Pharmacy Benefit Management Institute (PBMI) helps industry professionals manage pharmacy benefit programs through research-based drug benefit education.

9:00 am – 9:45 am
Creating Benefit Plan Designs to Increase Patient Adherence

William Shrank, MD, MSHS, Instructor, Harvard Medical School and Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital

Peer-reviewed research continues to document the links between rational cost-sharing strategies and increased patient compliance. Optimal cost sharing approaches for increasing patient adherence with drug regiments will be described, focusing on the role of generic drugs in compliance with maintenance drug therapies. The essential elements of drug information for patient education and prescription labeling will be presented.

9:45 am – 10:30 am
Building a Value-based Health Care Culture

Employee health status is not changed by plan design alone. A health care culture must be engendered to realize an optimal ROI from value-based benefit design. Review research findings from organizations ranging in size from 500 to 100,000 employees to develop strategies for building a value-based health care culture.

10:30 am – 11:00 am
Break – Educational Forum Café

11:00 am – Noon
Topic Forums
Attend one of three Topic Forums. Using a town hall format, industry experts will facilitate an audience discussion on what’s working and what challenges remain to be tackled on critical industry issues.

Challenges of Managing the Medicare Part D Benefit
Facilitated by Craig Stern, RPh, PharmD, MBA,
President, Pro Pharma Pharmaceutical Consultants, Inc.

Emerging Models in Community Pharmacy
Facilitated by Dana H. Felthouse, MBA, President, Pharmacy Benefit Management Institute

Implementing Value-based Drug Benefit Plan Designs
Facilitated by Estay Greene, PharmD,
Director, Pharmacy Benefits,Cleveland Health Network/Cleveland Clinic

Noon
Rx Benefit Innovation Awards Luncheon

12:45 pm – 1:15 pm
Exhibits Open – Educational Forum Café

Afternoon Breakout Sessions
1:15 pm – 5:10 pm
There are three programming tracks: HR Perspectives, Industry Trends, and Managed Care Perspectives. CPE credit is available for each Managed Care Pharmacy Perspectives session, as notated*. Learning objectives are included for this purpose.

HR Perspectives:
Identifying the Best Partner for Managing Your Drug Benefit: Broker, Health Plan or Pharmacy Benefit Manager

Providing drug benefits to employees and retirees is a complex and costly process. Discuss the major approaches used by employers today including integrated programs (with broker, managed care organization, or third-party administrator) or carve-out programs with a pharmacy benefit manager. Compare and contrast the benefits of each approach by reviewing case study examples of each approach.

Industry Trends:
High Tech to High Touch Continuum of Medication Therapy Management

Timothy Colligan, RPh, MS, Pharmacy Director, SummaCare
James Langman, RPh, Vice President, Clinical Services, Walgreens Health Initiatives
Alan Pendergrass, PharmD, MBA, Manager of Analytics and Outcomes, MemberHealth
Marissa Schlaifer, RPh, Director of Pharmacy Affairs, Academy of Managed Care Pharmacy

The Medicare Modernization Act created a mandate for medication therapy management (MTM) in Part D benefit offerings. The marketplace has responded with a multitude of MTM programs ranging from high tech services delivered via claims adjudication systems to high touch solutions that encompass face-to-face pharmacist consults and polypharmacy case management. Panel members will discuss this continuum and the evolution of MTM.

Managed Care Pharmacy Perspectives:
Implementation Strategies for Reference-based Pricing*

Reference-based pricing makes good economic sense for your drug benefit program. Determine critical communication strategies to implement a program effectively. Evaluate desired clinical and economic outcomes from this approach, often referred to as a therapeutic MAC (maximum allowable cost) program. ACPE #027-999-08-002-L04-P. Learning objectives.

