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Are You Paying Attention to Trends?

A survey of universities, large non-profit organizations, and governmental agencies was conducted to determine if pharmacy trends in the non-profit labor market differ from reported industry trends. With rising concerns of affordability plans are challenged to keep costs low. Plans are pursuing a wider array of approaches to reduce health care costs and risk.

Their focus includes:
  • Proactively managing pharmacy spend, especially related to specialty pharmacy costs and utilization
  • Selecting a pharmacy benefit manager based on their ability to reduce costs and demonstrate improved outcomes
  • Growing use of plan designs to increase out-of-pocket costs to discourage use of overused and high-cost drugs.

Angelo Monaco, Market Research Consultant
Nicole Hancy, PharmD, Vice President of Clinical Services, Citizens Rx
Bill Barre, Executive Vice President of Business Development, Citizens Rx

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Finding a Solution to Lower Prescription Drug Costs

High prescription drug costs can negatively impact plan sponsors and their members who need them. The recent Trump administration prescription drug cost-reduction plan has heightened the focus on finding a solution to reduce costs. As a result, many plan sponsors are demanding greater accountability and transparency from their pharmacy benefit manager (PBM). So, what can you do to ensure your PBM is delivering the most transparent and affordable solutions? During this session we will dive into the issues and important questions you should be asking your PBM to ensure transparency, the best possible financial performance, and complete alignment with your objectives.

Arlene Edlin, General Manager, Sales, Navitus
Gary Hattendorf, Regional Sales Vice President, Navitus

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Game On! Helping Patients Win Through Innovative Solutions

As humans, we all derive some emotional satisfaction from playing a game. It's the reason why Candy Crush Saga has 50 million active monthly users on Facebook. Playing a game gives us a reward, provides an opportunity to socialize, offers a distraction from the stresses of everyday life, and is just downright fun.

Games and healthcare are two words that don't always find themselves in the same sentence. Until now. Learn how Express Scripts is keeping patients engaged daily in their care through a fun, user-friendly mobile experience.

Kyle Amelung, PharmD, BCPS
Sr Manager, Health Technology
Express Scripts

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A Solution to the Generic Drug Price Inflation: Compound Alternatives

Over the past two years, the pharmacy industry has seen an an unprecedented surge in generic pricing, which has led to an unexpected increase in cost for many key stakeholders in the pharmaceutical supply chain. Under high generic drug prices, patients face higher copays and even decline their medications due to increased out-of-pocket costs. Plan sponsors struggle with higher drug spend and pharmacies receive inadequate reimbursements. Meanwhile, prescribers and pharmacists are switching disgruntled patients to alternative drug therapies, while plan sponsors scurry around to save on costs. PBMs and plan sponsors are now seeking guidance from local compounding pharmacists in search of compound alternatives. These alternatives are for medications that are on short supply, no longer on the market, and whose prices have been excessively inflated. Products such as Daraprim, oral vancomycin, Zovirax, and colchicine, are just a few examples of such medications that contain a compounding alternative in today’s market place.

This webinar presents results from compound alternative programs using claims information.

Del Doherty, PharmD, PhD, MPH, Vice President of Managed Care, PersonalMed, LLC
Angela Van Dyke, MHA, CPhT, National Sales Manager, PersonalMed, LLC

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Perspective on the Rx Pipeline: Understanding Market Impacts and How to Improve Plan Performance

The need to continuously monitor the drug pipeline, particularly with specialty medications, is increasingly important as treatment options change with new drugs coming to market. The evaluation and communication of clinical benefits and cost-effectiveness of newly approved medications has become vital for building trust and value with plan sponsors. Our Perspective on the Rx Pipeline (POP) reports provide ongoing insights with recommendations to protect and improve plan performance.

Learn from our team of clinical experts five key ways to distill the breadth and depth of drug pipeline information to its simplest form to uncover meaningful insights for your organization.

By the end of this webinar you will be able to:
  • Discuss current and future trends of the drug pipeline
  • Identify activities that impact drug utilization and costs
  • Understand how to tailor solutions for various stakeholders
  • Select key elements of a quality pipeline product
  • Asses the potential value of pipeline services

Christa Bigham, PharmD, RPh, MSCS, Drug Information Pharmacist, EnvisionRx
Christine Anderson, Director Clinical Services and Outcomes, EnvisionPharmacies
Ian Parnigoni, PharmD, RPh, Clinical Account Executive, EnvisionRx 

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Headaches No More...Improving Parity in Medical Specialty Reimbursement

A large public health plan in California identified issues in the payment of Specialty Rx paid under the medical benefit. An innovative approach was necessary to correct claim adjudication issues.

