Conference Program - Pharmacy Benefit Management Institute

Drug Benefit
Conference
March 2-4, 2015 • San Antonio Marriott Rivercenter • San Antonio, Texas
Conference
Program
20th Annual Drug Benefit Conference
Message from the Executive Director
Dear Members and Friends of PBMI,
As the new Executive Director of The Pharmacy Benefit Management Institute (PBMI),
I’m very excited to announce the 20th anniversary of our Annual Drug Benefit Conference.
Next year, our annual conference will be held in San Antonio, Texas from March 2-4, 2015.
To start our celebration, I’m pleased to announce that The Honorable Newt Gingrich will
kick off the conference as our 2015 keynote speaker. In addition, you will hear from several
health care thought leaders from across the industry who will share their expertise on hot
topics affecting the drug benefit today and into the future. Please take a look at the impressive list of speakers we have
lined up for you next year.
PBMI’s mission is to create the industry’s premier forum for health care purchasers to exchange ideas, advance best
practices, and drive appropriate changes in the pharmacy benefit marketplace. This landscape is becoming more complex,
and the road ahead presents challenges. PBMI is dedicated to helping plan sponsors and drug benefit stakeholders stay
abreast of the latest strategies to maximize the return on investment in drug benefit programs.
I encourage you to join us for what looks to be an outstanding conference. If you have any questions or comments, please
don’t hesitate to contact me or a member of the PBMI staff.
Can’t wait to see you in San Antonio in 2015!
Jane Lutz
Executive Director, PBMI
Celebrate With Us at the San Antonio
Marriott Rivercenter Hotel
The conference will be held at the Marriott Rivercenter hotel located on the banks of the
renowned San Antonio River Walk. You’ll enjoy lots of shopping at the River Walk mall,
several dining options, and entertainment in this historic area.
PBMI has reserved a block of rooms at the conference rate of $219* per night.
Conference attendees are responsible for making their own hotel reservations at the
host property. This rate expires February 2, 2015.
* P lease note: All reservations must be accompanied by a first night room deposit or guaranteed
with a major credit card. Hotel room rates are subject to applicable state and local taxes in
effect at the time of check-out.
Attendees have two options to make their reservations:
1. Online – visit https://resweb.passkey.com/go/pbmi2015
2. Phone – Call 1-877-622-3056 and reference PBMI Conference as the group name.
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2015 Conference Keynote Speaker
The Honorable Newt Gingrich
Sponsored by
Newt Gingrich is the host of CNN’s political show Crossfire, which was restarted in
the fall of 2013 after an eight-year hiatus. He hosts the show alongside conservative
commentator S.E. Cupp, former Obama campaign spokeswoman Stephanie Cutter,
and green advocate Van Jones.
Widely recognized for his commitment to a better system of health for all Americans,
his leadership in the U.S. Congress helped save Medicare from bankruptcy, prompted
FDA reform to help the seriously ill and initiated a new focus on research, prevention,
and wellness. His contributions have been so great that the American Diabetes Association
awarded him their highest non-medical award and the March of Dimes named him their
1995 Citizen of the Year.
To foster a modern health system that provides better outcomes at lower cost, Newt
launched the Center for Health Transformation in 2003, and continued there in a leadership
role until he stepped down in 2011 to seek the Republican nomination for President of the
United States.
Recognized internationally as an expert on world history, military issues, and international affairs, Newt served as a
Member of the Defense Policy Board. He was the longest-serving teacher of the Joint War Fighting course for Major
Generals. He also taught officers from all five services as a Distinguished Visiting Scholar and Professor at the National
Defense University. Newt was a member of the Terrorism Task Force for the Council on Foreign Relations. In 2005,
Newt co-chaired the Task Force on U.N. Reform, a bi-partisan Congressional effort to reform the United Nations.
In 1999, Gingrich was appointed to the United States Commission on National Security/21st Century, Hart/ Rudman
Commission, to examine our national security challenges as far out as 2025. The Commission’s report is the most
profound rethinking of defense strategy since 1947. The report concluded that the number one threat to the United
States was the likelihood over the next 25 years of a weapon of mass destruction — nuclear, chemical, and/or biological
— being used against one or more major cities unless our defense and intelligence structures underwent a massive
transformation. That report was published six months before September 11.
But there is a lot more to Newt Gingrich than these remarkable achievements. As an author, Newt has published
twenty-four books including 14 fiction and nonfiction New York Times best-sellers. Non-fiction books include his latest,
Breakout, A Nation Like No Other, in addition to Ronald Reagan: Rendezvous with Destiny, To Save America, Rediscovering
God in America, 5 Principles for a Successful Life, Drill Here, Drill Now, Pay Less, Real Change, A Contract with the Earth,
Winning the Future: A 21st Century Contract with America, To Renew America, Lessons Learned the Hard Way, Saving
Lives & Saving Money, Window of Opportunity, and The Art of Transformation. He is also the author of a series of
historical fiction books including, Gettysburg, Grant Comes East, Never Call Retreat: Lee and Grant the Final Victory,
1945, Pearl Harbor, Days of Infamy, To Make Men Free, To Try Men’s Souls, Valley Forge, and his latest, Victory at
Yorktown. These novels are active history studies in the lessons of warfare based on fictional accounts of historical
wartime battles and their aftermaths.
