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Just a few short years ago health plans were fairly “hands off” when physicians prescribed specialty therapies. And it was not merely a matter of deferring to the physician. For many plans, a majority of their specialty drug costs fall under the medical benefit, which makes them extremely difficult to track and manage. But as specialty drug costs have skyrocketed, and been such a major component of overall cost increases, plans have taken a far more aggressive approach to managing these drugs. At the same time, providers who have seen their drug margins erode have become more willing to work together with payers to find the most effective way to treat patients. Hear from a team of experts — two consultants and a payer and provider who are working together — as they outline effective strategies that can be used to improve oncology outcomes and increase efficiencies. You will get all the details of:
LYNN NISHIDA is director of clinical pharmacy services for RegenceRx, which is The Regence Group's internal pharmacy benefit management service. Regence serves 3 million members through health plans in Oregon, Washington, Idaho and Utah. Ms. Nishida’s responsibilities include overseeing the evaluation of pharmaceutical products and how these products are positioned within the pharmacy benefit. She also manages and oversees evidence-based review of formulary medications, development of consumer-focused programs and information about pharmaceuticals, analysis of pharmaceutical trends, medication-related quality improvement activities, and medical and medication policy development. Ms. Nishida is a registered pharmacist and received her B.S. in pharmacy from Oregon State University. She received a residency certificate from the Portland Veterans Administration Medication Center in Oregon. With extensive experience in managed care pharmacy, as well as experience in retail, hospital, community-based research and home care, Ms. Nishida has spoken locally and nationally on a variety of pharmacy benefit management topics. RICHARD McGEE, M.D., a medical oncologist, is co-founder and president of Puget Sound Cancer Centers. He has been practicing medicine for more than 35 years. Dr. McGee has served on boards of directors for health plans and has consulted on quality assurance, case management and utilization review. In addition to being a member of various medical societies, he is the past and also current president of the Washington State Medical Oncology Society. Research, cancer genetics and new advances in cancer treatment technology are areas of special interest for Dr. McGee. He received his B.S. in biology at John Carroll University in Ohio and his M.D. at Johns Hopkins University School of Medicine in Baltimore. NICHOLAS OPALICH is the managing principal of Strategica Health Partners, L.L.C., a health care consulting firm. His consultancy practice involves strategic market development, marketing and strategies, and strategic physician alliances. Mr. Opalich’s main areas of focus include specialty oncology pharmacy and cancer disease management, infusion therapy, ambulatory infusion centers and physician e-prescribing platforms. Prior to starting Strategica Health Partners, Mr. Opalich was the founder, president and CEO of a midmarket regional specialty pharmacy and infusion company that served more than 2,000 specialty patient lives in 33 states. Additionally, he was the founder, president and CEO of other home infusion/pharmacy companies that were sold to major public companies. Mr. Opalich has been involved as an owner and senior executive in the health care industry since 1979. DAVID CHESS, M.D., is founder and CEO of Enhanced Care Initiatives Inc. (ECI), a specialty care management company that focuses on high-risk medical populations. He has been involved in the disease management space for the last eight years. As an internist and geriatrician, Dr. Chess has practiced medicine for more than 25 years. He was the founder and president of PriMed, a large multispecialty medical group in Connecticut, where he created medical management systems integrated with physician practices. In addition, Dr. Chess is the founder of Project Patient Care, a nonprofit organization dedicated to data-driven health care policy. Moderator: Angela Maas, managing editor of AIS’s Specialty Pharmacy News.
Strategic planners; product development, contracting and marketing executives; pharmacy, clinical services and medical directors; and financial and operations executives at:
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