AMCP Nexus: The Academy of Managed Care Pharmacy Nexus

There is a role for both payers and providers to make small changes that would increase the use of biomarker testing to ensure patients are receiving the appropriate treatment, said Susan Wescott, RPh, MBA, senior director of managed care pharmacy, Mayo Clinic.

Co-pay accumulators and maximizers are 2 programs that insurers have started implementing to help them redirect financial assistance from the patient, said Kimberly Westrich, MA, chief strategy officer, National Pharmaceutical Council.

A lot of attention has been on the drug price negotiation aspects of the Inflation Reduction Act (IRA), but the implementation of out-of-pocket smoothing is something to keep an eye on, said Adam Colborn, JD, of AMCP.

The prevalence rates of metabolic dysfunction–associated steatohepatitis (MASH) and metabolic dysfunction–associated steatotic liver disease (MASLD) are likely underestimated using claims data alone.

Researchers explored innovative approaches to overcome barriers and drive sustainable biosimilar utilization.

Bipolar disorder is commonly misdiagnosed depending on the features that present, explained Stephanie Hsia, PharmD, MAEd, BCPP, of University of California, San Francisco.

Experts explored the latest trends, approvals, and pipeline developments in cell and gene therapies, rare disease, immunology, and more.

As a result of vertical integration, health plans may have 2 different coverage policies on the medical benefit side and the pharmacy benefit side for the same drug.

Patients with schizophrenia have a lot of life-changing consequences when they are being treated properly, and these are only amplified when the patient goes untreated, explained Megan Ehret, PharmD, of University of Maryland, School of Pharmacy.

Schizophrenia may be misdiagnosed as depression or bipolar disorder, which delays treatment and negatively impacts the prognosis, explained Megan Ehret, PharmD, MS, BCPP, of the University of Maryland, School of Pharmacy.

Because sickle cell disease isn’t as progressive a disease as others that have gene therapies available, there isn’t as much urgency to start on these expensive therapies, said Kevin Niehoff, PharmD, BCMAS, associate director, Market and Financial Insights, IPD Analytics.

Experts discuss pricing, utilization, and health plan strategies to drive biosimilar uptake.

Two posters compared health care resource utilization (HCRU) and financial burdens of people living with HIV with a non-HIV population and people with HIV who are heavily treated with those have experienced less treatment.

Although the cost of biomarker testing isn’t cheap, the cost of therapy for patients can be much higher, making it important to conduct these tests to start the right therapy, explained Susan Wescott, RPh, MBA, of Mayo Clinic.

Experts reevaluate coverage policies and the financial impact of antiobesity medications based on updated clinical data and key utilization trends.

Speakers from across the care continuum will discuss legislative updates, glucagon-like peptide-1 (GLP-1) use for weight management, and more at this year’s AMCP Nexus.

Kimberly Westrich, MA, chief strategy officer of the National Pharmaceutical Council, discusses key agenda highlights that will be presented at the 2024 AMCP Nexus conference.

Jeff McIntyre, MA, of the Global Liver Institute (GLI), discusses the importance of the health care community understanding non-alcoholic steatohepatitis (NASH) and how to mitigate its global impact.

Kimberly Westrich, MA, of the National Pharmaceutical Council, explained how she envisions value assessment tools to be used in the US health care system in coming years.

From the 2023 Academy of Managed Care Pharmacy (AMCP) Nexus meeting, held in October, expert interviews and insightful updates on the Inflation Reduction Act, gene therapy affordability and access, and the 340B Drug Pricing Program comprise the conference highlights.

Kimberly Maxfield, PhD, of the FDA discussed actions been taken by the FDA since President Biden's reauthorization of the Biosimilar User Fee Act (BsUFA) III last year, as well as what they plan to achieve through 2027.

Saira Jan, PharmD, MS, of Horizon Blue Cross Blue Shield of New Jersey, discussed cost savings that occurred so far from their collaborative pilot program with Rutgers Cancer Institute of New Jersey and RWJ Barnabas Health and also noted those they predict to occur as the program continues.

Saira Jan, PharmD, MS, of Horizon Blue Cross Blue Shield of New Jersey, provides an overview of their collaborative pilot program with Rutgers Cancer Institute of New Jersey and RWJ Barnabas Health, discussing the program's origin, objectives, and beyond.

A poster presented at AMCP Nexus 2023 reported that payers believe implementing the Inflation Reduction Act (IRA) will impact Medicare Part D plans financially.

Timothy O'Shea, PharmD, MS, discussed the most surprising findings from a home infusion pilot program and explained how he thinks home infusion will continue to evolve.

Psoriasis status from time of diagnosis to initiation of current treatment was less favorable for patients with mild psoriasis compared with moderate psoriasis, according to one study.

Christina Barrington, PharmD, of Priority Health, explained the keys to leading a successful managed care organization, as well as where she predicts the industry will be in the future.

Prerakkumar Parikh, PharmD, of Megallen Rx Management/Prime Therapeutics, detailed the impact of formulary placement of biosimilars on cost burden along with how stakeholders can work with pharmacy benefit managers to promote biosimilar use.

Saira Jan, PharmD, MS, of Horizon Blue Cross Blue Shield of New Jersey, discussed the primary findings of their collaborative pilot program with Rutgers Cancer Institute of New Jersey and RWJ Barnabas Health, focusing on patient and provider experiences.

Operational forecasting for patients who are eligible for gene therapies will be crucial for addressing the accessibility and affordability challenges with these agents, especially as more gene therapies are expected to enter the market in the next few years.