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20th Annual Drug Benefit Conference
Schedule-at-a-Glance
Monday, March 2, 2015
8:00 am to 7:00 pm
Registration
Pre-Conference Workshop — By Invitation Only
10:30 am to 12:00 pmJeopardy (PBM Contracts Edition): Is It a Game
You’re Willing to Play? SuAnn Stone, Director,
Business & Product Development, OmedaRx
1:00 pm to 2:15 pmOpening Remarks by Jane Lutz, Executive Director,
PBMI, and Keynote Address by The Honorable
Newt Gingrich
2:20 pm to 3:20 pm
Educational Session (3 sessions)
3:25 pm to 4:25 pmGeneral Session: Joel Owerbach, PharmD,
Consultant, Pharmaceutical Strategy - Solutions
4:25 pm to 4:55 pm
Break – Educational Forum Café
4:55 pm to 5:40 pmGeneral Session: Steven G. Avey, RPh, MS, FAMCP,
Vice President, Specialty Programs, MedImpact
Healthcare Systems, Inc.
5:40 pm to 7:10 pm
Opening Reception – Educational Forum Café
Tuesday, March 3, 2015
7:30 am to 8:30 am
Breakfast – Educational Forum Café
8:30 am to 9:30 amGeneral Session: George Hill, Director,
Equity Research Analyst, Deutsche Bank
9:30 am to 10:15 amGeneral Session: Rx Innovation Award and
PBMI Specialty Drug Benefit Report
10:15 am to 10:45 am Break – Educational Forum Café
10:45 am to 11:45 am Educational Session (3 sessions)
11:45 am to 1:15 pmLunch – (Educational Forum Café open
during lunch)
1:15 pm to 2:15 pm
Educational Session (3 sessions)
2:20 pm to 3:20 pm
Educational Session (3 sessions)
3:20 pm to 3:35 pm
Break – Educational Forum Café
3:35 pm to 4:35 pmPrize Drawing Winners Announcement and
General Session: Unique Medication Therapy
Management Program Model
4:35 pm to 6:05 pmNetworking Evening Reception – Educational
Forum Café
Wednesday, March 4, 2015
7:30 am to 8:30 am
Breakfast – Educational Forum Café
8:30 am to 9:30 amGrand Prize Drawing Winner Announcement and
General Session: Biosimilar Roundtable Discussion
9:40 am to 10:40 am Educational Session (2 sessions)
10:40 am to 11:00 am Break – Educational Forum Café
11:00 am to 12:00 pm Educational Session (2 sessions)
12:00 pm to 12:15 pm Closing Remarks
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Conference Attendees
Health Care
Coalitions
Human
Resource
Executives
Pharmaceutical
Manufacturers
Health
Pharmacy
Plan
Directors
Executives
Benefits
Technology Companies
Managers
Consultants
Pharmacy
Benefit
Managers
Who You’ll Meet at the
Drug Benefit Conference
Our annual meeting draws a wide variety of attendees
from across the nation, and even some international
visitors. Attendees include individuals at the front lines
of decision making about drug benefit management
programs, as well as experts from some of the nation’s
top consulting firms, universities, and pharmacy benefit
management companies.
No matter what role you play in designing and administering these programs, you’ll find exceptional value in
attending our conference.
Exhibit Hours
Monday, March 2nd
Tuesday, March 3rd
Wednesday, March 4th
4:25 pm to 4:55 pm
5:40 pm to 7:10 pm
7:30 am to 8:30 am
10:15 am to 10:45 am
11:45 am to 1:15 pm
3:20 pm to 3:35 pm
4:35 pm to 6:05 pm
7:30 am to 8:30 am
10:40 am to 11:00 am
2015 Conference Highlights
Learn. Learn. Learn.
Customize your learning experience. This year we have expanded
our agenda to include 16 insightful breakout sessions to provide
you with the strategies and tools to effectively manage the drug
benefit. In order to give you more content, we have combined some
presentations thematically into single sessions. These are denoted
with Talk 1 and Talk 2 on the conference program descriptions.
Select from three educational tracks:
•Track 1 — Business Policy: Understand and engage in best
business practices and policies to promote a sustainable drug
benefit
•Track 2 — Clinical Management: Maximize the clinical value
of the prescription drug dollar, promote patient safety, and
enhance member outcomes
•Track 3 — Specialty and Compounds: Anticipate and plan
for new and ongoing developments in the fast-growing
specialty drug pipeline
Follow a specific track or mix and match—the choice is yours!
Achieve Learning Objectives
After participating in the conference, attendees will be able to
understand and act on:
•Information about the effects that health insurance exchanges
have on key marketplace stakeholders
•Effective strategies for managing compounded medications
•Appropriate management strategies for controlled substances
•Opportunities to effectively manage specialty drugs, including
hepatitis C, within both the pharmacy and medical benefits
•Effective approaches to enhancing consumer engagement
•Strategies for pricing, pharmacy network management, and
PBM relationships within the traditional pharmacy benefit
•Appropriate utilization of integrated pharmacy and medical
claims data
Earn Free Continuing Education Credit
PBMI offers continuing education credit for pharmacists (Accreditation Council for Pharmacy Education). Participants attending the
conference can select from 14 sessions and may earn up to six (6)
contact hours of CPE credit. Each session identified with an ACPE
UAN code is worth 1.0 contact hour. Recertification credit is also
available for HR Professionals (WorldatWork Society of Certified
Professionals).
For full details on Continuing Education Credits, please see page 11.
