High Drug Costs, PBM Reform, and Access Challenges Take Center Stage at AMCP 2025

As managed care pharmacy faces rapid transformation, professionals must stay ahead of evolving policies, high-cost drug strategies, and groundbreaking therapies. The upcoming annual meeting of the Academy of Managed Care Pharmacy (AMCP) will spotlight the key trends, challenges, and innovations shaping the industry, offering attendees critical insights into the future of health care.¹

As managed care pharmacy navigates rapid transformations in policies, high-cost drug strategies, and innovative therapies, the upcoming AMCP annual meeting will provide critical insights into legislative impacts, drug affordability, formulary design, and emerging treatment trends. | Image credit: DelmaineDonson - stock.adobe.com

With sessions covering legislative impacts, high-cost drug strategies, the Inflation Reduction Act (IRA), and cutting-edge therapies, attendees will gain valuable insights into the evolving health care landscape.

One session will focus on the implications of site of service legislation and its impact on managed care organizations and patient care. Attendees will explore how varying state regulations limit insurers in mandating specialty medication sources, reshaping managed care strategies. Speakers will discuss how health plans are adapting to these legal restrictions while balancing cost control with patient access. The session will also highlight the influence of site-of-service programs on patient experience, affordability, and satisfaction, concluding with a call to action for innovation, advocacy, and collaboration.

Another session will examine the role of employers and insurance purchasers in evaluating high-investment drugs. With the growing presence of expensive therapies, these stakeholders play a crucial role in determining drug affordability and access. This session will explore emerging high-impact drug classes, evolving trends in pharmacy benefit management, and employer strategies for sustainable access and optimized outcomes.

The IRA is set to create a significant ripple effect on Medicare Part D formulary design, impacting patients, pharmacy benefit managers (PBMs), health plans, and 340B-covered entities. A dedicated session will analyze unintended consequences of the IRA, including changes in incentives for PBMs and health plans and implications for formulary decisions. Experts will discuss current research on the drugs selected for price negotiation and projected trends in health care stakeholder impact.

Food allergies, affecting nearly 11% of adults and 8% of children in the US, impose economic burdens and health disparities.^2,3 With the recent FDA approval of omalizumab for immunoglobulin E–mediated food allergies, one session will explore its potential impact on patient care. Managed care organizations will play a critical role in improving access, coordinating care, and supporting preventive measures like early allergen introduction. Discussions will emphasize the need to address socioeconomic and racial disparities in allergy prevalence and treatment.

A keynote session will provide an up-to-the-minute analysis of pharmaceutical market trends and their impact on managed care professionals. Attendees will receive forecasts on health care industry developments and insights into how these trends will shape pharmacy benefit management in the coming months.

The AMCP Foundation’s Emerging Trends Initiative will also be featured, highlighting a process for identifying and assessing emerging trends in managed care pharmacy. Using a survey, experts identified key areas such as information technology, therapeutics, payment models, pharmacy operations, and public policy. The session will discuss how the survey findings can inform strategic planning within managed care organizations.

The FDA’s Accelerated Approval Program, initially developed during the HIV epidemic, has played a pivotal role in expediting access to innovative treatments. However, confirmatory trials are not always conducted as expected. This session will examine the successes and challenges of the program, discuss management strategies from national payers, and explore innovative payment models to optimize the use of accelerated approval drugs.

Lastly, glucagon-like peptide-1 (GLP-1) receptor agonists are gaining traction beyond diabetes treatment, with potential applications in obstructive sleep apnea, binge eating disorder, substance use disorder, and neurocognitive disorders like Alzheimer disease and Parkinson disease. A keynote session hosted on the final day of the meeting will delve into the latest advancements in the GLP-1 agonist pipeline, including emerging therapies and implications for managed care. The discussion will also address challenges in formulary management and benefit design, emphasizing the potential of GLP-1 therapies to revolutionize patient care.

References

1. Agenda. AMCP 2025. Accessed March 24, 2025. https://amcpannual.org/agenda-program/meeting-agenda

2. Gupta RS, Warren CM, Smith BM, et al. The public health impact of parent-reported childhood food allergies in the United States. Pediatrics. 2018;142(6):e20181235. doi:10.1542/peds.2018-1235

3. Gupta RS, Warren CM, Smith BM, et al. Prevalence and severity of food allergies among US adults. JAMA Netw Open. 2019;2(1):e185630. doi:10.1001/jamanetworkopen.2018.5630