This webinar will present the approach to the problem, the analyses, the current health plan interventions, and the plans for future next steps. The goal is to present what one health plan has done, and plans to do, to make Specialty Rx more efficient, accurate, and less costly.

Craig S. Stern, RPh, PharmD, MBA, President, Pro Pharma Pharmaceutical Consultants, Inc.

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It's Your Pharmacy Plan...Practical Ways to Take Control of It

Join us for this encore presentation from our 2018 annual conference. During this webinar, attendees will increase their fundamental PBM knowledge and learn how to have more productive dialogue.

Learning objectives:
  • Increase fundamental knowledge of PBM terminology to improve decision making
  • Describe how to create a practical framework for evaluating disruption
  • Demonstrate how to develop and use questions to create optimal outcomes
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Innovative Ways Plan Sponsors Can Optimize Healthcare Spend Using Precision Medicine

Precision medicine, an emerging trend in pharmacy benefits, offers an opportunity for plan sponsors to meet the challenges of rising healthcare costs. The convergence of clinical and technological advances have enabled significant innovations in medicine.

Pharmacogenetics, a component of precision medicine, looks at metabolic traits that influence an individual’s ability to process medications. These traits can impact the risk and severity of medication side effects, as well as whether an individual is able to achieve a safe and effective therapeutic level of the medication. Pharmacogenetic data can help to reduce adverse drug reactions and improve healthcare outcomes.

Jennifer Fuhrmann-Berger, PharmD, Senior Vice President of Clinical Services, Benecard PBF
Michael Perry, President, Benecard PBF

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Diabetes: Multifaceted Approaches to Address Adherence, Cost, and Improved Outcomes

Diabetes is the leading cost driver for clients, accounting for more than 10% of total drug expenditures, and these numbers continue to rise as the diabetes epidemic continues.  Diabetes is the most expensive therapy class in traditional drug spending, and higher than specialty therapeutic classes such as oncology, multiple sclerosis, and HIV.  Adherence rates for diabetes medications continue to be less than optimal, and overall hemoglobin A1c does not appear to be trending down despite increases in drugs and costs.

This webinar discusses a multifaceted approach on how to manage spend via different utilization management strategies, identify and address adherence issues from a global perspective, improve clinical pathway selections, and increase patient engagement to drive clinical outcomes. 

Patty Taddei-Allen, PharmD, BCACP, BCGP, Director, Outcomes Research, WellDyneRx
Nick Page, PharmD, Vice President, Specialty and Clinical Operations, WellDyneRx

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Are You Ready to Comply with 455? How the CMS Regulation Affects You.

A 2015 report estimates that approximately $60 billion of American tax money, or more than 10% of Medicare’s total budget, was lost to fraud, waste, abuse and improper payments in 2014.

Centers for Medicare and Medicaid Services’ (CMS) strategy for ridding the system of fraud has been to move away from a pay-and-chase system to a preventive model. Identifying high-risk providers on the front end is easier than tracking and unraveling complicated transactions on the back end.

To help reduce the risk of fraud, waste and abuse, CMS has established requirements for Medicaid programs to validate their networks. All Medicaid PBMs, especially Managed Medicaid PBMs, may bear the brunt of this risk assessment.

This webinar explores the new CMS regulation, the impact on PBMs, and how PBMs can use data, analytics and advanced technology to be in compliance.

Learning objectives:
  • Understand the scope of the 455 regulations as it relates to PBMs
  • Explore the kinds of data available to screen and validate providers
  • Evaluate data solutions to comply with 455 requirements and network validation
Bobbie Riley, RPh, Director, Pharmacy, LexisNexis Risk Solutions
Brian Eidex, Director, Pharmacy, LexisNexis Risk Solutions

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Findings from PBMI's 2018 Trends in Specialty Drug Benefits Report

Did you know that 58% of plan sponsors use coinsurance for member cost sharing over copayments?  Employers continue to look for creative ways to battle the growing cost of specialty drug trend while continuing to offer quality benefits for their employees.

Listen to this webcast to learn more about this strategy and many others employers are using to manage their specialty drug benefits.

Report and webinar sponsored by Walgreens and AllianceRx Walgreens Prime.

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Impacting Drug Trend: Spend Less, Get More

Analytics and patient engagement strategies are the foundation to understanding, building, and executing strategies to decrease drug spend and improve quality.

During this webinar, Michael T. Einodshofer, Chief Innovation Officer, Maxor Plus, examines these strategies and how they can be used to deliver a drug trend guarantee for clients.

Learning objectives:
  • Learn about innovative clinical strategies and formulary/benefit designs that decrease drug trend
  • Understand how clinical strategies and PBM savings can be bundled together into a “guarantee”
  • Apply examples to a case study that illustrates a drug trend guarantee
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