AMCP: The Academy of Managed Care Pharmacy

With the high cost of medications, pharmacoeconomic analysis to determine the additional benefit being derived from additional cost is important, explained Renee JG Arnold, PharmD, RPh, practice lead for health economics and outcomes research at Quorum Consulting, Inc.

Working closely with oncologists on value assessment frameworks can save money for the healthcare system while guaranteeing great outcomes for patients, Steve Miller, MD, senior vice president and chief medical officer of Express Scripts, said during a pre-meeting session of AMCP Managed Care & Specialty Pharmacy Annual Meeting 2016.

Steven D. Pearson, MD, president of the Institute for Clinical and Economic Review, discussed the specialty conditions that are having the biggest impact on overall healthcare expenditures and pharmaceutical spending.

The FDA recently approved the biosimilar infliximab and found that from an immunogenicity profile it was more or less similar, which is important for payers and providers, explained Jeremy Schafer, PharmD, MBA, vice president and director of specialty solutions at Precision For Value.

With patients increasingly demanding more of anyone involved in their healthcare, technology is playing an important role, explained panelists at a session of Specialty Pharmacy Connect, a pre-meeting program held ahead of the AMCP Managed Care & Specialty Pharmacy Annual Meeting 2016.

The specialty pharmacy industry is unique in many ways, but the price growth for these drugs is no longer sustainable, Steve Miller, MD, senior vice president and chief medical officer of Express Scripts, said during a pre-meeting session of AMCP Managed Care & Specialty Pharmacy Annual Meeting 2016.

During the session on "Federal and State Legislative and Regulatory Updates" at the Academy of Managed Care Pharmacy's 27th Annual Meeting & Expo, there was talk of the ongoing initiatives being proposed by CMS, explained Debbie Meyer, RPh, resident program director, student pharmacists, career programs, Humana, Inc, who moderated the session.

The Patient‑Centered Outcomes Research Institute (PCORI) takes 2 different approaches to conduct research and gather evidence to help patients make decisions, Joe V. Selby, MD, MPH, executive director of PCORI, said at the Academy of Managed Care Pharmacy's 27th Annual Meeting & Expo.

Although Rhode Island is the smallest state in the United States, it had the fourth highest healthcare spend, which meant the state was spending "way too much" on healthcare, according to Beth Hebert-Silvia, RPh, managing director and assistant vice president of pharmacy at Blue Cross and Blue Shield of Rhode Island (BCBSRI).

Although there is a lot of promise for comparative effectiveness research as a tool to help healthcare providers, policy makers, and patients make better decisions, there are a number of issues to be resolved, according to speakers at the Academy of Managed Care Pharmacy's 27th Annual Meeting & Expo.

In a session at AMCP's 27th Annual Meeting & Expo that was so popular that attendees were being directed to an overflow room, Aimee Tharaldson, PharmD, senior clinical consultant in emerging therapeutics at Express Scripts, highlighted specialty pharmaceuticals that are currently in development and expected to come to the market in the next few years.

Orphan medications are gaining a lot of focus from manufacturers, Aimee Tharaldson, PharmD, senior clinical consultant for emerging therapeutics at Express Scripts, said at the Academy of Managed Care Pharmacy's 27th Annual Meeting & Expo in San Diego, April 7-10.

Pathways, particularly in oncology, have been gaining a lot more attention lately as payers are looking to bundle payments, Robert W. Dubois, MD, PhD, chief science officer and executive vice president of the National Pharmaceutical Council, explained at the Academy of Managed Care Pharmacy's 27th Annual Meeting & Expo in San Diego, April 7-10.

Pharmaceutical pricing is opaque for a reason and increased transparency may not be a benefit, said the speakers during the "Drug Pricing: Manufacturer, Payer, Prescriber, and Patient Perspectives" session at the Academy of Managed Care Pharmacy's 27th Annual Meeting & Expo in San Diego, April 7-10.

Trends in healthcare are driven by innovation, which is largely being driven by specialty innovation, Douglas M. Long, MBA, vice president of industry relations at IMS Health, said during the headline session "Marketplace Trends" at the Academy of Managed Care Pharmacy's 27th Annual Meeting & Expo.

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.