ICYMI: AMCP Nexus Conference Highlights

The 2023 Academy of Managed Care Pharmacy (AMCP) Nexus meeting was held October 16-19 in Orlando, Florida. Sessions and speakers covered a wide variety of regulatory and policy updates, as well as evolving managed care strategies. These conference highlights reflect the meeting’s mission to transform managed care pharmacy; they encompass expert interviews and insightful updates on the Inflation Reduction Act, gene therapy affordability and access, and the 340B Drug Pricing Program.

Peruse these 2023 AMCP Nexus highlights, and check out all of our coverage from the meeting here.

5. Dr Ben Urick Compares Value of Medically Integrated Specialty Pharmacies With Mail Order Pharmacies

In this video interview with The American Journal of Managed Care^®, Ben Urick, PharmD, PhD, senior principal health outcomes researcher, Prime Therapeutics, compared the service value provided between specialty (or medically integrated) and mail order pharmacies. “The value of medically integrated pharmacies can be thought of in a couple of different ways,” he said. “Key to value is the idea of quality divided by cost.” Urick went on to discuss how the member experience can be influenced by such factors as time to therapy initiation, improved treatment adherence, the provider experience, cost-effectiveness, and waste rate.

4. Specialty Pipeline Includes Drugs for Alzheimer Disease, Hemophilia, NASH, and More

This writeup of a session from Aimee Tharaldson, PharmD, senior clinical consultant, Emerging Therapeutics, Express Scripts, discussed potential major approvals of nononcology drugs over the next 5 years. Disease states covered by these approvals are inflammatory disease, multiple sclerosis, HIV, nonalcoholic steatohepatitis, Alzheimer disease, paroxysmal nocturnal hemoglobinuria, Duchenne muscular dystrophy, and gene therapies. This article also addressed updates on the growth of the biosimilars market in 2023, which saw the launch of 8 products referencing Humira (adalimumab) alone and approval of the first tocilizumab and natalizumab biosimilars.

3. Panelists Highlight Gaps in Research on Whether 340B Discount Program Is Working

Originally part of 1992’s Public Health Services Act, the 340B Drug Discount Pricing Program has come under increasing scrutiny of whether the plan is indeed effective. Prime concerns about the program, according to the panel session covered in this article, are its transparency and lack of guidance on discounts for eligible patients and services, how discounts are used, and measuring if the patient benefits portion of the program is effective by evaluating such areas as out-of-pocket (OOP) costs, patient assistance programs, health outcomes, and less aggressive pursuit of debt. In addition, this article compares the streamlined approach of the program in 1992 compared with the often complex and multifaceted relationships eligible entities have today.

2. Panelists Discuss IRA Provisions Impacting Medicare in 2024 and Beyond

Within this conference presentation, several consultants from health care consultancy BluePeak Advisors reviewed how the Inflation Reduction Act (IRA) has affected Medicare pharmacy spend, including OOP caps for Part D drugs (Part D is a voluntary outpatient prescription drug benefit), and how changes to the Medicare Prescription Payment Plan could soon affect plans, pharmacy benefits managers, and patients regarding liability. Another notable point of discussion was CMS’ list of the first 10 drugs up for price negotiation under the IRA, starting in 2026, which had already given rise to 8 lawsuits to prevent this provision from being implemented.

1. As More Gene Therapies Come to Market, Access and Affordability Remain Concerns

When this conference article was written, there were 8 FDA-approved gene therapies and 2 more were predicted by end of year; on December 8, exagamglogene autotemcel (Casgevy, Vertex Pharmaceuticals) and lovotibeglogene autotemcel (Lyfgenia, bluebird bio) were approved to treat sickle cell disease. With more than 2000 candidates in the development pipeline, affordability and access have become chief concerns because of alternative payment model fixed pricing policies and forecasting candidates. At present, the price tag for gene therapies ranges from approximately $800,000 to $3.5 million for a 1-time infusion.