Day TwoWednesday, 11 December 2024 - CST/CDT (Central Daylight, GMT-5)

Discover actionable insights on developing benefit plans for weight loss drugs as we delve into effective strategies for structuring GLP-1 coverage in health plans.

• Gain insights into the changing dynamics of PBM contract evaluation and RFP processes.
• Master negotiation strategies and ensure compliance with ERISA requirements when contracting with PBMs.

Dive into the complexities of formulary management, one of the most critical yet misunderstood aspects of pharmacy benefit management (PBM). With growing scrutiny on PBMs, employers are demanding greater transparency and better value, especially when it comes to formulary decisions. Join us for a deep dive into actionable strategies that move the needle on member health while driving lower costs for both employers and members.

In June 2022, the FTC announced an investigation of the PBM industry and market. On July 9, 2024, the FTC released its Interim Staff Report. By September 2024, the FTC sued the largest PBMs for allegedly driving up the costs of insulin products in violation of the antitrust laws. Besides the FTC, state legislatures have enacted various laws in the past few years addressing various PBM practices, and several State Attorneys General have sued PBMs for alleged anticompetitive actions. Brad Kitlowski will give a rundown of these matters and discuss the latest developments.

• Explore the latest developments in copay maximizer and accumulator programs.
• Examine the potential impact of recent federal court rulings on health plans and PBMs.
• Gain insights into best practices for PBMs to review their internal policies and practices related to these programs.

• Exploring the Core Issue of 340B Double Payments.
  • Drug manufacturer actions and the resulting legislative and legal responses.
• Challenges of Shifting 340B upfront discount to a Rebate Model .
  • Analyze why efforts to transition the 340B program to a rebate model have faced significant resistance from covered entities and the Health Resources and Services Administration (HRSA).
• The Role of a 340B Clearinghouse (e.g., Tungsten PLUS) .
  • as a practical solution, ensuring the timely identification of 340B transactions including compliance with IRA regulations.
• Emergence of 340B Clean Drug Rebate Commercial Contracting Strategy.
  • Discuss the development and benefits of a "340B claims clean drug rebate" contracting strategy within the commercial market.

• Explore the economic landscape of biosimilars and specialty therapeutics.
• Discuss strategies for managing rising costs, highlighting alternatives to traditional copay benefits.