The AIS Guide to Blue Cross and Blue Shield Plans: 2010

Webinars on: Conducting Internal Investigations; Electronic Health Records; Star Ratings for Medicare Quality Bonuses; Medication Therapy Management


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Recording and written materials of
AIS's audioconference on
September 9, 2009
Using Comparative Effectiveness and Cost Data in Drug-Access Decisions: New Health Plan Strategies

Private payers aren’t waiting for comparative effectiveness research (CER) data to start flowing from ARRA research funds. To help make drug formulary decisions that can improve patient outcomes, payers are already generating their own information and turning to other sources of data. Find out what kind of CER and cost data health plans, PBMs, specialty pharmacy providers (SPPs) and other industry groups are now employing ... and how payers are using this information to evaluate various treatment options.

Sponsored by Atlantic Information Services, Inc., publisher of Specialty Pharmacy News, Drug Benefit News and Health Plan Week.

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In their pursuit of more efficient health care services and coverage, many health plans, PBMs and SPPs have begun bringing comparative effectiveness research (CER) and cost data into the equation. With the availability of federally funded CER data still some time away, many plans, PBMs and SPPs are already taking different paths to access and apply this information.

Hear leading payer industry experts assess different strategies health plans, PBMs and SPPs are pursuing to generate and utilize their own CER and cost data and/or obtain them from external sources. You’ll get insider perspectives on what plans, PBMs and SPPs are doing now and changes they expect in the next two years on questions such as:

  • What internal comparative effectiveness, outcomes, cost and other data are health plans collecting and generating to compare drugs for formulary and other access decisions?
  • What external sources are plans using to gather comparative effectiveness, outcomes, cost and other data?
  • What data do payers want from manufacturers? From independently funded third parties?  
  • How (and why) do health plan perceptions of different data types/sources vary so much? Which data sources do they trust and value the most and why? 
  • How does health plan use of CER and cost data vary by therapeutic class or type of drug?

 

Speakers

GARY OWENS, M.D., is the president of Gary Owens Associates, a consulting firm for health plans, employee benefit management firms and pharmaceutical and biotech companies. Before that, he was vice president for medical management at Independence Blue Cross (IBC), Pennsylvania’s leading health plan, with more than 2 million members. In that role, he managed pharmacy operations for more than 2 million members. Dr. Owens has expertise in the evaluation of new technology, medical management programs and strategy, health plan operations, benefit design, formulary development and drug management. He has managed medical review services, including precertification of medical procedures, hospital care level reviews, high-tech radiology precertification, discharge planning activities and case management. Dr. Owens was responsible for evaluation of new drugs and new technologies as manager of the technology evaluation unit, a department that he founded in 1993 at the Pennsylvania payer. While at IBC, he headed the team that developed an injectable management strategy, which included a program to assess and manage biotech and bio-oncology products.

SARAH COLLINS is president of PharManage, LLC, a consulting group of senior industry executives specializing in reimbursement services, including strategy development and market assessment, for pharmaceutical and biotechnology clients. She has an extensive background within the pharmaceutical and biotechnology industries. She has worked in research and consulting for Apical Research Team, PAREXEL and Abt Associates. For the last decade, Ms. Collins’ work has focused on public and private payers, including managed care organizations, CMS, PBMs, the Department of Defense and the Department of Veterans Affairs. Her reimbursement work has included oral agents, physician- and self-administered agents and alternative delivery mechanisms, such as transdermal patches and sprays. She has led projects in numerous therapeutic categories, including oncology, cardiovascular disease, HIV/AIDS, rheumatoid arthritis, osteoarthritis, allergies/asthma, women’s health, insomnia, diagnostics, ophthalmology and others.

STEVE MILLER, M.D., is senior vice president and chief medical officer in research and clinical sciences for Express Scripts, Inc. He joined Express Scripts in 2005 and has years of experience as a medical researcher, clinician and administrator. Dr. Miller has been actively involved in the development of Express Scripts’ clinical programs supporting the use of generic pharmaceuticals and specialty medications. He is a leader in the promotion of legislation to create a pathway at the FDA for regulation of biogenerics and biosimilars. He previously served as vice president and chief medical officer at Barnes-Jewish Hospital/Washington University School of Medicine in St. Louis, where he had responsibility for oncology services, radiation oncology and patient safety and quality, among other areas. Dr. Miller earned his medical degree from the University of Missouri-Kansas City and received additional training in the Pathology and Research fellowship at the University of Alabama at Birmingham and training in cardiology at the University of California, San Francisco. Dr. Miller also earned an MBA at the Olin School of Business at Washington University in St. Louis. He has published more than 80 scientific articles in the areas of acute and chronic renal failure, transplantation, hypertension and medical economics.

Moderator: Angela Maas, managing editor of AIS’s Specialty Pharmacy News.

 

Designed Especially For

Pharmacy, clinical services and medical directors; strategic planners; product development, contracting and marketing executives; and financial and operations executives at

  • Health plans
  • Specialty pharmacies
  • PBMs and pharmacy benefit administrators
  • Pharmaceutical manufacturers
  • Employers
  • Group-purchasing organizations
  • Physician groups
  • Infusion suites
  • Consulting firms
  • Disease management companies
  • Third-party administrators

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*CDs and MP3 files will be available within three weeks of the conference date.

 

Written Materials

Listeners will also receive practical written information to supplement information covered by the audioconference speakers.

 

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