Understanding and Managing Pharmacy PMPM Risk Through the Use of AMCP Dossiers and Value Frameworks
Moderator: Karl Gregor, PharmD., MS
Presenters: Jim Davidson, PharmD, MBA, Karl Gregor, PharmD., MS, Kim Gwiazdzinski RPh, MBA, VP
A significant number of drug approvals have occurred in the past few years. The availability of new drugs at increasing prices have increased pharmacy PMPM cost risk. There are two useful tools that can help stakeholders plan for and manage this increased risk: the Academy of Managed Care (AMCP) Format for Formulary Submissions (known as the AMCP Dossier) and value frameworks.
The intent of this session is to improve actuaries' understanding of valuable information contained in the AMCP Dossier and introduce relevant value frameworks and illustrate how they can help to inform actuaries and payer coverage decisions through value assessment. There will be focus on what the value frameworks can help with today, and what questions still remain about the utility of the frameworks in the formulary decision making and health plan budgeting process.
Prescription Drugs: Pricing, Trends, and Market Structure
Presenters: Scott Fry, FSA, MAAA, Rebecca Owen, FSA, MAAA,FCA, Gregory Warren, FSA, MAAA, FCA
This presentation provides a summary of how the prescription drug market is organized and priced, from the manufacturer to the patient and all the stakeholders in-between. There will also be an overview of recent trend rates for prescription drugs and other changes in the prescription drug landscape such as rebates, coupons, specialty medications and biosimilars.
Consumer Impact of the Prescription Drug Market
Moderator: Gregory Warren, FSA, MAAA, FCA
Presenters: Johnathan Gray, ASA, CERA, Sarah Hellems, FSA, MAAA, CERA, Karen Nixon
Pharmaceutical manufacturers use a variety of methods beyond simply targeting physicians to promote their products and gain market share. Direct-to-consumer advertising, drug manufacturer coupons, copay assistance programs, and drug rebates are strategies frequently employed to gain name recognition and address affordability concerns among consumers and gain access to a health plan's formulary. This session will explore the impact these strategies have had on consumers and their drug utilization patterns. In addition, it will highlight the government and health plans' responses to these strategies and why actuaries should be paying attention