AMCP Nexus: The Academy of Managed Care Pharmacy Nexus

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.

Aimee Tharaldson, PharmD, a senior clinical consultant in Emerging Therapeutics for Express Scripts, provides an update on recently approved speciality medications and which we will likely see approved in the remaining months of 2018.

Jane F. Barlow, MD, MPH, MBA, senior advisor, Center for Biomedical Innovation at Massachusetts Institute of Technology, discusses how curative, high-cost therapies will impact patient out-of-pocket (OOP) costs and cost sharing.

A new session at the Academy for Managed Care Pharmacy Nexus 2018 allowed for sharing ideas that have recently been put into practice.

There has been dramatic growth in the number of labels relevant to precision medicine, but there remains a gap in the number available and what health plans actually cover, explained Kibum Kim, PhD, MSc, research assistant professor, University of Utah.

Dan Mendelson, MPP, founder, Avalere Health, outlines the impact recent healthcare policy changes have on pharmacists and providers.

A life-saving therapy is challenging to administer and poses financial risks for patients and institutions alike. Speakers at the Academy of Managed Care Pharmacy Nexus 2018 address some approaches to paying for it while CMS develops long-term policies.

Program audits are the chief tool used to evaluate how well health plans deliver care to an ever-growing share of Medicare's 60 million beneficiaries.

Real-world evidence helps to inform high-quality care in a number of different ways, and health information technology has really improved the quality and the caliber of real-world data available, explained Jennifer Graff, PharmD, vice president of comparative effectiveness research, National Pharmaceutical Council.

Christopher Diehl, PharmD, MBA, BCACP, clinical pharmacist, Excellus BlueCross BlueShield, discusses how the role of pharmacists has evolved with presence of value-based models and how pharmacists can ensure these value-based models succeed.

The combination therapy lets patients take a single pill once a day for treatment, which leads to improved adherence. Results of the study were presented at the Academy of Managed Care Pharmacy Nexus 2018 in Orlando, Florida.

A major bill to curb opioid abuse and the Trump administration's blueprint to rein in drug prices highlighted a busy year in the legislative and regulatory arena for the Academy of Managed Care Pharmacy.

The introduction of new curative—or durable—treatments has brought 3 challenges to the reimbursement landscape, explained Jane F. Barlow, MD, MPH, MBA, senior advisor, Center for Biomedical Innovation at Massachusetts Institute of Technology.

Current key market trends include biosimilar, cancer, and orphan drug approvals, explained Aimee Tharaldson, PharmD, a senior clinical consultant in Emerging Therapeutics for Express Scripts.