2024 Health Meeting - Session 8H: UCB Session Series - Session 2: The Impact of Site of Care and Benefit Design on Pharmaceutical Costs 6.25.24 Recording

The true cost of a drug and its therapeutic outcome is impacted by a myriad of factors. This session will utilize case studies in high-cost, chronic diseases to illustrate to participants what factors can be critical to evaluating the true cost of a pharmaceutical intervention. Differing from session one, session two will focus on site of care, buy-and-bill aspects, and the differences between a medical and pharmacy benefit and how these factors ultimately impact the total cost of patient care. Similarly, using Myasthenia Gravis for consistency as one case study, a class of specialty products exist with similar mechanisms of action, but very different costs associated with site of care, HCP reimbursement, method of administration, and benefit design and management. Helping attendees better understand the economic impact of these factors is critically important in their efforts to inform clients about the impact of pharmaceutical costs on the organization. The chosen presenter will be a Medical or Pharmacy Director from a national health plan who evaluates products for formulary inclusion as part of their daily responsibilities - an expert in their field and a great facilitator to have an active dialogue with attendees. After participating in the session, the attendees will have an augmented understanding of the numerous factors, beyond just list price, that contribute to the true cost of a pharmaceutical intervention including site of care administration, the economics of buy-and-bill, and differences between the management of medical and pharmaceutical benefit products. This augmented understanding will aid the participants in providing a more holistic assessment of the cost impact associated with utilization of specialty drug therapies. Informed decision making is a critical skill for actuaries and consultants to possess in working with their clients to establish cost-effective benefit designs.