Pre-Conference Workshop
Sponsored by
Jeopardy
(PBM Contracts Edition):
Is It a Game You’re Willing to Play?
By Invitation Only
SuAnn Stone, Director, Business & Product Development, OmedaRx
Using an interactive jeopardy-style game format to engage the
audience on the topic of PBM contracts, the speaker will examine
various contracts, define terms, and address differences and
concerns among them. This workshop will be held on March 2
from 10:30 am to noon.
Enjoy Daily Networking Opportunities
Take advantage of opportunities to network and establish relationships
with peers and colleagues:
•Breakout sessions designed for benefits generalists and
managed care professionals
•Educational Forum Café with reference materials on topics to
address your specific drug benefit needs from various
exhibitors
•Networking receptions, breaks, and meals
Visit the Educational Forum Café
Conference attendees can mingle, network, and collect reference
materials on drug benefit topics at the PBMI Educational Forum Café.
This popular conference feature offers a limited number of exhibitors
the opportunity to distribute research reports, monographs, and other
educational materials.
New for 2015
Conference Mobile App
Sponsored by
Through this application, attendees will have quick access to the
agenda, speaker, sponsor, exhibitor details, and receive up-to-date
conference information. Login details will be shared with conference
attendees a few weeks prior to the meeting. This application is
compatible with Androids, Blackberrys, smartphones, and all tablet
devices.
About PBMI
PBMI provides research and education to help health care benefit
executives work with pharmacy benefit managers (PBMs) and
other professionals to design prescription drug benefit programs.
PBMI provides a forum for purchasers to exchange ideas and drive
marketplace changes that improve pharmacy benefits and control
costs. To learn more, visit www.pbmi.com.
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2015 Conference Speakers
Eytan Alpern, MD,
Founder and Chief
Operating Officer,
Advanced Medical
Reviews
Himmet Dajee,
MD, FACS,
Medical Director Medical
Management, CalOptima
Brian N. Anderson,
Consultant, Milliman
Steven G. Avey,
RPh, MS, FAMCP,
Kent L. Bradley,
MD, MPH, MBA,
David Calabrese,
RPh, MHP,
Karen Coderre,
PharmD, MS, BCPP,
Kevin Colgan,
MA, FASHP,
Pat Gleason,
PharmD, BCPS,
FCCP,
Andrew Hertler, MD,
Marc Hudak, MBA,
Sean Karbowicz,
PharmD,
Melissa Sherer
Krause, PharmD,
Joel Owerbach,
PharmD,
Cynthia J. Pigg,
BSPharm, MHA,
FAMCP,
Renee Rayburg, RPh,
Kirsten Tiberg, RPh,
Chris Williams,
PharmD,
Vice President, Specialty
Programs, MedImpact
Healthcare Systems, Inc.
Matthew Gibbs,
PharmD,
Chief Commercial Officer,
EnvisionRx Options
Lynnae Mahaney,
BSPharm, MBA,
FASHP,
Brand Newland,
PharmD, MBA,
Gary Rice,
RPh, MS, MBA, CSP,
Andrew Shim,
PharmD, JD, MAM,
Jim Smith,
Vice President, Clinical
Services, Diplomat
Executive Director,
Center for Pharmacy
Practice Accreditation
International Director,
Field Medical and
HE&OR, Medical Affairs,
Hospira
Chief Medical Officer,
New Century Health
Director of Health
Outcomes, Prime
Therapeutics
Susan Maddux,
BS Pharmacy,
PharmD,
Chief Pharmacy Officer,
UnitedHealthcare
Senior Vice President
and Chief Medical
Officer, Safeway Inc.
Vice President of
Business Development,
OutcomesMTM
Associate Director
Biosimilar Education and
Strategy, AbbVie
Consultant,
Pharmaceutical Strategy
– Solutions
Catherine I. Starner,
PharmD,
Senior Health Outcomes
Researcher, Prime
Therapeutics
Vice President,
Chief Pharmacy Officer,
Catamaran
Vice President, Care
Innovation & Integration,
Blue Cross & Blue Shield
of Rhode Island
Binita Patel,
PharmD, MS,
Director of Ambulatory
Pharmacy, Froedtert &
Medical College of
Wisconsin
Craig S. Stern,
RPh, PharmD, MBA,
President, Pro Pharma
Pharmaceutical
Consultants, Inc.
Note: Not all speaker photos available at time of printing.
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Clinical Pharmacist,
Health New England
Director, Policy and
Clinical Business
Development, OmedaRx
Associate Vice President,
University Hospital
Consortium
Consultant Pharmacist,
Pharmacy Healthcare
Solutions, Inc.
Senior Director, Clinical
Consulting, Artemetrx
Independent Consultant,
Era4Pharmacy Solutions
Vice President,
Specialty Clinical
Program Development,
Prime Therapeutics
Pharmacy Advocate,
Manatee County
Government – Manatee
YourChoice Health Plan
2015 Conference Program
Monday, March 2, 2015 Conference Program Descriptions
Registration
8:00 am to 7:00 pm
10:30 am to 12:00 pm
Pre-Conference Workshop sponsored by OmedaRx Conference Rooms 17 & 18
SuAnn Stone,
Jeopardy (PBM Contracts Edition): Is It a Game You’re Willing to Play?