2:05 pm – 2:15 pm
Break

2:15 pm – 3:05 pm
HR Perspectives:
Employer & Union Case Study: Carving Out a Transparent Drug Benefit

Keith D. Bruhnsen, MSW, Assistant Director Benefit Office and Manager Prescription Drug Plan,
University of Michigan
Mike Meyer, Senior Vice President, Sales and Marketing, SXC Health Solutions, Inc.
Daniel J. Sullivan, RPh, Director of Pharmacy, Teamsters Rx – Northern New England Benefit Trust

Pharmacy benefit manager (PBM) and plan sponsor relationships are often challenged by the competing interests of PBM profitability and plan sponsor cost containment. Employer and union trust fund case studies will illustrate how developing a collaborative relationship with a transparent PBM fosters greater control, plan flexibility, and utilization management. Both case studies demonstrate how a “carve-out” approach offers significant advantages in cost savings and quality improvements. The University of Michigan and the Teamsters Rx have both achieved substantial savings and will share their experience, operational processes and lessons learned.

Industry Trends:
Managing Medication Utilization in Workers’ Compensation Populations

Maria Sciame, PharmD, Director of Clinical Services, PMSI
Toby Hittinger, Assistant Vice President, PMA Insurance Group

Pharmacy utilization management in Workers’ Compensation populations is a challenge in an arena mired in state-specific regulation. Discuss formulary strategies that facilitate cost containment while maintaining quality patient care standards. Describe clinical programs that target appropriate and effective use of medication therapies to contain costs and mitigate risk.

Managed Care Pharmacy Perspectives:
Emerging Pharmacy Standards for Improving Patient Safety*

New standards in the practice of pharmacy are emerging. Identify how Pharmacy Quality Alliance metrics to monitor patient safety are being implemented. Discuss the value of improved patient safety to your drug benefit program. ACPE #027-999-08-003-L05-P. Learning objectives.

3:05 pm – 3:20 pm
Break – Educational Forum Café

3:20 pm – 4:10 pm
HR Perspectives:
Employer Case Study: Importance of Creating Incentives for Lowest Net Cost Drug

Kristin M. Dossey, Senior Benefits Analyst, Salt River Project
Ryan Kuehn, Senior Account Manager, RxAmerica

Arizona’s Salt River Project (SRP) is the nation’s third-largest public power and water utility. SRP provides benefits to 4,800 employees and 1,900 retirees. Identify drug cost savings for employers, focusing on the importance of driving utilization to lowest net cost drug medically appropriate for a patient. Describe the impact of this lowest net cost strategy on Medicare Part D Retiree Drug Subsidy reconciliation.

Managed Care Pharmacy Perspectives:
Tackling Specialty Pharmacy Management Challenges*

Despite rising costs, managing specialty drug therapies effectively is critical for a positive return on investment. This session explains optimal processes for providing needed support services for specialty drug therapies. Different pharmacy dispensing channels for these high cost drugs will be compared and contrasted. Clinical programs designed to optimize patient outcomes will be presented. ACPE #027-999-08-004-L04-P. Learning objectives.

4:10 pm – 4:20 pm
Break

4:20 pm – 5:10 pm
HR Perspectives:
City of Milwaukee’s Strategy for Managing Drug Trend with Pay-for-Performance

Michael Brady, Employee Benefits Director, City of Milwaukee
Steven Jones, MBA, Program Manager, Navitus Health Solutions

Effectively managing drug spend through transparent pay-for-performance products, such as Drug Utilization Review (DUR) programs, is risk free to the plan sponsor. Learn how the City of Milwaukee reached its savings and health management objectives through successful execution of this clinical program.

Industry Trends:
Managing Long-term Cost of Retiree Drug Benefits In the GASB 43 and 45 Era

The Governmental Accounting Standards Board (GASB) statements 43 and 45 about other post-employment benefits (OPEB) liabilities have far-reaching impact on the financial statements of public sector employers. As public employers comply with GASB 43 and 45 that govern the funding of retiree health care and drug benefits, plan designs may change. Review case study examples of how some public entities may change drug benefit plan designs to minimize OPEB liabilities.

Managed Care Pharmacy Perspectives:
Integrating Pharmacy & Medical Data from Value-based Drug Benefit Programs*

Patrick P. Gleason, PharmD, Director of Outcomes Assessment, Prime Therapeutics

Current trends have led to an increase in value-based pharmacy management. Integrating medical and pharmacy claims from these value-based programs creates opportunities to use risk stratification to improve outcomes and control costs. The selection and use of clinical programs based on risk stratification to improve health outcomes will be discussed. ACPE #027-999-08-001-L04-P. Learning objectives.