Day 2, Tuesday, November 19, 2024Tuesday, 19 November 2024 - ET (Eastern Time, GMT-05:00)

National healthcare policy trends and legislative changes continue to be top-of-mind for many industry stakeholders in the access and reimbursement space, particularly with a new configuration of the Federal government in January 2025.

• State of play of federal and state legislative efforts related to patient affordability issues and PBM reforms
• Review of key regulatory and legal updates across copay adjustment programs, alternative funding programs, and Medicare OOP smoothing
• Impact of 2024 elections on access and reimbursement issues and potential policy developments to monitor in 2025

Hear directly from U.S. attorneys on trends of upcoming areas of focus and enforcement for 2024 and beyond, specifically looking at guidance on field-based roles, prior authorization and other focal points.

• Overview of common coding systems (e.g., CPT, ICD-10) and their relevance to deciding eligible payments
• Key considerations for co-pay structure and clear communication with patient and providers to ensure compliance
• Utilizing advanced software and technologies for streamlined coding and billing processes
• Data gathering and reimbursement trends analysis of EOBs/remittances
• Staying abreast of regulatory requirements in coding and billing practices
• Industry best practices in copay optimization through coding accuracy

In today’s complex landscape, the considerable financial burden of high-cost treatments presents ongoing barriers not only for patients, but also for pharmaceutical companies working to bring therapies to market. To effectively address these challenges, it’s crucial to adopt a customized affordability approach that considers the diverse needs of patients and the unique characteristics of drug classifications. Enhanced copay programs, supported by a comprehensive pharmacy network, play a vital role in improving patient access to necessary medications. Discuss ways to help ensure innovative affordability solutions are comprehensive and tailored to meet the specific needs through integrated actionable data, effective brand safeguards, and specialized expertise throughout the brand lifecycle.

Copay adjustment programs, encompassing maximizers, accumulators, and alternative funding programs, have become a complex landscape for patients, manufacturers, and insurers. This session will dissect these programs, describe the impact on patients, and provide an update on regulatory and legislative activity to address the issues.

Across the board, the healthcare industry has seen a shift in the overall money funnel and many companies are facing strict budget constraints. In turn, manufacturers are looking to invest later in their processes in order to derisk earlier. During this session, learn how to weigh the costs of innovation, ensuring that your organization remains dynamic, forward thinking and patient centric even amidst financial limitations.

• Take a look at the different states that have enacted comprehensive privacy legislations and their respective implications
• Ensure that your copay data is being stored and used in a way that is appropriate and compliant
• Understand the types of data that manufacturers can, and cannot, have access to and how to use such data to improve your provided services
• Strategize on how to assess, and reassess, should you encounter firewalls surrounding Patient Health Information (PHI)
• Discuss HIPAA, including the types and number of signatures that should be required on your patient services form