Director, Business & Product
Definitions, Terms and Knowing Your Numbers
Development, OmedaRx
By Invitation Only
1:00 pm to 2:15 pm
General Session Salon C-E
Jane Lutz,
Opening Remarks
Executive Director, PBMI
The Honorable Newt Gingrich, A Vision for a Transformed Health Care System
Keynote Speaker
2:20 pm to 3:20 pm
Breakout Sessions (choose one of three)
Track 1
Business and Policy Salon C-E
ACPE UAN 0221-9999-15-002-L04-P
Gregory Warren, FSA, MAAA, Impact of the ACA on Pharmaceutical Manufacturers and Effect on Rebates
The session will demonstrate how the shifting demographics caused by the Affordable Care Act (ACA) can affect
Vice President, Actuarial
pharmaceutical manufacturer sales volumes and margin mix. It will also explore how episode groupers and risk adjustment
Consulting, OptumInsight
techniques can be employed to bridge the gap between the traditional disciplines of health economic outcomes research
Matthew M. Nieszel, MBA,
(pharmaceutical manufacturers) and actuarial science (payers) in the creation of risk/gain-share agreements.
Director, Pharmacy Analytics
Consulting, Optum
Track 2
Clinical Management Conference Rooms 1-3
ACPE UAN 0221-9999-15-003-L04-P
Eytan Alpern, MD,
The Importance of Revisiting Medication Regimens and a Look at the Founder and Chief Operating
Role of Nonprescription Medications in the Review Process
Often individuals stay on medications long after the benefit has been received. We will look at why it is important to
Officer, Advanced Medical
do regular pharmacological reviews during patient care and why these should be done more often. We will review data
Reviews
that shows which types of medications individuals often stay on and the potential effects on long-term patient health.
Considering that in 69% of pain medication cases prescribing physicians implemented our physician recommendations,
we will demonstrate how and what our reviewer team looks for. We will also look at the role that nonprescription
medications should play in the pharmacological review process.
Track 3
Specialty and Compounds Conference Rooms 17 & 18
ACPE UAN 0221-9999-15-004-L04-P
Pat Gleason, PharmD, BCPS,
The Future of Hepatitis C: A Financial Forecast and Tools to FCCP, Director of Health
Effectively Manage New Drugs
Outcomes, Prime Therapeutics This session provides an overview of hepatitis C diagnosis trends, treatment regimens, and costs from integrated
pharmacy and medical benefit data to forecast future expenditures. Additionally, participants will learn about tools to
Kirsten Tiberg, RPh,
manage hepatitis C specialty drugs that can help maintain safety, appropriate use, and affordability, as well as the
Vice President, Specialty
Clinical Program Development, decision-making process for formulary placement of various agents in the pipeline. Specific pharmacy and medical
benefit data on adherence, prior authorization outcomes, sustained viral response (SVR), and care management results
Prime Therapeutics
will be shared.
3:25 pm to 4:25 pm
General Session Salon C-E
Joel Owerbach, PharmD,
The 2014-2015 Marketplace: Public Exchanges Shaping the New Pharmaceutical Benefit and
Consultant, Pharmaceutical
Management Evolution
In the first year of the public Marketplace Exchanges, enrollment exceeded 8 million members. Millions more qualified
Strategy - Solutions
for and enrolled in Medicaid programs. Enrollment is expected to reach at least 13 million in 2015 and 24 million by 2016.
Drug benefits and pharmaceutical management are evolving to meet the realities of the new ACA actuarial and regulatory
requirements. This session will compare and contrast Marketplace pharmacy benefits, formularies, and drug coverage
with those of commercial plans and will outline how this Marketplace serves as a window on the broader commercial
pharmacy benefit evolution ahead.
4:25 pm to 4:55 pm
Break Educational Forum Café Salon A, B & F
4:55 pm to 5:40 pm
General Session Salon C-E
Steven G. Avey, RPh, MS,
The Future of the Drug Benefit: Is It Sustainable?
In this “30,000-foot” view of the drug benefit, a widely respected industry executive will share his perspective on its
FAMCP, Vice President,
past, present, and future. Topics to be addressed include long-term trends; changes in store for plans in light of current
Specialty Programs,
and pipeline blockbuster drugs; and best practices to promote and maintain a benefit that provides sustainable access
MedImpact Healthcare
to clinically important medications.
Systems, Inc.
5:40 pm to 7:10 pm
Opening Reception – Sponsored by Outcomes MTM Educational Forum Café Salon A, B & F
Tuesday, March 3, 2015 Conference Program Descriptions
7:30 am to 8:30 am
Breakfast Educational Forum Café Salon A, B & F
8:30 am to 9:30 am
General Session Salon C-E
George Hill,
Wall Street’s Outlook on the PBM Industry
This session will provide an inside look into the PBM landscape from a Wall Street perspective. Attendees will learn about
Director, Equity Research
the issues affecting PBMs and their role in the health care supply chain.
Analyst, Deutsche Bank
9:30 am to 10:15 am
General Session – Rx Innovation Award and PBMI Specialty Drug Benefit Report Salon C-E
10:15 am to 10:45 am
Break Educational Forum Café Salon A, B & F
10:45 am to 11:45 am
Breakout Sessions (choose one of three)
Track 1
Business and Policy Salon C-E
ACPE UAN 0221-9999-15-005-L04-P
Craig S. Stern, RPh, PharmD,
Utilizing Big Data Integration to Achieve Clinical Quality Improvements
This presentation will focus on appropriate utilization of integrated data sets of pharmacy and medical encounter
MBA, President, Pro Pharma
claims, laboratory values, enrollment files, Workers’ Comp files, and other file types for reporting, and will provide
Pharmaceutical Consultants,
real-life examples of financial and clinical monitoring/oversight to achieve quality improvements.
