The PCMA PBM Policy Forum was hosted April 11, 2016 in Washington, DC. The forum, focused on the cost of prescription drugs and the latest efforts to bring those costs down, brought together healthcare and drug industry advocates from think tanks, patient advocacy groups, and industry trade associations.
Pharmacy benefit managers (PBMs) are at the forefront of implementing innovative contracting techniques that better align the cost of medications with their value. By offering additional tools to manage specialty drugs, including the use of specialty pharmacies, PBMs and payers are improving the quality and continuity of care patients receive, while ensuring they derive the greatest value from their medications. Over the next 10 years, PBMs and specialty pharmacies will save an estimated total of $654 billion on drug costs for health plan sponsors.
The insights shared from these industry thought leaders will continue to share the future of the specialty pharmacy industry.
How Policymakers Can Leverage Competition to Reduce Rx Costs
Mark Merritt – President & Chief Executive Officer, PCMA
PCMA President and CEO Mark Merritt kicked off the conference and highlighted one of the critical challenges in healthcare today: how to manage pharmacy costs and improve access in an era when high cost medicines are becoming a larger part of drug spending. Merritt outlined how PBMs are meeting this challenge by using innovative management techniques that increase choice and competition, while reducing costs.
Managing High Impact Pipeline Drugs: Evolving Payer Considerations
Farrah Wong – Director, Pipeline and Drug Surveillance, OptumRx
PBMs require more outcomes data from manufacturers to ensure these treatments are safe, effective, clinically appropriate for patients, and can increase patient survival. Improved outcomes data and competition in the market will allow PBMs to identify the most effective treatments for patients while ultimately lowering costs.
What Makes Specialty Pharmacies Special and Why They Are Crucial to the Future of Drug Cost Management
Everett Neville – Senior Vice President, Supply Chain, Express Scripts
Compared to traditional pharmacies, specialty pharmacies are able to prove their cost containment abilities and implement more complex criteria for patients using specialty drugs. When specialty pharmacists guide patients through each step of their treatments and apply PBM tools to the process, these pharmacies continue to achieve markedly different impacts on clinical outcomes and cost reductions from unmanaged patient care, up to a 50% trend difference.
Managing the Escalating Cost and Utilization of Medical Benefit Drugs
Alan Lotvin – Executive Vice President, CVS/specialty, CVS Health
“By using a relatively non-aggressive prior authorization, it’s possible to take out 3% of the drug spend under the medical benefit. When applied to the Medicare population, this could save $1.3 billion. Without impairing or restricting care, it is possible to make a huge impact on the budget with a relatively small amount of work.”
The Challenges of High Cost Drugs for Medicare
Sean Cavanaugh – Deputy Administrator & Director, Center for Medicare, Centers for Medicare & Medicaid Services
“The Medicare Part D program is in great shape, with over 40 million beneficiaries receiving benefits, and premiums having been essentially stable since the passage of the Affordable Care Act. We have been touting the successes of the program and rightfully so, with many in this room having helped contribute to the success of this program, and we thank you.”
Value-Based Contracting and How it Is Being Applied in the Commercial Marketplace for Savings
Chris Bradbury – Senior Vice President, Integrated Clinical Solutions and Specialty Pharmacy, Cigna Pharmacy Management
As the industry progresses toward an explosion of innovation, patients and all stakeholders must be committed to managing the total affordability and sustainability of healthcare long-term. In the midst of these increasing expenditures, PBMs are asking manufacturers to stand by their products in the real world and rely on the support of specialty pharmacies to provide the right support to patients and providers.
The FDA’s Role in Competition: Streamlining Approval Processes and Facilitating Biosimilars
Rich Moscicki – Deputy Center Director for Science Operations, Center for Drug Evaluation and Research, Food & Drug Administration
FDA leaders prioritized the approval of backlogged applications based on public health priorities, including those classes with sole source drugs on the market. Although the FDA could not consider the cost of drugs as a prioritization factor, by prioritizing the application of sole source drug classes, the FDA succeeded in addressing competition in the market.