BLOG: Top takeaways from the 2018 Pharmacy Networking Meeting

Sara Neese, Health Plan Alliance


The Alliance hosted 28 pharmacy leaders from 12 member plans in Dallas last week for a one and half day session focused on pharmacy program management.  While our plans have always been leaders in the development of strategies to effectively manage pharmacy cost and utilization trends, given the accelerated pace of change in the pharmacy industry and the increased complexity of pharmacy program management, ongoing discussions like this will play a critical role in plan success as we continue to navigate this complex and ever changing environment.   This meeting featured both member driven roundtable discussions, along with presentations from a number of key subject matter experts.


"Everybody speaks the same language and experiences the same challenges"

"I liked the networking, getting new ideas from other health plans"

"I enjoyed the honest discussions"

"Relevant speakers. I learned a lot"


A big note of thanks and kudos goes out to the following plans who actively participated in the planning for this event:

Baylor Scott & White – John Chaddick and team
Health Alliance Plan – Tony Petitta and team 
Presbyterian – Louanne Cunico and team
Providence – Helen Noonan-Harnsberger and team
SelectHealth – Eric Cannon and team
Sentara (Optima) – Tim Colligan and team 


State Policy Overview
We heard from Jane Horvath, Senior Policy Fellow with the National Academy for State Health Policy regarding state approaches to the proactive management of pharmacy costs.  As pharmacy costs continue to escalate, states lack some of the commercial tools available such as closed formularies and copays, so they are looking at legislative action to help improve their cost position.   Jane shared the fact that there have been 160 total bills initiated so far in 2018 related to pharmacy benefit managers (PBMs), manufacturers’ price transparency and drug importation.   In addition to an overview of state legislative activities, Jane provided an update on a number of promising state approaches to managing pharmacy costs from New York State and Medicare Advantage (MA) along with an overview of suggested approaches that the Federal government could consider to assist states with their Medicaid pharmacy expenditures.   The National Academy for State Health Policy is a nonpartisan forum of policymakers throughout state governments, learning, leading and implementing innovative solutions to health policy challenges.  Their website holds numerous resources which would be of interest to you.  I recommend signing up for their newsletter.  
Presentation: State Policy Overview 

Federal managed care pharmacy policy issues
Mary Jo Carden, VP Government & Pharmacy Affairs with AMCP contributed to the discussion by sharing the latest information from Washington and providing a general update on Congress and the Administration’s 2018 health care agenda.  She led with an overview of President Trump’s Blueprint to Lower Drug Prices released on May 11, 2018. The blueprint includes dozens of proposals in the following categories:  1) increased competition; 2) better negotiation; 3) incentives for lower list prices and 4) lowering out-of-pocket costs.  AMCP also hosted on a webinar on May 21 regarding the blueprint: American Patients First - Understanding the President’s Blueprint & the Implications to Managed Care Pharmacy.  
Presentation: Federal managed care pharmacy policy issues 

CMS Part D final 2018 rules
Babette Edgar, principal with BluePeak Advisors presented an in depth overview of the recently published CMS Part D – Final 2019 Rule and Call Letter and shared her suggestions for key areas of focus in the areas of 1) Part D tiering exceptions, 2) special enrollment period changes, 3) transition fill modifications, 4) generics and other midyear formulary changes, 5) updates to biological products, 6) part D formulary updates, 7) improving drug utilization controls for opioids, 8) B vs D for immunosuppressants and 9) Medicare Part D benefit updates.  The group used this time together to discuss some of the perceived “gray” areas in the guidance to gain clarity going forward.  Summaries of the final rule and call letter and can be found on the BluePeak website
Presentation: CMS Part D Final 2018 Rules 

Opioid management
We did a deep dive with Beth Brusig, clinical pharmacy specialist, Managed Care, at Sentara Health Plan, and Vanita Pindolia, VP, Ambulatory Clinical Pharmacy Programs, Health Alliance Plan, on strategies and initiatives to address more effective opioid management.  The discussion was focused around plan protocols and programs being implemented around acute and chronic opioid use management.  Numerous initiatives are being proposed both federally and at the state levels for restrictions in day limits, requirements for the implementation of both patient and provider contracts, and the introduction of new alternatives for pain management. One initiative of interest shared is the use of battlefield acupuncture at the Detroit Veteran Affairs Medical Center.  The Virginia Board of Medicine, along with other states, is adopting regulations to establish rules regarding the prescribing of opioids for pain treatment and buprenorphine for addiction treatment.   Plans shared many of the steps that they are taking to respond to both state and federal requirements in this space and develop internal processes and programs to effectively identify and manage opioid dependency in their patient populations.
Presentation: Opioid Management - Health Alliance Plan

MA Star Ratings
The group participated in an energetic conversation led by Charlotte Luebbert, director of Medicare Part D Pharmacy Service, and Chad Valdez, clinical pharmacist at Presbyterian, on effective strategies to help optimize plan success with MA Star Ratings.  Included in discussions of best practices for medication adherence were 90 day refills for two copays, member outreach for missed fills and creation of a database to track outcomes. Strategies for increasing medication therapy management (MTM) comprehensive medication review (CMR) completion rates include vendor contract guarantees and new internal workflows for technicians and pharmacists. 
Presentation: MA Star Ratings

Specialty drug management
The final morning of the meeting offered an opportunity for interactive conversation around specialty pharmacy innovations and strategies in discussions led by Tony Pettita, VP, Pharmacy Care Management, and Marina Nikolavsky, clinical pharmacy manager at Health Alliance Plan.   The group shared significant levels of detail regarding their programs through these discussions which focused on 1) plan relationships with specialty pharmacy providers, 2) benefit design including specialty tiers and co-insurance levels and 3) formulary management and rebate strategies.  
Presentation: Specialty Drug Management

The meeting concluded with discussions regarding the design of future Alliance pharmacy programming, so watch for additional opportunities to join the conversations and participate in learning and networking opportunities with your peers.  As many of you are aware, many of the insights shared and “gold nuggets" found during an Alliance meeting occur in the scheduled sessions, but the rest of this happens in the conversations outside of the meeting room during dinners, breaks and in the hallways.  This meeting was no exception and there were many conversations around various aspects of prescription drug management including PBM acquisitions, specialty pharma management, innovative approaches to cost management, compliance challenges, etc.  Your presence is what makes these meetings valuable for everyone. We look forward to you joining us at one of our upcoming in-person events.




To post comments, Click Here to Login