Inc.
Key principles/“rules” for integrating and reporting to monitor outcomes/measure benefits are: integrating data,
Himmet Dajee, MD, FACS,
scrubbing lessons, and reporting categories. Discussion on key management areas will include:
Medical Director Medical
• Financial and clinical oversight using dashboards and drill-down to drivers, profiling, and corrective actions which
Management, CalOptima
lead to physician/patient-specific data mining for positive outcomes,
• Quality oversight utilizing compliance with national/regional guidelines,
• Real solutions for effective utilization of integrated datasets to achieve desirable financial and clinical outcomes.
Track 2
Clinical Management Conference Rooms 1-3
ACPE UAN 0221-9999-15-006-L04-P
Catherine I. Starner, PharmD, Combating the Controlled Substance Abuse Epidemic: Senior Health Outcomes
Pharmacy Benefit Manager and Health Plan Tools
During the past decade, increases in controlled substance prescribing have coincided with higher rates of misuse, abuse,
Researcher,
hospitalizations, and deaths. In this session, we will discuss how health plans and pharmacy benefit managers’ clinical
Prime Therapeutics
programs can help reduce controlled substance abuse through provider intervention, member care management, and
behavioral health involvement.
Track 3
Specialty and Compounds Conference Rooms 17 & 18
ACPE UAN 0221-9999-15-007-L04-P
Compounded Medications: Challenges and Strategies
Delford Doherty, PharmD,
Talk 1: Rethinking Compounds: Effective Compounding Management Strategies
Following a rapid utilization increase in recent years, compounded medications now represent 1% of total prescriptions
PhD, MPH, Director of
Managed Care Services, PCCA filled and account for approximately 1%-5% of total drug spend in the United States. In addition to compliance with
new regulations from state and federal agencies, PBMs and health plans continue to implement plan design and clinical
(Professional Compounding
management strategies to manage compounds. Personalized compounded medications are an integral component of
Centers of America)
patient care and are viable alternatives for patients where traditional medications have been unsuccessful. This presentation
John Voliva, BSPharm, RPh,
will provide an overview of the regulatory landscape and provide strategies to manage compounding without impeding
Director of Legislative
patient care.
Relations, PCCA
Susan Maddux, BS Pharmacy, Talk 2: Are Compounding Medications Compounding Your Costs?
Compounded medicines are increasingly being dispensed for common disorders such as pain management, women’s
PharmD, Chief Pharmacy
health, men’s health, and weight loss and are also being prepared as vitamins, supplements, and cosmetic treatments.
Officer, UnitedHealthcare
Between 2012 and 2013, our customers saw a 35% increase in spend for compounded prescriptions, which are now a
common top 5 trend cost driver. In this session, we will describe the challenges to quality, cost, and patient safety posed
by the growing use of compounds, as well as practical approaches to addressing them.
11:45 am to 1:15 pm
Lunch Salon G & M Educational Forum Café open during lunch
1:15 pm to 2:15 pm
Breakout Sessions (choose one of three)
Track 1
Business and Policy Salon C-E
Tips and Techniques For Effective Contracting With Your PBM
Chris Brown,
Talk 1: Contracting Pitfalls and Opportunities
The talk will cover several critical contracting points that are often misunderstood or ignored by benefits advisors, as well
Regional Sales Manager,
as actionable ideas and information that can be used in future PBM contract negotiations. In particular, the importance
Truveris, Inc.
of clear, precise, and enforceable definitions of drug classifications, along with the inextricable relationship of these
definitions to an effective contract and claims auditing process, will be discussed in detail.
Talk 2: Effective PBM RFP and Contracting Processes
Brian N. Anderson,
Effective PBM request for proposals (RFP) and contracting processes can save money for payers while aiding in
Consultant, Milliman
maintaining their level of benefits. This talk will provide an overview of the RFP and contracting processes including
cost factors, transparency, pass-through pricing, administrative and dispensing fees, clinical processes, rebates, disclosures,
and approaches to ensure that the plan sponsor receives items promised in the RFP.
Breakout Sessions continued on next page.
8
Track 2
Clinical Management Conference Rooms 1-3
Purpose and Impact of Patient Assistance Programs for Plan Sponsors and Patients ACPE UAN 0221-9999-15-008-L04-P
Anthony Mollica, RPh,
Talk 1: The Impact of Patient Assistance Programs
In the context of rapidly rising specialty drug costs, patient assistance programs have become increasingly important to
Vice President Pharmacy
payers and patients. This talk will address the following topics: types of patient assistance plans, education on their
Operations, Omnicare
purposes, history of these plans, adherence to care, impact on pharmacy plan cost avoidance, and formulary rebates.
Specialty Care Group
Talk 2: Helping Patients Maximize the Value of New Hep C Treatments: The Role of Assistance Programs
Cynthia J. Pigg, BSPharm,
This talk will describe a care management initiative, Hep C Assist, whose goals are to optimize patient outcomes and
MHA, FAMCP,
maximize the payer’s investment in recent treatments for hepatitis C. Patients with comorbidities of hepatitis C and
Independent Consultant,
mental health issues, including substance abuse, represent the target population. Hep C Assist focuses on the holistic
Era4Pharmacy Solutions
health needs of the patient, beginning with the initial prior authorization request and continuing through completion of
the treatment plan. Continuity of therapy, assessment of responsiveness, intelligent dispensing, and provider assistance
are hallmarks of the program. Program outcomes will be discussed.
