Annual Meeting 2017

As the other sessions at the conference highlight, a number of challenges and opportunities exist for the future of the prescription drug market.  During his session, PCMA’s incoming Chairman of the Board, Tim Wentworth, will offer a strategic perspective with regard to those challenges and opportunities.  Tim will offer comments on the state of PBM-manufacturer relations and business objectives. Additionally, he will review changes in the pharmacy marketplace, options for changes to public policy, and a path forward to solve legislative and regulatory issues of interest to both the PBM and pharma industries.

Prescription drug cost continues to be an important subject for the PBM and pharma industries. Breakthrough therapies are entering the market and delivering tremendous value to our health care system. But we have to figure out how to pay for them. Every health care industry stakeholder including manufacturers, payers, PBMs, specialty pharmacies, hospitals, 340B entities, etc. has a role to play in managing the overall cost of care in the U.S. healthcare system and in ensuring patient access at a reasonable cost burden. Policymakers are telling all of us that if we can’t figure it out, they will figure it out for us and everyone in the audience can probably all agree that substantive government intervention would not be in the best interest of patient care.

During the course of this discussion, the panel will address the following proposed ideas that highlight the need for collaboration in addressing the challenges of drug access and affordability:

• The benefits and barriers to value-based pricing and the alignment of price to clinical value;
• The potential benefits and limitations of the proposed state-level transparency initiatives for both manufacturers and payers;
• The potential impact  of increased government intervention on patient access and the overall cost of healthcare; and
• How do we pay for transformative and curative therapies in a U.S. healthcare system built upon quarterly/annual budget cycles?

A once just imagined world where complex treatments like gene and CAR T-cell therapies brought new hope to people suffering from life-threatening and life-altering diseases is suddenly here today. These products have the potential to fundamentally change the way we treat disease, but upfront costs and long-term durability of response present pricing and market access challenges. Gene therapy specifically, is an emerging field filled with great discoveries and the potential of creating major medical breakthroughs, including new approaches that may provide long-term, life-altering benefits to patients through the one-time administration of therapy. The health care system will need to evolve to be able to support the availability of these medical breakthroughs. Manufacturers and PBMs are exploring new and unique payment and delivery models to accommodate these new therapies.

During this session, the panel will explore the thought processes and steps it takes to navigate these unique arrangements and they will reflect on early lessons learned.  The panel will talk about the steps taken and issues considered to get where they are today, why it’s important to start the process early, and the importance for both sides to be willing to consider alternative, innovative solutions to help ensure access to innovative therapies.

The discussion will start with a foundation of novel, one-time therapies with key considerations and opportunities, followed by short-term solutions and finally discussing what some of the longer-term solutions may look like.

Patients, payers, and policy makers are demanding value. “Value” seems to be the most recent buzzword used by payers, PBMs, and manufacturers when talking about improving care and lowering prescription drug costs but what does that really mean?

PBMs are working with manufacturers to deliver results, including keeping the drug trend lower than the cost of inflation and delivering more than $1.8B in savings in 2017 through the national preferred formulary or other innovative programs, but that’s not enough. Value is not just about trend but it’s about better overall health care and in order to ensure future affordability, we need to look beyond value. During this session Everett will share his views related to value, innovation, technology and the need for continued and deeper collaboration between our industries.

As drug costs continue to rise, employers also continue to cite managing their specialty and overall drug benefit cost trend as their number one priority. During this session, Kevin will share the trends coming out of the payer community in terms of how they are structuring pharmacy benefit designs. He will discuss the increasing pressure payers are putting on their PBMs, how PBMs are shifting their business practices to demonstrate value, and what value means to their clients.

The following are a few of the key topics that will be addressed:

• Managing cost is key;
• Addressing transparency concerns;
• Increasing the use of incentives to encourage healthy employee behaviors;
• Benefit design opportunities and the impact of specialty; and
• What this means for manufactures.