PBM Hub: Employer Strategies to Break the Monopolies

Wednesday, November 20, 12:30 p.m. - 5:30 p.m. (ET)

See below for Agenda

 

HRCI & SHRM credits will be available!

The PBM Hub offers employers a unique opportunity to gain actionable insights on driving transparency in their pharmacy benefit design. This groundbreaking event empowers employers to lead the charge for change to take control of their pharmacy benefits—an effort initiated during our recent PBM purchaser workshops. The goal is to inspire and inform employers to take bold, decisive action that transforms their approach to pharmacy benefits.

In conjunction with the Annual Forum, National Alliance of Healthcare Purchaser Coalitions has launched a PBM Hub, a pioneering initiative to foster collaboration, education, and innovation among employer/purchasers and the next generation of PBMs. 

The National Alliance, its member coalitions, and employer/purchaser members have the power to influence policy reforms that address harmful PBM practices. PBM Hub participants will learn to confidently set expectations for enhanced transparency, consultant independence, and value-based care. 

PBM hub will provide a unique platform for employer/purchasers to engage directly with transparent PBMs, offering an unparalleled opportunity to discuss and shape the future of pharmacy benefit management. 

The PBM Hub is a hybrid program consisting of two virtual sessions and one onsite session. 

  • November - Introduction and preparation for November 18 (90-minute virtual session)
  • November 20, 2024 - 12:30 p.m. - 5:30 p.m. (ET) (on-site at the Annual Forum)
  • Early December - Debrief, questions and wrap-up (90-minute virtual session)

Key Focus Areas:

  • PBM Contracting Language: Delve into the intricacies of effective contracting, ensuring clarity and fairness for all parties involved.
  • Rebates: Explore strategies for negotiating and managing rebates to maximize value and transparency.
  • Spread Pricing: Examine the impact of spread pricing on drug costs and discuss best practices for transparency and accountability.
  • Legislation: Review current and upcoming PBM-focused legislation, with an emphasis on compliance.
  • Transparency: Define what true transparency means in the PBM industry and how it can be achieved and maintained.
  • Consolidated Appropriations Act: Analyze the implications of the Consolidated Appropriations Act on PBM operations and benefit design.

Benefits of Participation:

  1. Direct Engagement: Engage directly with PBMs, gaining insight into their strategies, practices, and innovations. This direct interaction will help you understand the landscape and influence future PBM services to better meet your needs.
  2. Thought Leadership: Learn from industry leaders about cutting-edge practices in contracting, rebates, and transparency. Benefit from expert discussions that can inform your decision-making and benefit design strategies.
  3. Networking: Build relationships with PBM representatives and other key stakeholders in the healthcare and benefits sectors. Expand your professional network and explore potential collaborations that can enhance your benefits offerings.
  4. Learning and Development: Access rich educational content provided by expert speakers and panel discussions. Stay informed about industry trends, best practices, and legislative changes that impact pharmacy benefits, enabling you to make more informed decisions for your organization.
  5. Understanding PBM Contracting Language: Gain a deeper understanding of PBM contracting language and its importance. Learn how to negotiate contracts that ensure clarity and fairness, protecting your organization's interests and optimizing benefit management.
  6. Value of Transparent PBM Partners: Discover the value of working with transparent PBM partners. Understand how transparency in PBM operations can lead to better cost management, improved service quality, and more effective collaboration.

Please contact Karlene Lucas with any questions!

Space is limited so sign up today!

Agenda

12:00 – 12:30 Lunch provided for all attendees & faculty

12:35 - 12:45 PM | Welcome & Opening Remarks

Speaker: Shawn Gremminger, President & CEO, National Alliance of Healthcare Purchaser Coalitions

  • Overview of the PBM Hub
  • Introduction to faculty and session goals
  • Setting expectations for interactive sessions and actionable takeaways

 

12:45 - 1:00 PM | Overview of National Alliance Addressing PBM Misalignment: A National Alliance Initiative

Speaker: Christina Bell, Director of Healthcare Advancement, National Alliance of Healthcare Purchaser Coalitions

1:00 - 1:20 PM | The Need for PBM Oversight

Speaker: Josh Bindl, CEO, National CooperativeRx

Topic: "What Plan Sponsors Need for Proper Pharmacy Oversight"

  • A well negotiated contract minimizes a PBMs ability to change financial performance after a contract is signed.
  • Oversight over the entire industry eliminates wasteful medications, pricing games, lowers trend, and will drive the best outcomes for patients.