Track 3
Specialty and Compounds Conference Rooms 17 & 18
ACPE UAN 0221-9999-15-009-L04-P
The Future of Specialty Drug Management: The Coming Pipeline and “Next Generation” Strategies
Talk 1: Mind the Gap: Specialty Medications and FDA’s Expedited Approvals:
Sean Karbowicz, PharmD,
Drug Management Challenges and Opportunities
Director, Policy and Clinical
In 2013, almost one-half of the new medications approved by the FDA were approved through an expedited FDA-approval
Business Development,
process, which requires less rigorous scientific evidence and a shorter review period than the standard FDA approval
OmedaRx
process. Many of these products are specialty medications and biologics with costs that continue to generate headlines.
Payers need to understand and address the gaps in clinical information to determine optimal management strategies
for specialty pharmaceuticals, including channel management, site-of-care, formulary tiering, utilization management,
and cycle management. In this talk, the speaker will discuss the challenges and opportunities payers have in anticipating
the cost and clinical impact of specialty products, with emphasis on how a rigorous product assessment can assist in
identifying actionable management strategies.
Talk 2: Next Generation Specialty Management is More Than Traditional Trend Management
Surya Singh, MD,
Disconnected patient care models, infusion services, and health information systems can limit your ability to manage
Vice President, Specialty
drug costs, quality, and the patient experience. Managing specialty drug costs is imperative, but strategies to manage
Client Solutions, CVS Health
drug costs address less than half of the total cost. The best way to control all aspects of specialty spend is to support
high-cost patients beyond their drugs. The focus of this talk is to highlight innovations in specialty management.
2:20 pm to 3:20 pm
Breakout Sessions (choose one of three)
Track 1
Business and Policy Salon C-E
Lynnae Mahaney, BSPharm,
The Value of Pharmacy Practice Accreditation in Drug Benefit and Pharmacy Network Management
This session will discuss the Center for Pharmacy Practice Accreditation (CPPA) practice standards and accreditation
MBA, FASHP, Executive
Director, Center for Pharmacy program intended to evaluate the delivery of pharmacy care, enabling safe and cost-effective patient care outcomes.
A panel of presenters will describe the community and specialty pharmacy practice standards, criteria, and metrics
Practice Accreditation
applicable to payer performance monitoring strategies, such as star ratings and patient satisfaction. The panel will also
Kevin Colgan MA, FASHP,
provide specific examples of (1) how accreditation can realize the pharmacist’s value in managing medication therapy
Associate Vice President,
University Hospital Consortium to improve outcomes and reduce costs while collaborating effectively with payers and (2) how the accreditation process
allows pharmacists to be accountable for patients’ therapeutic outcomes by working cooperatively with managed care
Gary Rice, RPh, MS, MBA,
in ways that create sustainability, network management criteria, and ongoing benefit design.
CSP, Vice President,
Clinical Services, Diplomat
Track 2
Clinical Management Conference Rooms 1-3
ACPE UAN 0221-9999-15-010-L04-P
MTM in an Ambulatory Setting to Meet Transition-Of-Care Goals
Binita Patel, PharmD, MS,
Talk 1: Providing Optimal Medication Management in an Ambulatory Setting
The speaker will discuss a model that was built to provide access, affordability, and education about outpatient
Director of Ambulatory
medications. By the end of 2015, Froedtert will have twelve outpatient pharmacies including an off-site mail service to
Pharmacy, Froedtert &
provide patients access points to their medications. Even with enhanced access points, patients may not be able to
Medical College of Wisconsin
afford their medications, so a team was formed to help with prior authorizations and patient assistance. Lastly, education
by pharmacists will be discussed as a best practice in improving medication use and patient outcomes.
Talk 2: Transitional Care Medication Therapy Management
David Calabrese, RPh, MHP,
Because medication errors and noncompliance commonly occur when a patient moves from hospital to home, effectively
Vice President, Chief
managing medication therapy is crucial to ensuring the patient stays on the road to better health. Through close
Pharmacy Officer, Catamaran
Karen Coderre, PharmD, MS, collaboration and coordination, a payer and its PBM can better address medication therapy and adherence issues, reduce
hospital readmissions, lower health care costs, and improve coordination of care for members during transitions.
BCPP, Clinical Pharmacist,
To illustrate the benefits of PBM/payer collaboration, the presentation will discuss the process and outcomes of a
Health New England
PBM/health plan partnership to administer a hospital discharge program for the plan’s commercial members.
Breakout Sessions continued on next page.
9
Track 3
Specialty and Compounds Conference Rooms 17 & 18
ACPE UAN 0221-9999-15-011-L04-P
James P. Langley, MBA,
Current View of Biosimilars: Pipeline, Timing, and Planning Considerations
This session will provide a current view of biosimilars as the initial biosimilar applications process through the FDA.
Chair, Healthcare and Life
The presentation will review the following topics: updated pipeline and timing considerations, likely FDA approach in
Sciences Practice, Mead
the next couple of years, key biosimilar/pharma manufacturer trends, payment system trends impacting biosimilar
Consulting Group
adoption, and implications for plan design.
