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Health plans and PBMs continue to grapple with how to handle members who take multiple medications, rack up enormous bills, and often suffer adverse outcomes due to the lack of effective medication management. By some estimates, less than 3% of the patient population accounts for roughly one-third of total pharmacy spending. To rein in this out-of-control cost center — and to try and improve therapeutic outcomes — insurers and PBMs increasingly are turning to medication therapy management (MTM) programs, but no consensus exists on how they should be structured.

With the 2003 Medicare reform law,  Part D sponsors were required to provide MTM programs to members who take “multiple” medications for “multiple” chronic conditions, and whose Part D drug costs are expected to exceed $4,000 annually. MTM programs, however, continue to run the gamut from extensive face-to-face consultations with pharmacists to simple educational mailings describing proper drug usage. Many key questions remain, including: What are the most (and least) effective MTM services you can provide members in Part D and/or private plans? How can you design an MTM program that will provide a significant return on investment (ROI)?

Two experts on health plan and PBM strategies for MTM provide practical insights and solutions on these and other key topics:

• Where is CMS headed on MTM? Will MTM best practices be mandated, and if so what impact will this have on your operation?
• Which MTM services should be included in your pharmacy benefit and which should not be included? Why?
• How can plans and PBMs use retail pharmacists and in-house experts to implement MTM services most effectively?
• How should MTM programs be designed to handle substantially increasing numbers of participants?
• What steps did one PBM take to achieve a strong return on its MTM investment

Speakers

JIM LANGMAN is vice president of clinical services at Walgreens Health Services, the managed care division of Walgreen Co. Mr. Langman started with Walgreens in 1981 as a pharmacy technician. He was promoted to assistant store manager in 1983 and then to store manager in 1985. After managing several Chicago-area stores, he was promoted to district pharmacy supervisor in 1998. He was named to his current position in 2001. Langman received a B.S. degree in pharmacy from the University of Illinois in 1982.

EDMUND PEZALLA, M.D., is national medical director at Aetna Pharmacy Management. Dr. Pezalla is a graduate of Georgetown University (B.S. and M.D.), and received his master of public health from the University of California at Berkeley. He is a board-certified pediatrician, having trained at the Bethesda Naval Hospital. Dr. Pezalla has also completed a fellowship in health services research and the coursework for the doctoral degree in health services organization and policy at the University of Michigan. He has worked with several health care organizations in administration, disease management and pharmacy benefits including Prescription Solutions, a unit of UnitedHealth Group. Dr. Pezalla joined Aetna in August 2007 as national medical director for pharmacy management.

Moderator: Neal Learner, managing editor of AIS’s Drug Benefit News.

Designed Especially For

Executives, product developers, business development and marketing directors, financial managers, pharmacy directors, medical officers, clinical services directors, consultants and contracting executives at:

• Health plans
• PBMs
• Pharmaceutical companies
• Disease management vendors
• Health care IT firms
• Large employers
• Public employee retirement plans

*Please note that shipping of CDs and materials will begin within three weeks of the conference.

Written Materials