As the growth and spending curves in the specialty class continue to climb upward, specialty pharmacies, payers, manufacturers, and providers are continuously reviewing and retooling their protocols and business strategies to respond to new market demands and realities. Perhaps most impactful to all companies, is the ever-increasing demand to manage costs while continuing to put patient outcomes first.

During this session, the panel will discuss:

»» SP network strategies

Exclusive and preferred networks; Medicare Part D vs. commercial; managing a Medicaid SP network; thoughts on new AWP and pricing; considerations for ACOs

»» Medical Benefit Drug Management

The management of drugs in the medical benefit will continue to be a focal point for payers. Will they be successful in implementing utilization controls, formularies, and new reimbursement protocols for providers?

»» Oncology

Manufacturer market strategy; Physician and provider groups; HUBs, Mid-market players

»» Biosimilars

How will payers, SPs and the overall industry behave in a biosimilars market that lacks interchangeability?

»» Affordability

Manufacturers, payers, SPs and providers all have a stake in the affordability of SP drugs for patients. What does the future hold for 4^th tiers, co-insurance, and co-pay assistance programs? What implications will PPACA have?

This dynamic lineup of panelists — representing some of our industries’ best thought leaders and decision makers — will discuss the key issues facing the pharmaceutical marketplace today. The discussion will touch on increasing areas of alignment between the payer community and drug manufacturers, emerging issues in drug trend management, the impact of government action and inaction, healthcare technology innovation, the affordability of medicines and much more.

This session will provide the audience with a unique look at the one-year-old research partnership between Humana and Pfizer. Dan Leonard from the National Pharmaceutical Council will provide opening context for the session with an update on the research and data demands of the market, and why payers and manufacturers have not always been aligned on how to meet these demands. William Fleming from Humana and Steve Romano from Pfizer will then discuss why and how their companies entered into this unique partnership, and the value they believe it will bring.

During this session, the panel will discuss:

»» The critical need for payers and Pharma to have these collaborations

»» The shared goal that Pharma-payer collaborations increase the betterment of patient health outcomes, through increased transparency and alignment of research initiatives between all parties involved

»» The importance that both parties have equal input on the research agenda and contribute to the design, conduct, and review of study results

»» The potential for these collaborations to influence change toward improved population health

»» Humana and Pfizer takeaways to date

The politics of healthcare policy in Washington has a tremendous impact on our industries, and with the elections in three weeks — regardless of the winners and losers — change is something we can be assured of. We’re pleased to have two of the most highly regarded political thinkers in the world of healthcare policy here to walk us through the post-election scenarios. The session will begin with a discussion on the top trends shaping the Washington landscape.

During this session, the panelists will discuss:

»» What does the Washington environment look like today? During a second Obama term? Or a first Romney term?

»» How do the House and Senate factor in?

»» Regardless of who wins, pressure points exist that must be addressed by the end of the year. The debt limit, sequester, budget challenges, and tax reform will all take priority over PPACA for at least the first 6 months after the election.

»» What are the prospects for all or part of PPACA being repealed?

»» What are the prospects for implementation of elements related to PBMs and Pharma? IPAB, PCORI, closing the donut hole, the 340B Program, and settlement

»» Medicare vs. Medicaid Politics - How will Medicaid impact the budget negotiations?

»» Tax reform politics

»» Why are no political figures talking about the deteriorating quality of healthcare?

The PBM industry continues to grow and change at a rapid pace. Not one year passes without significant changes to the industry environment and players. We’re pleased to have PCMA’s outgoing Chairman of the Board, George Paz, and incoming Chairman, Mark Thierer, here to share their take on it all. As the Chairman and CEO of Express Scripts, the largest PBM in the country, George Paz will offer his thoughts on the public policy and market dynamics that have impacted the PBM industry during the last year. Mark Thierer, Chairman and CEO of Catamaran, one of the fastest-growing PBMs in the country, will share his unique perspective on delivering enhanced value within the pharmaceutical supply chain, the importance of innovation around science and technology in our industry, and key opportunities and challenges in today’s ever-changing marketplace.

Wall Street’s take on our respective industries is always of special interest to PCMA conference attendees. The session will begin with a discussion on the top trends each analyst sees reshaping the face of the Pharma and PBM industries over the next decade.

During this session, the panelists will discuss:

»» How the end of traditional growth drivers are forcing an evolution and differentiation of PBM services models

»» Specialty reimbursement issues including “buy and bill” and physician compensation

»» Healthcare reform implications

»» The new dynamics being created from diagnostics

»» The ever-growing focus on integration and outcomes

»» The end of “me too” drugs, and the need for alignment between manufacturers and payers during R&D and clinical trials

»» Pharma’s strategy around OTC market segmentation

During the last 15 years or so, a slow but monumental shift has occurred in the way drug manufacturers research, develop and commercialize products. This change is largely the product of payers’ and PBMs’ relentless pursuit to ensure that patients have access to effective and safe medications at the lowest possible cost. Clinical outcomes and data that were non-existent in the past are now a critical factor in payers’ and PBMs’ decision making. Payers and PBMs seek to reward innovative products that deliver new value, and to discourage “me too” products and those that offer no new value to patients. As a result of this, manufacturers are working more and more closely with the payer community during the development and commercialization of their new and even existing products. During this session the panel will discuss the strategies and impact that this new dynamic has brought to the pharmaceutical care business.

Back by popular demand are Kristin Bass from PCMA and Ian Spatz from Manatt to discuss what Pharma and PBMs should be prepared for as implementation of PPACA continues to pick up steam. Kristin and Ian’s straightforward and entertaining dialog will address the most relevant aspects of the program and its overall impact on the commercial markets, Medicare Part D and the states.

 During this session, the panelists will discuss:

»» Discounting the donut hole

»» Biosimilars pathway

»» Medicaid market opportunity and role of the state insurance exchange

»» Essential health benefits, state mandates and Medicare protection classes

»» MLR rules for insurers

»» PBM transparency

»» Private sector issues: duals demo, ACOs, risk

»» Payment reform: focus on the doctors and hospitals, pharmacy spend increase from specialty

»» PCORI’s Future

At the conclusion of the Annual Meeting, Susan will have served as moderator for five PCMA conferences over the last two years. For those of you who attended some of these events, you know that Susan’s vast knowledge of the healthcare industry brings a fresh and informed perspective to all discussions. During this wrap-up session, Susan will offer her insights and conclusions regarding the issues covered at this event. Of note, Susan will continue to serve as PCMA’s conference moderator for our 2013 events as well.