Day TwoWednesday, 9 December 2026 - CST/CDT (Central Daylight, GMT-5)

• Deconstruct PBA vs PBM: real differentiation vs marketing language
• Evaluate admin fee and fee-for-service models under cost pressure
• Identify which models hold up operationally and financially

• Identify real applications: forecasting, utilization management, contracting insights
• Evaluate limitations: data fragmentation, integration challenges, regulatory constraints
• Separate operational value from vendor-driven hype

As employers seek greater control over pharmacy spend, some are exploring in-house or tightly aligned pharmacy models. This session evaluates whether these approaches represent a meaningful shift or a limited-use strategy.

• Define in-house pharmacy and employer-aligned dispensing models
• Compare cost, transparency, and control vs traditional PBM structures
• Assess where these models are viable based on employer size and infrastructure
• Examine operational, financial, and regulatory tradeoffs
• Evaluate whether this approach delivers measurable savings or replicates existing services

• Evaluate eligibility and access strategies for high-cost therapies, including GLP-1s
• Assess biosimilar adoption dynamics (e.g., Humira, Stelara)
• Compare PBM vs health plan strategies and real-world case studies
• Analyze trade‑offs between high‑cost/high‑rebate and low‑cost/low‑rebate drug pricing models
• Examine the use of PBM–or retailer–sponsored branded biosimilars as preferred formulary options

• Analyze how employer demand shapes PBM models and pricing
• Evaluate preference for “easy button” solutions vs customized strategies
• Examine role of HRSA plans and intersection with state legislation

As employers increasingly rely on brokers and consultants to evaluate PBMs, differentiation is no longer defined by what PBMs claim—but by how those claims are interpreted, filtered, and prioritized in broker-led decision processes. This session examines how PBMs position themselves in a crowded market—and how brokers and employers assess those differences in practice.

• Identify what PBMs position as differentiation: transparency, pricing models, clinical programs, and technology
• Examine how brokers structure RFPs and vendor comparisons—and what actually stands out
• Where vendor commitments break down, including exclusions and loss of transparency
• Evaluate whether newer models (PBA, disaggregated, fee-for-service) represent meaningful differentiation or repackaging
• Assess where PBMs fail to differentiate in ways that matter to employers
• Explore how employers interpret broker guidance—and where misalignment occurs

• Will disruptors persist or be absorbed?
• How will GLP-1 pricing and MFP reshape contracting?
• Which PBM models survive regulatory and employer pressure?
• What breaks first: margins, access, or network stability?