Agenda for Day 1– Tuesday November 17, 2026Tuesday, 17 November 2026

Before diving into deeper, supplemental sessions, take this opportunity for a broader level set. Gain insight into current policies and pending changes to understand how the copay industry has been affected in 2026, and will be affected in future years, and learn the steps that your organization should be taking to prepare and adapt accordingly.

Highlight how cutting-edge tools such AI, automation, EHR, EMR and eBV can elevate copay programs by improving efficiency, enhancing user experience and streamlining processes. Learn how to leverage these technologies to optimize patient access and provider workflows.

• Leverage AI and automation to predict patient needs, streamline claims processing and reduce administrative burdens

• Understand the benefits of integrating EHR and EMR systems to enable seamless benefit verification, prior authorization and prescription workflows

• Utilize eBV tools to simplify real-time benefit verification and reduce delays in the copay process

• Explore emerging technologies and best practices to enhance patient access, adherence and satisfaction

Dive into the unique considerations and nuances for designing and managing copay programs for medical vs pharmacy benefit products. Explore strategies to address affordability challenges, navigate reimbursement complexities and optimize patient access while adapting to payer-driven policies.

• Examine the distinct challenges of implementing copay programs for buy-and-bill vs specialty pharmacy models

• Analyze the impact of payer-driven policies, such as copay accumulators and maximizers, on copay program design and patient affordability

• Explore best practices for tailoring copay programs to align with benefit verification, prior authorization and reimbursement requirements under each benefit structure

• Understand the evolving role of field teams in supporting copay programs for medical versus pharmacy benefit products, ensuring seamless patient and provider experiences

The reimbursement landscape is undergoing significant change due to policy shifts, pricing adjustments and evolving payer dynamics. Explore how to adapt your program strategies to ensure patient access while also maintaining profitability.

• Analyze the financial impact of Medicare drug price negotiations and WAC (Wholesale Acquisition Cost) adjustments, including how these pricing mechanisms directly influence reimbursement models, profitability and patient affordability

• Delve into the operational and strategic effects of the first round of Medicare drug price negotiations implemented in January, and prepare for the anticipated second round next year, focusing on how these changes reshape payer relationships and access dynamics

• Identify innovative contracting strategies that align with patient access goals and payer expectations

Access to robust claims data is essential for optimizing reimbursement processes and improving patient outcomes. Explore how to leverage data to identify bottlenecks, reduce denial rates and enhance the claims journey. Learn how to use analytics to drive efficiency and patient satisfaction.

• Identify common errors in claims processing and develop targeted solutions to address them

• Analyze denial rates, time-to-payment metrics and clinic success rates to improve reimbursement efficiency

• Explore tools and strategies to map the patient claims journey and identify key drop-off points

Explore the critical role of data infrastructure in consolidating insights, mapping the patient journey and leveraging copay data to enhance patient engagement and profitability. Learn how to build robust data systems that enable seamless integration and proactive patient support.

• Develop a data infrastructure to consolidate information across multiple vendors, ensuring a smooth patient journey

• Leverage consented and de-identified data to react quickly, engage patients compliantly and drive profitability

• Utilize copay data effectively to enhance program design, improve access and support patients throughout their treatment journey

• Strategize for key transitions, such as loss of exclusivity (LOE) or mergers and acquisitions, by using data to proactively engage patients and ensure continuity

Explore the growing trend of direct-to-patient (self-pay) mail order pharmacies as a strategic channel for pharmaceutical companies. Gain insights into consumer trends, program development and legal considerations shaping this innovative approach.

• Examine direct-to-patient (self-pay) mail order pharmacy as a channel strategy for pharma, highlighting its potential to enhance patient access and engagement

• Analyze consumer, patient and insurance trends driving the adoption of direct-to-patient self-pay pharmacy programs

• Discuss key considerations in developing a direct-to-patient pharmacy offering, including product suitability, pricing strategies, financial implications and selecting the right pharmacy partners

• Address critical legal and regulatory issues associated with direct-to-patient pharmacy programs to ensure compliance and operational success

The patient affordability landscape has fundamentally shifted; with copay maximizer programs now impacting nearly half of commercially insured lives, broad and undifferentiated copay strategies are no longer viable. This session examines what separates high-performing programs from the rest, exploring how intelligent program design built on real-time, claims-based identification, seamless patient transitions and operational transparency drives measurably better outcomes than legacy approaches. Attendees will leave with a practical framework for evaluating solution partners and a sharper focus on the only metric that truly matters: how many patients stayed on therapy because access was never a question.

• Why claims-based, first-fill identification is the new operational standard for maximizer mitigation

• How invisible program transitions protect adherence and reduce therapy abandonment

• What disciplined expansion methodology signals about a vendor's overall quality

• The transparency and reporting benchmarks manufacturers should demand from solution partners

As traditional copay models evolve, manufacturers must rethink their approach to affordability and access. Explore how to leverage technology, innovate program design and create patient-centric strategies to enhance copay solutions.

• Build tech-enabled programs that reduce the burden on patients, providers and pharmacists while improving engagement

• Identify key factors to consider when designing copay programs, including patient demographics, disease states and evolving market dynamics

• Explore strategies to enhance visibility, simplify enrollment and increase utilization of patient support and copay programs

• Evaluate the potential of subscription-based and hybrid copay models to enhance affordability, access and the overall patient journey

Over the years, patient "out of pocket" costs for branded drugs have grown far faster than wages, medicine prices or insurance premiums, coinciding with benefit designs that expanded exposure to variable coinsurance and moved away from fixed copayments. However, average trends often obscure the problem and who is most affected. This presentation pulls back the curtain by using empirical data to quantify the true extent of the patient burden and examines policy approaches to reduce it.

• Understand the scale and patterns of today’s patient cost burden in employer-based plans

• Recognize who benefits – and who is left exposed – under current benefit designs

• Learn from real‑world evidence in West Virginia how point‑of‑sale rebate pass‑through changes patient costs and medication use