AMCP Nexus

There is a need for strict policies regarding the use of AI in the managed care space, according to Douglas S. Burgoyne, Pharm.D., MBA, FAMCP, adjunct associate professor at the University of Utah College of Pharmacy.

Health plans and PBMs are using AI to aggregate data, summarize information and enhance their formulary decision-making processes, according to Douglas S. Burgoyne, Pharm.D., MBA, FAMCP, adjunct associate professor at the University of Utah College of Pharmacy.

Technology can help address the complexities of specialty medications by automating processes and enabling proactive interventions to ensure patients stay on their critical therapies, according to Kristen Whelchel, Pharm.D., CSP, Research and Patient Care Improvement Pharmacist with Vanderbilt Specialty Pharmacy's Department of Health Outcomes and Research.

Here’s what you missed this week on Managed Healthcare Executive.

Only 15% of those who start a glucagon-like peptide 1 (GLP-1) for weight loss are still taking it two years later according to Prime Therapeutics’ real-world evidence, says Ben Urick, Pharm.D., Ph.D., a health outcomes researcher for the pharmacy benefit manager.

Kristen Whelchel, Pharm.D., CSP, Research and Patient Care Improvement Pharmacist with Vanderbilt Specialty Pharmacy's Department of Health Outcomes and Research, explains how technology identifies at-risk patients, coordinates medication refills and more.

The FDA has already made more than a dozen cancer drug approval decisions this year and more expected in the next several months and in early 2025, according to Kaelyn Boss, who gave an oncology drug pipeline talk at the 2024 AMCP Nexus meeting this week.

Meanwhile, newly approved Cobenfy and the long-acting injectable antipsychotics may help with the long-standing problem of nonadherence to schizophrenia treatment.

Large PBMs are removing Humira from some of their formularies. AMCP Nexus panelists still see challenges and a need for education and more attention to patient interests.

Crescent Moore, Ph.D., Pharm.D., Director of Part D/Pharmacy at BluePeak Advisors, highlights the expected shift of Medicare beneficiaries towards Medicare Advantage Prescription Drug (MA-PD) plans.

Crescent Moore, Ph.D., Pharm.D., Director of Part D/Pharmacy at BluePeak Advisors, explains the impacts of the upcoming changes to Medicare Part D.

Charlie Dragovich, Senior Director and Client Strategist at Cencora, talks about the way regulations usually work and how the road to the Preapproval Information Exchange Act was different.

An overview of the preapproval information exchange (PIE) from Charlie Dragovich, Senior Director and Client Strategist at Cencora

Several companies are developing new drugs to treat transthyretin amyloidosis cardiomyopathy (ATTR-CM), a formerly obscure condition that is getting an increasing amount of attention.

How health plans are implementing strategies to leverage biosimilars to lower costs for both payers and patients, according to Javier Gonzalez, Pharm.D., chief growth and commercial officer of Abarca

Cynthiya Ruban, Ph.D., M.S., Director of Digital Solutions at Cencora says to keep the following in mind as AI use accelerates.

Ways AI is increasingly used in healthcare and how it can benefit healthcare decision makers, according to Cynthiya Ruban, Ph.D., M.S., Director of Digital Solutions at Cencora.

It's not the multimillion dollar prices, says Kevin Niehoff, Pharm.D., of IPD Analytics. The pool of sickle cell disease patients who are prime candidates for sickle cell disease gene therapy was overestimated, according to Niehoff.

Only a small group of patients have started the process to receive the new gene therapies for sickle cell disease, says Kevin Niehoff, Pharm.D., of IPD Analytics.

Just a small percentage of employers use alternative funding programs, including accumulators and maximizers. But approximately 60% of employers who do use these programs said in a survey they are effective at managing healthcare costs.

Prior to the IRA, there were no limits on beneficiary OOP spending throughout the year. However, by 2025 the IRA will introduce the $2,000 maximum OOP expenses.

The Minnesota-based pharmacy benefit manager says a program that resulted in patients switching from two incretin therapy prescriptions to one yielded $7,500 in savings per patient and a total of $3.5 million.

In a platinum award winning poster presented at the AMCP Nexus 2023 conference in Orlando, “Specialty drug use varies by race and wage among employees with employer-sponsored health insurance,” authors expressed that spending on specialty medications for autoimmune conditions has increased in recent years, raising affordability concerns for employers.

Research continues to develop new therapies for rare cancers and to provide options that allow for fewer toxicities. At the same, however, more new drugs are launching with high price tags.

Adopting evolving computer system tools like artificial intelligence and machine learning in managed care pharmacies have resulted in efficiency when addressing the challenges they are faced with, according to Jessica Hatton, PharmD, BCACP, associate vice president of Pharmacy at CareSource and Nick Trego, PharmD, senior vice president of Clinical Analytics and Client Services at HealthPlan Data Solutions, Inc.

The program yielded savings of $25,000 per patient in its pilot phase but is not expected to produce savings as a routine offering because reimbursement for home infusion was matched to reimbursement at a facility. Horizon executive Timothy O’Shea, Pharm.D., M.S., says cost savings were a “secondary outcome” of the program and noted the high patient satisfaction.

Just over 160 patients have participated in the insurer's oncology home infusion program since it started in late 2020. Patient satisfaction is high, according to Horizon officials, who are looking to expand the program with other providers in its market and to include more drugs that patients could be treated with at home.

Using an AI platform, Magellan Health was able to better support providers in prescribing behavioral health medications and addressing medication problems, which reduced pharmacy costs and increased adherence.

Jessica Hatton, PharmD, BCACP, associate vice president of Pharmacy at CareSource caught up with MHE to discuss value assessment tools and their use in the managed care pharmacy space. This topic and more were addressed by Hatton during her presentation today in Orlando at the AMCP Nexus 2023 conference.

The results of a recent feasibility study on the outpatient administration of cell therapies is creating growing interest in whether home-based management may be possible in the future.