3:20 pm to 3:35 pm
Break Educational Forum Café Salon A, B & F
3:35 pm to 4:35 pm
Prize Drawing Winners Announcement and General Session Salon C-E
ACPE UAN 0221-9999-15-015-L04-P
Brand Newland, PharmD,
Unique Medication Therapy Management Program Model: Engaging Pharmacists from a Variety of Practice Settings to Deliver Services
MBA, Vice President of
Which Impact Quality and Control Cost
Business Development,
In July 2014, OutcomesMTM partnered with Blue Cross & Blue Shield of Rhode Island to implement a unique MTM
OutcomesMTM
program that utilizes pharmacists in retail settings as well as pharmacists in Patient Centered Medical Home settings
Marc Hudak, MBA,
to deliver MTM services. This session will describe this unique program design, the technology utilized to launch this
Vice President, Care
initiative, and key results from the program’s first six months.
Innovation & Integration
Beth Hebert-Silvia,
Managing Director, Pharmacy,
Blue Cross & Blue Shield of
Rhode Island
4:35 pm to 6:05 pm
Networking Evening Reception Educational Forum Café Salon A, B & F
Wednesday, March 4, 2015 Conference Program Descriptions
7:30 am to 8:30 am
Breakfast Educational Forum Café Salon A, B & F
8:30 am to 9:30 am
Grand Prize Drawing Winner Announcement and General Session Salon C-E
Round Table Panel:
Biosimilars from Diverse Perspectives: A Roundtable Discussion
Jim Smith,
When asked in PBMI’s 2014 Specialty Drug Benefit Survey about the likely effect that biosimilars will have on specialty
Associate Director Biosimilar
medication costs, nearly one-half of employers reported that they were uncertain, 15% indicated that biosimilars will
Education and Strategy, AbbVie substantially reduce costs, and 36% anticipated a marginal impact. What will the actual impact of biosimilar development
Andrew Shim, PharmD, JD,
and approval be? This question will be discussed from a wide variety of stakeholder perspectives—each with a unique
MAM, International Director,
and informed view of this critically important question.
Field Medical and HE&OR,
Medical Affairs, Hospira
Moderator:
Renee Rayburg, RPh,
James P. Langley, MBA, Chair, Healthcare and Life Sciences Practice, Mead Consulting Group
Senior Director, Clinical
Consulting, Artemetrx
9:40 am to 10:40 am
Breakout Sessions (choose one of three)
Track 2
Clinical Management Conference Rooms 1-3
Chris Williams, PharmD,
The Pharmacy Advocate: What It Is, How It Works, What’s In It For You
Pharmacy Advocate, Manatee This session will describe the addition of a Pharmacy Advocate in a 6,500 member health plan, resulting in improved
County Government – Manatee patient care and annual savings of more than $500,000. The plan’s full-time pharmacist leads various initiatives including
YourChoice Health Plan
efficient switching from prescription to over-the-counter medication; utilization management in the areas of ADHD, pain,
Melissa Sherer Krause,
and mental health; and member communications. The Pharmacy Advocate’s oversight optimizes the involvement of
PharmD, Consultant
student PharmD candidates, expanding the reach of the pharmacist while providing a valuable educational opportunity.
Pharmacist, Pharmacy
The speaker will explain the process and “value added” for the Pharmacy Advocate position for plan sponsors.
Healthcare Solutions, Inc.
Track 3
Specialty and Compounds Conference Rooms 17 & 18
ACPE UAN 0221-9999-15-012-L04-P
Andrew Hertler, MD,
Controlling Oncology Medication Costs Through Risk-Based Reimbursement Chief Medical Officer,
& Quality-Driven Utilization Management Models
Managing medical oncology costs is critically necessary as oncology pharmacy trend continues to soar at double-digit
New Century Health
rates annually. Many health plans and providers are collaborating to explore risk-based strategies to reach “triple aim
goals” of improved patient care quality, reduced costs, and better patient outcomes. This presentation will describe
and present the outcomes of strategies for managing oncology pharmacy costs through risk-based reimbursement
methodologies that are integrated with a clinical quality management program.
10:40 am to 11:00 am
Break Educational Forum Café Salon A, B & F
10
11:00 am to 12:00 pm
Breakout Sessions (choose one of two)
Track 1
Business and Policy Salon C-E
ACPE UAN 0221-9999-15-013-L04-P
Kent L. Bradley, MD, MPH,
Empowering Choice Through Prescription Benefit Design
Reference pricing of lower-cost alternatives within therapeutic categories has been shown to significantly reduce
MBA, Senior Vice President
prescription costs while maintaining good clinical outcomes. This presentation will explain the concept of reference
and Chief Medical Officer,
pricing and therapeutic equivalency, review the evidence, and highlight recent data from several larger self-insured
Safeway Inc.
employers in the United States. It will describe the overall shift to increased consumerism in the health benefit arena
and discuss strategies on how prescription benefit design can also increase consumerism and patient empowerment.
Track 2
Clinical Management Conference Rooms 1-3
ACPE UAN 0221-9999-15-014-L04-P
Medication Management in the Public and Private Sectors
Talk 1: The Evolving Roles of Employers and Government Payers with the Rx Benefit
Matthew Gibbs, PharmD,
Payment mechanisms for prescription drugs have changed significantly over the past 10 years with the evolution of
Chief Commercial Officer,
Medicare Part D, Duals demonstration projects, Medicaid expansion, and the commercial impact of the Affordable Care Act.
