PBMI National Conference

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.

Mike Steelman, vice president, Managed Markets, Dexcom presented on the pathways to implement non-prescription digital therapeutics at the 2023 PBMI Annual National Conference in Orlando. In this interview with Managed Healthcare Executive, Steelman suggests that creating "certainty in an uncertain world" in the digital therapeutic space could potentially open up doors for further use of these tools.

Mike Baldzicki, chief commercial officer, Premier Pharmacy Services, shared some takeaways from his presentation on the rare-ultra orphan disease market and its therapies at the 2023 PBMI Annual National Conference in Orlando.

There is a huge opportunity for savings from the recently launched Humira biosimilars and others expected to reach the market in the next few years. But plans and PBMs will need to step into the role that pharmaceutical manufacturers once did in supporting patients and prescribers.

At the 2023 PBMI Annual National Conference in Orlando, Ellen Feeney, director of Clinical Pharmacy Strategies at Highmark discusses how these new programs payers are using to control medication costs work, and shares how costs of the GLP-1s should be managed.

Payers are trying to figure out how to provide access to patients who would benefit from weight loss drugs such as semaglutide but also control costs.

As cell- and gene-based therapies become available for new and expanded indications with a higher incidence of patients, payers will be challenged to find ways to provide access to patients.

At the 2023 PBMI Annual National Conference in Orlando, Ellen Feeney, director of Clinical Pharmacy Strategies at Highmark shares the tools payers are using to control medication costs outside the traditional ones like utilization management. Feeney also talked about the new program that Highmark kickstarted in 2022 to help manage medication costs.

At this year's PBMI Annual National Conference in Orlando Ben Urick, principal health outcomes researcher at Prime Therapeutics, shared methods for medical cost savings through adherence improvement using integrated medical and pharmacy claims data.

Greg Baker, CEO of AffirmedRx, one of the many new, smaller pharmacy benefit managers (PBMs) challenging the status quo, listed the eight things that employers should know about their PBM. Baker planned to share six key points at the 2023 PBMI National Annual Conference in Orlando, but shared two more with conference goers.

Sampson Davis, M.D., an emergency medicine physician and best-selling author, says a tailored approach is needed.

Case and care management can help health plans cope with seven-figure cell and gene therapies, according to panelists at the Pharmacy Benefit Management Institute’s annual meeting.

PBM transparency and data reporting requirements are likely to be part of a larger healthcare bill that Congress will work on this fall.