In an effort to lower out-of-pocket costs for patients, manufacturers, insurers and plan sponsors have the opportunity to align on reimbursement goals and develop partnerships to ensure value to the patients and lower health care expenditures. Gain a multi-stakeholder perspective into value-based pricing structures and opportunities for stakeholder alignment.
- Gain insight into value-based pricing agreements and reimbursement trends
- Discuss the pharmaceutical drug price, spending, and affordability debate from varying stakeholder perspectives
Chief Medical Officer
UPMC Health Plan
Chief Executive Officer
Since 2012, List prices for Insulin in the United States have doubled. Mike Mason, Vice President, Lilly Diabetes has testified in the United States House of Representatives congressional hearings, in an effort to address the factors that led to list price increases for Insulin. In this session, explore future policies aimed at increasing affordable access to diabetes medication.
- Explore congressional hearing testimonies and policy proposals to address high insulin prices
- Gain insight into how Eli Lilly’s patient assistance programs improve patient education, affordability and access for uninsured patients, people in the coverage gap of Medicare Part D, and those with high deductible insurance plans
- Explore opportunities for cross-stakeholder partnerships between pharma, PBM, employer and health plan to improve patient access to reduce out-of-pocket costs for patients
- Explore the role pharma plays in determining insulin prices in international markets
Vice President, Lilly Diabetes, Senior Vice President, Connected Care and Insulins
Eli Lilly and Company
Prescription drug costs have been a major concern for public and private payers and is now a major campaign theme for the 2020 elections. Public scrutiny of drug prices has led to political discussions aimed at changing the way drug pricing models are structured and regulated. The CMS final rule that required drug manufacturers to provide the list price of their products in direct-to-consumer ads and the elimination of drug rebates were both examples of efforts to establish regulations targeting the price and affordability of prescription drugs.
- Unpack the latest proposals, recommendations, and regulations being brought to the table around pricing and affordability of drugs
- Explore which changes may be most likely given the current political, economic, and regulatory climate
- Examine proposed changes to drug importation laws and its impact on pricing strategy
Senior Advisor to the Secretary for Drug Pricing Reform
U.S. Department of Health and Human Services (HHS)
Several states have passed their own drug price transparency laws that require drug makers to report the reasons behind dramatic price increases. Gain insight into state-by-state drug price transparency efforts to ensure compliance, create transparency, and meet price reporting requirements.
- Gain insight into state transparency requirements in California SB17, Oregon HB 4005, Texas HB 2536, and Colorado HB 1216
- Assess federal initiatives for transparency
- Navigate reporting requirements to comply with state drug pricing transparency laws
Senior Director, Policy, Pricing, and Reimbursement
United Therapeutics Corporation
Assistant Vice President, General Counsel
Due to the withdrawal of the rebate rule, the Trump administration is shifting its focus to the use of an international pricing index model to cap US payments for physician-administered drugs. CMS has issued an advanced notice of proposed rulemaking to leverage the international pricing index model for Medicare Part B drugs. Understand the mechanics of the international pricing index model on the US pharmaceutical drug pricing model as well as international markets.
- Gain insight into proposals from CMS and the Trump Administration regarding the use of International Pricing Index Models
- Understand the impact of the international drug pricing model of Medicare Part B drugs
Director, Public Policy
Regulatory and market pressures to reduce health costs have led to the adoption of value-based pricing for pharmaceuticals. Discuss ways to align incentives with payer organizations, and innovative approaches being considered in various value-based pricing arrangements.
- Understand how to define value metrics within these types of agreements
- Overcome barriers to implementing value-based pricing
- Examine the intersection of value-based pricing requirements and drug pricing transparency laws
Vice President, Market Access
Part B reimbursement changes, importation rules from Canada, direct negotiation by Medicare and state contracts in Medicare are all shaping up to change the way in which manufacturers price their products in the United States. Gain insight into evolving reimbursement models in the US and abroad and what these changes will mean for price and access to medications in the United States.
- Explore the impact of the Prescription Drug Pricing Reduction Act on Medicare reimbursement and state efforts to reduce Medicaid drug spend
- Understand the impact of reimbursement models on patient access
Former President and CEO, Medicaid Health Plans of America; Former EVP, strategy and External Relations
Current therapy pipelines show an increase in research and drug approvals for gene and rare therapies. Although gene therapies can be lifesaving, the high list price make it the most expensive drug in the market. Gain insight into the value-based pricing mechanisms proposed by manufacturers and understand the legislative environment that will direct payment for cell and gene and rare disease therapies.
- Gain insight into alternative payment models for novel therapies
- Understand how pricing schemes will work for Medicare and Medicaid
- Explore nuances in pricing strategies for cell and gene and rare disease therapies
Director, Legal and Compliance
Sobi North America