AMCP: The Academy of Managed Care Pharmacy

As more high-cost drugs reach the market, the meaning of value gains more attention, especially in the specialty pharmacy market. One way to assess value is to use a cost-effectiveness analysis to guide formulary decisions.

The way drugs are priced should have less in common with healthcare services and more in common with a consumer product like a computer operating system, Dana Goldman, PhD, the Leonard D. Schaeffer Chair and Director of the Schaeffer Center for Health Policy and Economics at the University of Southern California, said at AMCP's 27th Annual Meeting & Expo in San Diego on April 7-10.

Employers who manage the high cost of care associated with specialty pharmacy face a number of challenges that are being addressed by the National Employer Initiative on Specialty Pharmacy, said Cheryl Larson, BA, vice president of the Midwest Business Group on Health.

For Douglas Long, MBA, vice president, industry relations, IMS Health, Inc, keeping up-to-date on the trends and forecasts of the evolving managed care arena is crucial to remaining competitive.

Michael Fischer, MD, associate professor of medicine, Harvard Medical School, associate physician, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, said that the complexity of the healthcare system is part of the challenge of managing adherence.

Dual eligibles-the class of Americans that qualify for both Medicaid and Medicare coverage-are mostly older adults with low incomes and tend to be the sickest beneficiaries covered by either Medicaid or Medicare.

Almost all pharmacy and therapeutic committees have a unique process for evidence-based formulary decision making, said Steven Pearson, MD, founder & president, Institute for Clinical and Economic Review.

The dynamic landscape of healthcare and managed care pharmacy will be deeply impacted by new and emerging specialty medications. The ever-spiraling costs of specialty medications have led many experts to question whether these treatments translate into true improvements in health outcomes or patients' quality of life.

Not surprisingly, Thomas Merrill, lead researcher, Center for Accountable Care Intelligence, Leavitt Partners, LLC, said that cost is a major work flow challenge associated with Accountable Care Organizations.

In this interview, Curtis Triplitt, PharmD, associate professor and assistant dean of research, Texas Tech University Health Sciences Center, Permian Basin, explains why diabetes should be treated with a patient-centered approach.

Jeff Goldsmith, PhD, healthcare futurist and analyst, says that the Affordable Care Act (ACA) has significantly impacted healthcare policy, in both negative and positive ways.

The patient-centered medical home (PCMH) has many key goals and components. When paneled, the majority of AMCP 2013 Nexus attendees agreed that the PCMH is best described as a practice model that organizes primary care practice operations and incentives to deliver patient-centered, coordinated, comprehensive care with the goal of improved quality and efficiency.

Since 2010, the growth and proliferation of accountable care organizations (ACOs) has increased, and the rise of this collaborative care model is not without reason. Lack of consumer engagement, lack of competition, and misaligned incentives have made care less affordable.

Richard Stefanacci, DO, chief medical officer, The Access Group, said that it is necessary for retail pharmacists to break out of their silo. Dr Stefanacci noted that retail pharmacists are being utilized within practices and stepping out of their normal roles.

Suzanne Tschida, PharmD, vice president, specialty benefits & outcomes, OptumRx, said that at UnitedHealth Group a tiering system is used for the management of specialty medications with a cost-share or copay structure.

Highlights from The Academy of Managed Care Pharmacy's 25th Meeting & Expo, which took place on April 2“5, 2013, in San Diego, CA, are available in a newsletter published by The American Journal of Managed Care.

Yelena Yankovskaya, PharmD, a managed markets fellow at the Mayes College of Healthcare Business and Policy, describes the expectations and roles of predictive modeling, value-based insurance design, and gamification/social media in contemporary managed care pharmacy.

In an educational symposium entitled, "The Evolution of Multiple Sclerosis Treatment: The Role of the Managed Care Pharmacist," Kristen Helms, PharmD, and her 2 colleagues discuss how treatments for multiple sclerosis (MS) have evolved over the past 2 decades, explore the novel and emerging therapeutic strategies for MS, and cover strategies to improve medication adherence for the chronic disease.

Daniel Tomaszewski, PharmD, PhD Candidate, an assistant professor at the University of Minnesota, College of Pharmacy, Duluth, discusses the impact of managed care pharmacy on current legislation, regulatory policies, and ongoing healthcare reform.

Eric A. Wright, PharmD, BCPS, an investigator at the Geisinger Center for Health Research, discusses the implications of medical moments of truth (MMOTs) on current therapeutic and managed care strategies.

In an educational session satellite symposium entitled "Biologic Therapies for Chronic Diseases: Factors Influencing Treatment Decisions," Robert P. Navarro, PharmD, along with his colleagues, delves into the current trends of specialty pharmacy and biological therapies, and how managed care discussions have evolved to optimize patient outcomes within a cost-constrained healthcare environment.

Rebecca P. Snead, RPh, the executive vice president and CEO of the National Alliance of State Pharmacy Associations, discusses the current movement toward pharmacist provider status, and elaborates on the challenges and opportunities encountered.

In an educational seminar entitled "How Much of the $3 Billion in Star Rating Bonuses Did Your MCO Capture?," David Nau, RPh, PhD, CPHQ, FAPhA, along with his colleagues, discussed Medicare star ratings and how managed care organizations have implemented practices and processes to ensure the delivery of high-quality care to their members.

Mattias Cheung, PhD, FCSHP, FASHP, discusses the ongoing progress of orphan drugs for rare diseases in today's health care environment, and explores their challenges and opportunities in the current managed care landscape.

Matthias Cheung, PhD, FCSHP, FASHP, a principal at Advanced Rx Consulting, LLC, and an adjunct professor of pharmacy practice at the University of the Pacific, Thomas J. Long School of Pharmacy and Health Services, discusses the circumstances and factors that catalyzed the passage of current legislation and regulatory policies for orphan drugs, rare diseases, and ultra-rare diseases.

Debora Sternaman, PharmD, the director of commercial formulary services at Catamaran in Georgetown, TX discusses the Health Insurance Marketplace and how the new model offers a different experience from the current managed care structure.

In a presentation entitled "Hemophilia Management: Collaborating in a New Era to Optimize Cost and Clinical Outcomes in Managed Care," 5 key thought leaders and managed care authorities shared their insights on the changing therapeutic landscape for hemophilia management.

Robert W. Dubois, MD, PhD, the chief science officer of the National Pharmaceutical Council discusses the initial expectations of implementing accountable care organizations (ACOs) and how those expectations have evolved over time.

In a presentation entitled "Accountable Care Organizations: 2013 and Beyond," 4 managed care experts shared their insights and thoughts on the ongoing paradigm shift in managed care towards accountable care organizations, elaborating on current trends, unmet needs, and the future direction of the managed care landscape.

Highlights from the Academy of Managed Care Pharmacy's 2012 Educational Conference, which took place on October 3-5, 2012, in Cincinnati, Ohio, are available in a newsletter published by The American Journal of Managed Care. Topics discussed include the ways in which heterogeneity shapes therapeutic decisions, patient outcomes, and coverage policies; assessment of the evidence for new medications; and phone-based medication therapy management services.