AMCP Nexus: The Academy of Managed Care Pharmacy Nexus

Americans not covered by Medicaid should be aware of 2 key factors: the use of copay accumulators in commercial health plans and management of emerging high-cost specialty prescription drugs.

A collaborative effort between the health system and health plan pharmacists, as well as care managers and prescribers is key to improving clinical, quality outcomes in value-based payment models.

Pharmacists have an important role to play in the success of value-based payment models, according to panelists who discussed their health plan’s value initiatives at the Academy of Managed Care Pharmacy Nexus 2020 meeting.

For pharmacy practices to effectively manage specialty drugs, an extensive staff of pharmacists with clinical and managed care expertise is needed, as well as a collaborative effort between all those involved in the care team.

In a panel discussion at the Academy of Managed Care Pharmacy Nexus 2020 meeting, experts discussed driving factors of and barriers to the use of real-world evidence by payers in oncology decision-making.

In assessing a post–coronavirus disease 2019 (COVID-19) world, several aspects may impact managed care pharmacy practices long-term, including self-administration of therapies and issues in pharmacy reimbursement spotlighted by the pandemic.

A panel discussion examined the changes in the health care landscape occurring due to the coronavirus disease 2019 (COVID-19) pandemic, particularly around pharmacists’ scope of practice, and which changes are likely to persist after the pandemic.

Marty Makary, MD, MPH, kicked off the Academy of Managed Care Pharmacy Nexus 2020 meeting with a call to action around reducing overprescribing, increasing price transparency, and recapturing the public’s trust in the health care system.

Attendees at the Academy of Managed Care Pharmacy (AMCP) Nexus 2020 meeting will hear a keynote from a surgeon who has become more visible over the past year and a half discussing what he says are “structural problems” behind the cost of US health care.

With the virtual format of this year’s Academy of Managed Care Pharmacy (AMCP) Nexus 2020, there will be several sessions and novel features to look out for, including networking events, educational programming, and a keynote speech.

A preview of some of the topics that will appear at next week’s Academy of Managed Care Pharmacy (AMCP) Nexus 2020 meeting, which will be held virtually.

Collaboration between stakeholders and the federal government is critical to addressing underlying gaps in patient care, said Debbie Witchey, MHA, executive vice president of the Healthcare Leadership Council.

Discussions around healthcare spending have been ignored for decades, but Robert Dubois, MD, PhD, chief science officer and executive vice president at National Pharmaceutical Council, believes we have the ability to start those discussions now.

By using the available evidence, data, and facts surrounding healthcare spending, we can begin conversations on necessary innovations, said Ceci Connolly, BA, president and chief executive officer of Alliance of Community Health Plans.

Although the number of people with nonalcoholic fatty liver disease, which progresses to nonalcoholic steatohepatitis (NASH), is growing, the health system is still trying to get a handle on which patients to target and how to identify them before the first treatments come to market, explained panelists during a session at AMCP Nexus 2019.

In a session at AMCP Nexus 2019, Melissa Andel, MPP, vice president of health policy, Applied Policy, covered the current state of health insurance coverage in the United States, major actions from the Trump administration impacting the Affordable Care Act (ACA), public sentiment around the ACA, and what stances presidential candidates have taken on healthcare.

Using value assessment models and data that predict real-world performance can assist in valuing drugs with limited or no real-world data, said Roger Longman, MA, chief executive officer of Real Endpoints.

The lack of FDA approvals for the treatment of nonalcoholic steatohepatitis (NASH) and safety concerns surrounding 2 recommended treatments contribute to the barriers blocking effective progress, said Karen Watkins, PharmD, pharmacist for emerging therapeutics strategy, MedImpact Healthcare Systems.

Increased competition is making its way into the specialty drug market, affecting orphan conditions, cancer types, and even common specialty conditions, which is presenting some cost savings opportunities, explained Aimee Tharaldson, PharmD, senior clinical consultant for emerging therapeutics at Express Scripts, who presented on the specialty pharmaceutical pipeline during her regular session at AMCP Nexus 2019.

Value needs to be considered early in the development life cycle of a therapy and should be continued throughout, even into the postlaunch space using real-world studies, according to a presentation on value-based services and their life cycles at the AMCP Nexus 2019 meeting.

Referencing patients as attributable examples of necessary care has assisted in developing strategies for pharmacy and medication benefits, said Jeremy Whalen, PharmD, BCOP, Specialty Clinical Program Director for Oncology at Prime Therapeutics.

New high-cost therapies require new financing mechanisms, but the challenge is coming to an agreement on what should be considered in these new payment models, said Jane Barlow, MD, MPH, MBA, executive vice president and chief clinical officer for Real Endpoints.

As the number of high-cost orphan drugs and gene and cell therapies continues to grow, there will be a greater need for alternative payment models to help figure out the best way to pay for these treatments.

As the number of expedited FDA approvals for cancer drugs that are based on surrogate end points increases, so does the need for new ways to uncover efficacy and safety data to justify the costs associated with these treatments. With the growth of data innovations and collaborations, the answer might be found in real-world evidence.

Dan Mendelson, MPP, founder, Avalere Health, discusses the impact that the shift to value-based care has had on prescribing patterns so far.

Aimee Tharaldson, PharmD, a senior clinical consultant in Emerging Therapeutics for Express Scripts, outlines specialty drug approvals she's keeping her eye on in the coming year.

The value of these mergers will really be dependent on how rapidly and effectively they can change the retail pharmacy setting, said Dan Mendelson, MPP, founder, Avalere Health.

There are a number of different ways that payers are looking at new reimbursement models for new, high-cost therapies, said Jane F. Barlow, MD, MPH, MBA, senior advisor, Center for Biomedical Innovation at Massachusetts Institute of Technology.

This administration is very focused on pharmaceutical pricing, explained Dan Mendelson, MPP, founder, Avalere Health.

Mergers and acquisitions are occurring in response to a change environment where organizations are trying to deliver a more comprehensive service, explained Dan Mendelson, MPP, founder, Avalere Health.