AMCP Nexus 2024: Specialty Drug, Biosimilar Adoption, and Health Policy Topics Highlight the Conference

The AMCP Nexus 2024 annual meeting took place between October 14 and October 17, 2024, in Las Vegas, Nevada. The conference featured over 30 education sessions and more than 50 exhibitors with over 2500 attendees from health plans, pharmacy benefit managers (PBMs), biopharmaceutical companies, consultants, and other leaders working within managed care pharmacy.

Specialty Drug Coverage

One key topic presented at the conference was on the specialty pharmaceutical pipeline and the drug coverage policy landscape for these medications. Attendees gathered in one of the meeting boardrooms for the “Specialty Pharmaceuticals in Development” key industry session. The presentation extensively overviewed the latest trends, recent approvals, and upcoming pipeline developments across key therapeutic categories, equipping decision-makers with the insights needed to navigate this dynamic and ever-changing space.¹ The session was presented by researchers Yuqian Liu, PharmD, senior director of Specialty Clinical Solutions, Prime Therapeutics, and Soumya Vishwanath, PharmD, senior manager of Formulary Strategy, Prime Therapeutics LLC.

“There's a lot of new pipeline products for a lot of different indications that don't have treatments,” said Vishwanath. “For a lot of these patients this is the first time that these patients will be able to even get a treatment for their disorders. And for a lot of them, a lot of these new novel entities will provide a unique mechanism, or a unique way that delivers for these patients.”

James D. Chambers, PhD, professor, Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, discussed how vertical integration of PBMs and insurers have led to strategies that create confusing and counterintuitive situations for patients navigating the specialty drug landscape.²

“The system's complicated enough as it stands,” Chambers told The American Journal of Managed Care^® (AJMC^®). “Also, it leads to inconsistencies in access, because we see that there's differences in coverage between the medical and pharmacy benefits for the same drugs. It really is a symptom, I think, of the vertical integration of the pharmacy chain in general.”

In another session, “Current Patterns, Future Shifts, and Best Practices in US Specialty Drug Coverage,” experts discussed utilization management practices, such as prior authorization, in shaping patient access to specialty drugs, often with considerable variation across health plans.³

Biosimilar Adoption

The conference included several sessions on the use of biosimilars and their impact on health care spending. The adoption of biosimilars in the US has been a slow and complex process, influenced by challenges such as reimbursement structures, provider education, and patient engagement.⁴ In the session titled, “Are Patients Getting a Fair Share of the Value of Biosimilars,” experts highlighted the need for innovative strategies to overcome these barriers and accelerate biosimilar uptake. Key approaches include aligning incentives across stakeholders, streamlining workflows with electronic health records, and enhancing education for both providers and patients. Policy changes, such as CMS guidance on interchangeability and legislative support, are also essential in driving sustainable biosimilar utilization to improve patient access and reduce health care costs.

"If we can really do this homework right, like we did with infliximab, we can really achieve great success in providing high-quality care for our patients, and in the meantime, balance the payer benefit and ideal benefit, and really save control costs for high-cost medications, especially biologics,” said Sophia Humphreys, PharmD, MHA, BCBBS, director of Formulary Management and Pharmacy Clinical Programs, Sutter Health, in a session, “Maximizing Utilization and Continuity of Care: Advancing Adalimumab Biosimilar Adoption in Managed Care.”⁵

The Presidential Election on Health Policy

On the final day of the conference, attendees gathered for the key industry session, “The 2024 Election and Its Impact on Health Policy,” led by: Melissa Andel, MPP, principal, CommonHealth Solutions LCC; Andrew McKechnie, partner, Tiber Creek; and Timothy Molino, consultant, Tiber Creek Group.

In the session, experts discussed the health care issues at stake, such as reproductive rights, the Affordable Care Act (ACA), and drug pricing reforms. In a Republican-controlled government, efforts to repeal or modify the ACA may resurface, while a Democratic administration would likely focus on expanding the ACA and enhancing drug price negotiations. Regardless of the election outcome, executive actions and regulatory measures will play a critical role in shaping the health care landscape, with topics like telehealth, Medicare Advantage reforms, and PBM regulations being key areas of focus.

“I think for Congress, [there’s] going to be a lot of these deadlines, but that will drive a lot of the agenda, lower any unforeseen events [like] COVID-19 or something like that,” said Molino.⁶ “A lot of it is going to be very hard, but it has to get done.”

Altogether, these are just some of the important topics highlighted at this year’s AMCP Nexus conference, with future insights to be presented at AMCP Nexus 2025, on October 27–30, 2025, in National Harbor, Maryland.

References

1. Steinzor P. Navigating the “really exciting” specialty pharmaceutical pipeline. AJMC. PublishedOctober 17, 2024. Accessed October 21, 2024. https://www.ajmc.com/view/navigating-the-really-exciting-specialty-pharmaceutical-pipeline.

2. Joszt L, Wehrwein P. Coverage trends of specialty drugs create confusing situations for patients. AJMC. Published October 17, 2024. Accessed October 21, 2024. https://www.ajmc.com/view/coverage-trends-of-specialty-drugs-create-confusing-situations-for-patients.

3. Steinzor P. Exploring the complex, ever-evolving landscape of specialty drug coverage. AJMC. Published October 18, 2024. Accessed October 21, 2024. https://www.ajmc.com/view/exploring-the-complex-ever-evolving-landscape-of-specialty-drug-coverage.

4. Steinzor P. Overcoming barriers to biosimilar adoption. AJMC. Published October 16, 2024. Accessed October 21, 2024. https://www.ajmc.com/view/overcoming-barriers-to-biosimilar-adoption.

5. Humphreys S, Bioc J. Maximizing utilization and continuity of care: Advancing adalimumab biosimilar adoption in managed care. Presented at: AMCP Nexus 2024; October 14-17, 2024; Las Vegas, NV.

6. Steinzor P. The 2024 presidential election: Implications for health care policy. AJMC. Published October 18, 2024. Accessed October 21, 2024. https://www.ajmc.com/view/the-2024-presidential-election-implications-for-health-care-policy.