forum agenda
Costs have been on the rise for self-insured health plans, with prescription drugs often being the biggest cost driver. In recognition of this trend, SIIA has developed this new educational program focused on helping introduce payer stakeholders to effective cost containment strategies and provide advice on how to most efficiently coordinate with other payer stakeholders to optimize results for payers and participants.
Wednesday, May 28
5:00 p.m. - 6:30 p.m.
Welcome Reception
(Joint reception with SIIA’s Cell & Gene Therapy Stakeholder Forum)
Thursday, May 29
7:00 a.m. - 8:00 a.m.
Networking Breakfast
8:00 a.m. - 8:15 a.m.
Welcome Remarks/Program Overview
8:15 a.m. - 9:15 a.m.
High-Cost Drug Market Update
Gain valuable insight from a leading industry expert regarding those drugs that have the highest price tags and utilization rates, preview the new high-cost medications expected to come to market over the next year, similar topics sure to be of interest to anyone involved with self-insured health plans.
SPEAKER:
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Erin O’Mara, PharmD
Lead Pharmacist, Pharmacy Operations
HM Insurance Group
9:15 a.m. - 10:15 a.m.
What Fiduciaries Need to Know About High-Cost Prescription
Drug Treatments
Increased regulatory requirements and legal scrutiny are focused on how self-insured health plans manage costs. Given that pharmacy benefits are often a leading cost driver for employer plans, this topic is of particular importance to health plan fiduciaries. How will the requirements under the CAA impact brokers and plan sponsors? Will the J&J and Wells Fargo employer lawsuits as well as the FTC action against the three largest PBMs impact the way a broker or TPA present PBMs to their clients? SIIA members and their business partners should also have good understanding of the current legal/regulatory environment. SIIA’s Washington Counsel and ERISA attorney provides real-time guidance on this critical topic.
SPEAKER:
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Chris Condeluci, Esq.
Washington Counsel
Self-Insurance Institute of America, Inc.
10:15 a.m. - 10:45 a.m.
Networking Break
10:45 a.m. - 11:45 a.m.
PBMs & Point Solutions - Complimentary or In Conflict?
Point solution companies continue to populate the self-insurance marketplace, particularly the pharmacy space. Should plans consider offering Point solutions in addition to or in place of PBM embedded offerings? If yes, what are the obstacles to doing so? It depends and can be complicated. How do payment integrity programs help satisfy fiduciary requirements? This session will provide clarity on these and related questions.
MODERATOR:
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Richard Fleder
CEO
ELMCrx Solutions
SPEAKERS:
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Joseph Jurewicz
Senior Vice President, Pharmacy Consulting
Alliant Insurance Services
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Brian Shonat
Senior Vice President, Business Development
Navion (Formerly AlignRx)
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Anthony Masotto
EVP and General Manager
Drexi
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John Cooper
Chief Growth Officer
S&S Health
11:45 a.m. - 1:00 p.m.
Hosted Lunch
1:00 p.m. - 2:00 p.m.
Cracking the Code – Understanding “J Code” Puzzle
A leading industry expert provides everything you need to know about “J Codes” relative to pricing for self-insured health plans, including how J code pharmacy claims differ from regular pharmacy claims. Attendees will also learn about options for pricing evaluation, fulfillment strategy, and other codes that could apply on specialty pharma medical claims.
SPEAKERS:
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Corey Belken, PharmD
Senior Employer Account Executive
Genentech, Inc.
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Jeff Auten, PharmD
Director of Clinical Consulting
Leaf Health
2:00 p.m. - 3:00 p.m.
High-Cost Drug Site of Care Strategies
Determining the site of care for high-cost medications has become an increasingly important consideration in managing both plan costs and patient outcomes. This session will provide an overview of alternative site of care options (infusion centers, home-based, etc.), discuss potential cost offsets and savings, examine the role of third-party care coordinators, and related factors that should be considered by employers, brokers, TPAs and others involved in the care and/or payment process.
SPEAKERS:
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Bob Gilkin
SVP, Trade & Specialty Strategy
Ascella Health
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Sabine Enright, PharmD
Lead, Integration Payer Business Unit
Ascella Health
3:00 p.m. - 3:15 p.m.
Networking Break
3:15 p.m. - 4:00 p.m.
Federal Health Program Changes – Implications for the
Commercial Market
This session will take a close look at changes to Medicare and other federal health programs relative to specialty drug coverage and pricing that are impacting the commercial market, including self-insured health plans. We’ll focus particularly on Medicare direct negotiation.
SPEAKER:
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Rob Shelley
Founding Principal
Leaf Health
4:00 p.m. - 5:00 p.m.
The Great Rebate Debate
Drug rebates have become increasingly common for self-insured health plans, but this often-opaque practice makes it difficult to evaluate the true benefits of rebates to the plan. Further complicating this evaluation are competing claims made by the “Big 3 PBMs” compared to “transparent” PBMs that have entered the market in recent years. This session will bring together multiple perspectives on these and related questions.
MODERATOR:
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Dave Parker
Vice President
TrueScripts Management Services
SPEAKERS:
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Trevor Daer
President/Founder
Granite Peak Consulting
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Christine Johnston
Co-Founder & Pharmacy Practice Leader
Foundational Pharmacy
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Kelly Chillingworth
Managing Partner
Integrity RX Partners
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Ted Levy
Vice President of Sales
Health Delegates
