Tuesday – 18th November 2025– Pre-Conference Half DayTuesday, November 18, 2025 - EST

The three largest vertically integrated PBMs control approximately 80% of the market and have clout.

Escalating rebates for formulary access coupled with PBM measures to limit utilization continues to put pressure on gross and net sales. The Inflation Reduction Act will have a profound impact on market access.

This course is designed to enable participants to understand practical implications of PBM utilization restrictions, rebate & pricing pressures, contracting challenges and the Inflation Reduction Act. Numerical examples will be presented illustrating key concepts and practical applications.

By attending this course, you'll learn about:

• Pharmaceutical ecosystem – PBMs, pharma companies, payers, and patients
• Unique dynamics of PBM expansion, consolidation and vertical integration
• PBM revenue sources
• Why PBMs prefer high-price drugs with high rebates
• Impact of PBM formulary tiers, formulary exclusions, prior authorization, and step edits
• Key factors impacting rebate rates and formulary position
• Copay and patient assistance programs
• Charitable foundations
• Specialty carveout/alternative funding programs
• Bridge programs
• Government programs
• Inflation Reduction Act:
  • Medicare Price Negotiation
    • Disincentive to develop small molecule drugs
    • Impact of pursuing new indications
    • Spillover to drugs not subject to price negotiation
  • Inflation Rebates
    • Risk of double whammy (inflation & price protection rebates)
    • Impact on Medicare Part D HCP reimbursement & out-of-pocket costs
  • Benefit Redesign
    • Implications of catastrophic discounts for drugs not subject to MFP
    • Potential GTN reduction due to higher volume & catastrophic discounts
• Rebate walls and biosimilar market access challenges
• Value-based & indication-based contracts
• Netflix and installment-based contracts
• ROI of PBM contracting scenarios and sensitivity analysis
• Optimizing market access – developing a compelling value proposition
• Case study – negotiating rebates & market access with PBMs

*Additional fee to participate

CPE Credits Available: 2.0

This in-depth panel is ideal for anyone with responsibilities around gross-to-net and for companies that are pre-revenue or early-stage revenue.

CPE Credits Available: 1.2

Join us for an engaging and interactive Hot Topic Roundtable discussion where thought leaders and industry experts converge to tackle the most pressing challenges and emerging trends in our field.

This dynamic session offers participants the unique opportunity to:

• Engage in meaningful dialogue with peers and subject matter experts
• Share diverse perspectives in a collaborative environment
• Explore innovative solutions to complex industry challenges
• Network with professionals facing similar opportunities and obstacles

Whether you're looking to contribute your expertise, gain fresh insights, or simply connect with like-minded professionals, this roundtable provides the perfect forum for stimulating conversation and knowledge exchange.

CPE Credits Available: 1.8