:30 am – 11:00 am

ACOs and IDNs: Understanding Payer Moves Toward Value-based and Outcomes Contracting

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Charles Kennedy, Vice President & Chief Medical Officer for Clinical Integration, Aetna

Hospitals, physician practices, and long term care facilities are continuing to consolidate under Integrated Delivery Networks (IDNs). Like the rest of the industry, health system reimbursement practices are moving towards outcomes and value-based care. There are currently two major themes in the evolution of health care payment methodologies: increasing accountability for both quality and total cost of care, and a greater focus on population health management as opposed to payment for specific services. Moreover, CMS’s strategy – to increasingly link physician financial reward to the value of the services they provide in keeping individuals and populations healthy – opens the door to structural re-alignment of health care delivery.

These advanced alternative payment models come with substantial risk elements. During this session, Dr. Kennedy will talk in detail about the challenges in aligning individualized value-based decision making and population based payment. He will share case studies demonstrating why individual, value-based analytics matter, and he will provide examples of newly available electronic patient datasets combined with new analytic frameworks that can result in successful health care knowledge bases that make the individual consumer centric experience a reality. Finally, he will share his perspectives on the role of pharma in this evolving reimbursement landscape.

11:00 am – 11:45 am

Perspectives from Wall Street

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George Hill, Director, Deutsche Bank

Bob Jones, Vice President, Goldman Sachs & Co.

Due to their unique vantage point, Wall Street analysts offer a distinctive perspective of our industries. During this session, George and Bob will share their thoughts on the most important trends impacting the intersection of PBMs and manufacturers. Some of the ideas that will be addressed include:

  • Impact of managed care consolidation;
  • Thoughts on channel consolidation;
  • Thoughts on industry pricing structures and models;
  • The value proposition PBMs are making to their clients around clinical management and specialty pharmacy – outcomes and indication-based contracts;
  • Formulary consolidation;
  • ePA process and how PAs impact manufactures; and
  • Biosimilars