Key Takeaways:

  • To properly manage the pharmacy benefit, internal plan experts or trusted external advisors are critical.
  • Individuals with expertise can hold the PBM accountable and navigate the entire pharmacy benefit landscape to drive higher value for patients and the plan.

1:20 - 2:20 PM | Rebates, GPOs, and Navigating Financial Complexities

Speaker: Bill Dreyer, Chief Strategy Officer, Health Delegates

Topic: "Understanding Rebates, GPOs, and Claims-Level Data Access"

  • Explanation of Zinc, Ascent, and Emisar, and how GPOs have reshaped the rebating landscape since 2019.
  • Importance of formulary design in driving the lowest net cost.
  • Claims-level data access and how employers use it to fulfill their fiduciary duties.

Key Takeaways:

  • Understand how GPOs impact rebate structures.
  • Formulary design strategies for lowest net cost.
  • The role of claims-level data in managing fiduciary responsibilities.

2:20 - 3:20 PM | PBM Contracts and Pitfalls to Avoid

Speaker: Greg Baker, CEO, AffirmedRx, PBC

Topic: "Deep Dive into PBM Contracts: Avoiding Pitfalls and Asking the Right Questions"

  • De-identified PBM contract review highlighting common pitfalls and red flags.
  • Key questions to ask consultants and PBMs for accurate comparisons in RFPs.
  • Evaluating proposals with a focus on hidden fees, transparency, and rebate pass-throughs.
  • How to ensure the comparison of PBMs is fair and accurate, especially around fees, rebates, and formularies.

Key Takeaways:

  • Identify red flags in PBM contracts.
  • Ensure transparent and accurate comparisons of PBMs.
  • Essential questions to ask for protecting your plan’s financial health.

3:20 - 3:35 PM | Networking Break

3:35 - 4:35 PM | Navigating the Consolidated Appropriations Act and Avoiding Compliance Pitfalls

Speaker: Renzo Luzzatti, President, US-Rx Care

Topic: "Understanding the Consolidated Appropriations Act (CAA) and Minimizing Risk in Benefit Design"

  • Overview of the CAA and its implications for benefit buyers.
  • How to ensure compliance and mitigate risks in PBM contracts.
  • Aligning PBM contracts with CAA regulations to avoid penalties.

Key Takeaways:

  • Grasp compliance requirements of the CAA.
  • Minimize risks in PBM contracts.
  • Best practices for ongoing compliance and fiduciary management.

4:35 - 5:15 PM | Biosimilar Strategies and Formulary Design

Speaker: Craig Burton, Senior Vice President of Policy and Strategic Alliances Association for Accessible Medicines

Topic: "Biosimilars, PBMs, and the Future of Formulary Design"

  • How major PBMs are becoming manufacturers and preferring their own products.
  • Case studies on how biosimilars reduce specialty drug costs.
  • How to push PBMs for biosimilar adoption in formulary design.

Key Takeaways:

  • Understand the role of PBMs as manufacturers and its impact on formularies.
  • Strategies for promoting biosimilar adoption.
  • Identifying and avoiding conflicts of interest in PBM-managed formularies.

 

5:15 - 5:30 PM | Forging a Clear Path to True Affordable Drug Pricing & Negotiation

Speaker: Joe Shields, Managing Director, Founder, President, Transparency-Rx

5:30 - 5:45 PM | Closing Remarks & Call to Action

Speaker: Shawn Gremminger, President & CEO, National Alliance of Healthcare Purchaser Coalitions

  • Recap of key insights from the sessions
  • Actionable next steps for benefit buyers
  • Additional resources and support available from the National Alliance