Day OneTuesday, 8 December 2026 - CST/CDT (Central Daylight, GMT-5)

• Evaluate telehealth/DTC players (e.g. Ro, Hims & Hers) and their dependency on reimbursement gaps
• Test the claim that these models become redundant as GLP-1 coverage expands
• Examine how PBMs can internalize or neutralize these capabilities

Manufacturers are expanding copay programs, digital patient acquisition, hub services, cash-pay offers, and direct-to-consumer models. This session examines how these strategies may shift control away from traditional intermediaries and how PBMs and plans should respond.

Discussion Points:

• Why manufacturers are investing in direct distribution and patient acquisition
• How copay support, cash-pay, and hub models affect PBM economics
• Which drug classes are most likely to move direct (GLP-1s, specialty, chronic)
• Risks to formulary leverage and traditional rebate models
• How PBMs can defend relevance through data, navigation, and outcomes
• Whether partnerships outperform resistance

As GLP-1 utilization accelerates, employers and PBMs must balance access, affordability, and long-term sustainability. This session examines how stakeholders are evolving beyond short-term controls to address underlying cost drivers.

• Compare eligibility frameworks and utilization impact across employers and PBMs
• Analyze future pricing dynamics, including Medicare negotiation (MFP) and commercial implications
• Evaluate sustainability vs short-term controls (PA, step therapy, caps)
• Assess whether lifestyle and behavioral interventions can reduce utilization or simply add cost
• Explore real-world case studies with measurable outcomes and implementation challenges

• Define network eligibility criteria and categorization frameworks
• Solve overlapping network and termination challenges
• Align network design with regulatory constraints while optimizing pricing

• Examine how formulary design shapes rebate flow and profitability
• Analyze reconciliation challenges and data limitations
• Evaluate transparency vs. financial performance tradeoffs

Rising drug spend, GLP-1 demand, and demands for transparency are changing how employers evaluate pharmacy benefit partners. Hear directly from plan sponsors and advisors on what drives vendor selection, where traditional models fall short, and how PBMs can differentiate in a broker-led market.

• What employers prioritize beyond lowest net cost
• How consultants shape finalist decisions
• Demand for transparency, audit rights, and guarantees
• Managing specialty and GLP-1 affordability
• Service expectations that retain employer clients

• Navigate inconsistent state-level regulations
• Share and discuss instances of unclear DOI guidance and regulatory interpretation
• Evaluate rebate transparency and margin exposure
• Assess implications of Medicare gap discount programs and rapid 340B expansion

Following a high-level regulatory overview, this interactive session gives attendees the opportunity to engage directly with experts and unpack the real-world implications of evolving policy and enforcement. Through structured roundtable discussions, participants will move beyond theory to examine how regulatory changes impact contracting, pricing, and operational strategy.

• Break down complex regulatory developments into actionable implications
• Engage directly with experts across key policy areas
• Compare how different stakeholders interpret and respond to change
• Identify immediate priorities and longer-term strategic considerations
  
  Table 1: Medicare & MFP Pricing Dynamics
• GLP-1 implications (e.g., Ozempic 2027)
• Downstream effects on contracting and pricing
  
  Table 2: 340B Expansion and Rebate Model Evolution
• Growth of the 340B Drug Pricing Program
• Tension between covered entities, PBMs, and manufacturers
  
  Table 3: Patchwork State Regulations
• State-by-state variability
• Inconsistencies in regulatory reporting requirements, including ERISA plan inclusion, network adequacy measures, rebate transparency, administrative fees, and acquisition cost methodologies
• Operational burden and compliance strategy
• Who wins with State mandated NADAC+ Professional Fees?
  
  Table 4: FTC Scrutiny and Antitrust Pressure
• Enforcement trajectory
• Implications for transparency and vertical integration
  
  Table 5: Federal PBM Reform
• Legislative outlook
• Contracting and pricing implications
• Federal preemption: key areas of focus, including:
• Contracting practices
• Minimum pricing implications (price appeals)
• Network adequacy and any willing pharmacy requirements
• Rebate pass‑through requirements
• Steerage and PBM vertical integration
  
  Table 6: GLP-1 Regulation and Coverage Policy
• Coverage mandates vs employer flexibility
• Regulatory pressure intersecting with cost containment
• Direct‑to‑consumer, B2B, and PBM program models focused on bypassing traditional insurance contributions