EnvisionRx Options
This presentation will review the various industry trend reports and explore the various purchasing shifts that are occurring
from the employer to the government payer. Additionally, specific focuses and strategies regarding the management
of the specialty pharmacy benefit and how each of these systems is managing the mix, cost increases, and utilization
variances will also be described.
Talk 2: Hepatitis C Medication Management – Just the Tip of the Specialty Iceberg
Kimberly Lenz, PharmD,
The treatment of Hepatitis C can be complex and financially challenging due to the cost of these highly curative therapies
Clinical Pharmacy Manager
and more so, the estimated number of people who are waiting to be treated and are yet to be diagnosed. Identifying
Paul Jeffrey, PharmD,
applicable management strategies in the evolving landscape of treatment is critical in order to ensure appropriate
Pharmacy Director for
access to care. During this session we will review utilization data, including regimens and genotypes, and discuss
MassHealth, Office of Clinical
successful management strategies which include a monitoring program that has to lead to significant cost avoidance.
Affairs, Commonwealth
We will describe challenging populations and topics of interest and controversy. Finally, we will share lessons learned
Medicine, University of
Massachusetts Medical School and the next steps surrounding management of this and other therapeutic classes.
12:00 pm to 12:15 pm
Closing Remarks Salon C-E
Continuing Education Credit
Pharmacists
848 West Bartlett Road, Suite 3E, Bartlett, IL 60103
Phone: 630-540-2848 Fax: 630-540-2849
www.ProCE.com
The continuing education activities for pharmacists have been developed
through a joint providership of ProCE and PBMI. The 14 sessions offering
ACPE credit are designated in the program announcement with a UAN
(universal activity number) and each session is worth 1.0 contact hours.
The release date for these activities is March 2, 2015.
P roCE, Inc. is accredited by the Accreditation Council for
Pharmacy Education as a provider of continuing pharmacy
education (CPE). Participants attending the conference
CPE activities may earn up to six (6) contact hours of
CPE credit. Note: some of the CPE sessions are being held concurrently.
Conference registration fees cover the cost of CPE credit. Statements of
completion will be issued at www.ProCE.com upon successful completion
of the online CPE activity learning assessment(s) and activity evaluation(s).
All learning assessment(s) and activity evaluation(s) must be completed
no later than April 3, 2015. No partial credit will be given for any individual
session. Conflict of interest disclosures are required of all faculty and shall
be provided to all participants at the conference.
Human Resource Professionals
The PBMI Drug Benefit Conference
qualifies for recertification credit for
the Certified Compensation Professional
(CCP®), Certified Benefits Professional® (CBP), Global Remuneration
Professional (GRP®), Work-Life Certified Professional® (WLCP®),
Certified Executive Compensation Professional (CECP)® and Certified
Sales Compensation Professional (CSCP)® designations granted by
WorldatWork Society of Certified Professionals. For more information on
recertification, visit the WorldatWork Society recertification webpage at
www.worldatworksociety.org/recertification.
11
2015 Conference Registration
2015 PBMI Drug Benefit Conference
March 2-4, 2015 • San Antonio Marriott Rivercenter Hotel • San Antonio, Texas
Register online at www.pbmi.com/shop/conferences/2015-conference-copy/
or complete and fax this form to 480-222-4229
Send payment to: 2901 North Dallas Parkway, Suite 420, Plano, Texas 75093
Mr./Mrs./Ms. ________________________________________ Title __________________________________________
Organization _________________________________________ Email __________________________________________
Address ___________________________________________________________________________________________
City/State/Zip _______________________________________ Phone ___________________________________________
PBMI
On or Before
2/2/15
After
2/2/15
Employers, Health Plans, and Union Groups
q $795
q $895
Best Value Join & Go For Nonmember Employers, Health Plans, and Union Groups*
q $850
q $950
PBMs, Industry Partners, Suppliers, Consultants, and All Others
q $1,295
q $1,395
Students (for eligibility, must register with student school email address)
q $199
q $199
MEMBERS — Login before registering online to get your 10% discount.
* Join & Go Package includes one-year PBMI Individual Membership ($150) with the member registration rate for the Conference.
q Charge my credit card
q Bill me
q My check/money order for $ ______________________ is enclosed
Name on credit card _______________________________________ Signature _____________________________________
Card# __________________________________________________________________ Exp: __________/____________
Hotel Reservations
Conference attendees are responsible for making their own hotel
reservations at the host property:
San Antonio Marriott Rivercenter Hotel
101 Bowie Street
San Antonio, Texas 78205
1-877-622-3056
PBMI has reserved a block of rooms at a conference rate of $219
per night – reference PBMI Conference as the group code.
Please note: All reservations must be accompanied by a first night
room deposit or guaranteed with a major credit card. Hotel room
rates are subject to applicable state and local taxes in effect at the
time of check-out.
Registration Policies
Cancellations received before February 16, 2015 will receive a
refund less a $150 administrative fee. Registration fees paid after
February 16, 2015 are nonrefundable. If necessary, substitutions
are acceptable. To transfer your registration to a colleague,
contact [email protected] before February 26, 2015.
2901 North Dallas Parkway, Suite 420 • Plano, Texas 75093 • Phone: 480-730-0814 • Fax: 480-222-4229 • www.pbmi.com
© 2014, Pharmacy Benefit Management Institute
All Rights Reserved
11/2014