The health care landscape is in constant flux so it’s important to be connected to folks and stay abreast with the latest trends and insights that relate to market access. Next week will be a big week to learn much and meet many at the CBI 7th Annual Reimbursement and Access conference in Philadelphia, PA. Here are the sessions that I will be attending.
It’s time to make big strides and turn heads–let’s go.
DAY 1
State of the industry: political and legislative trends impacting health care coverage and access
- Evaluate the current political landscape and state of the President’s Blueprint
- Anticipate new reimbursement models for PBM formulary management
- Discuss the potential of point-of-sale rebates and the impact on the patient OOP cost
- Gain insight into the state of oral arguments in the ACA legal challenge
- Analyze how innovation will continue to force change within the health care landscape
Assess potential for changes to pharmaceutical pricing, discounting and reimbursement for the future
- Over the last six months there have been a number of potential disruptors to pharmaceutical pricing. One of which was the potential removal of Safe Harbor Protection for Rebates. As we saw the official order withdrawn, in the same week the Most Favored Nation potential drug pricing policy was introduced. This session provides an update on current, proposed changes affecting pharmaceutical pricing and reimbursement. Point of sale rebates used to provide access to discounted medicines will also be discussed.
Realign access strategies to overcome challenges of copay assistance and PBM restrictions
- Analyze the current landscape of models of PBM restrictions and state efforts to ban them
- Discuss strategies to promote patient education and informed discussion to facilitate access
- Gain insight into trends showcasing impacts to patient OOP spend, access and adherence
- Hear considerations for manufacturers to identify the effect of copay accumulators and maximizers on brands
- Develop strategies to continue to support patients and address compliance concern
Compliance spotlight: trends in enforcement and oversight--what companies can do to ensure compliance
- Zero-in on top areas of focus, including relationships between manufacturers and charitable organizations, pre-approval communications, anti-kickback and pricing transparency
- Gain insight into recent trends in enforcement oversight and focal points for 2020
- Share key takeaways from recent high-profile cases to mitigate risk moving forward
New product launch in the era of precision medicine
- Explore product launch scenarios and patient service paradigms
- Delve into the role of digital health, how it assists and implications for channel strategies
- Understand data needs and the role of the patient journey
- Ensure teams, including the c-suite, are on the same page for consistent and timely effective decision support
Manufacturer spotlight--forward-thinking strategies to ensure market access and adherence
- Gain insight into innovative reimbursement, market access and launch strategies
- Discuss strategies to streamline income verification, refill reminders and electronic prescriptions
- Employ technology to support patient access and adherence
- Identify lessons learned and best practices to manage specialty pharmacies
- Navigate from access to utilization — Education, data and pull-through
Medicare and marketplace coverage policies impacting access
- Review the current state of policy affecting the six protected drug classes in Part D
- Analyze the proposed shift of drugs from Part B to Part D and associated changes in total spending and patient cost-sharing
- Discuss the increase in Medicare beneficiaries enrolling in Medicare Advantage Prescription Drug (MAPD) plans
- Navigate complexities of changes allowing step edits in Part C on patient access
- Gain insight into the potential ripple effects of Medicare changes on commercial coverage
- Identify considerations to alleviate the impact of step therapies and prior authorization requirements
New product commercialization/launch scenario planning
- Discuss timeline considerations for submitting NDAs, PDUFA dates, etc.
- Employ strategies to ensure effective communication internally during launch
- Identify best practices for due diligence for hub selection and patient assistance programs
- Evaluate the evolution that can occur in all aspects of a launch’s timeline and maturity
- Review the importance of redefining strategy based on the stage of launch
DAY 2
Changing the landscape for prior authorization and reimbursement support--reexamining the roles of the manufacturer and pharmacy
- Explore the existing landscape regarding manufacturers’ and pharmacy providers’ roles in the PA process
- Identify regulatory and payer enforcement trends regarding PA activities
- Address HIPAA, privacy and confidentiality considerations regarding access to PHI, including the role of third-party hubs
- Discuss activities of PBMs and PBM-owned pharmacies when independent providers submit PA requests
Trends in benefit design and the continued shift to high deductible plans
- Review recent trends in prescription drug pricing and coverage/formulary design
- Gain insight into efforts to promote value-based insurance design in both public programs and the commercial market
- Explore best practices and innovations in pharmacy management and reimbursement
- Examine implications for consumer affordability (premiums and OOP costs)
Pathways to improvement--insight on achieving a value-driven, transparent and affordable health care system
- Explore how CMS’ interoperability mandate will use transparency to fix every problem in health care (and what new problems it will create)
- Gain insight into ACA and how it might be the path to universal coverage after all
- Discuss commercial risk adjustment and the challenges it is currently facing
Paving the way for global access and commercialization
- Hear considerations for support that allows product access outside of the U.S.
- Leverage various access programs to access medicines prior to EU or in-country licensing
- Capture data, develop relationships and use insights to determine if it makes sense to launch in a particular country
- Gain insight into best practices to build a European presence
Building value and establishing market access pathways for cell and gene therapies
- Explore approaches and considerations to achieve market access and secure reimbursement
- Overcome challenges in reimbursement evaluation given the robust pipeline and potential significant costs
- Analyze value-based agreements and payment options
- Employ best practices to better anticipate challenges and make plans to mitigate
Payer negotiations for improved profitability--a role play exercise
- Examine payer dynamics, a market overview and access challenges
- Complete a SWOT analysis for an incumbent company, new entrant and PBM
- Leverage PBMs competition and preferred/exclusive formulary access to secure high rebates
- Tackle the development of proposals by PBM, incumbent company and new company (formulary position, rebate rate, copay buydown, prior authorization, step edit and price protection)
- Determine the impact of negotiation outcome on patients and PBM clients
- Debrief on negotiation outcome
