6th Pharmaceutical Pricing & Reimbursement

Agenda

DAY ONE – July 26th, 2010

8:00am
Pre-Conference Workshop Registration and Continental Breakfast for Workshop Participants

9:00am
PRE-CONFERENCE WORKSHOP BEGINS

STATE RUN DRUG & DEVICE ASSESSMENT PROGRAMS
State-Wide Health Technology Assessment Programs used to Ensure Medical Treatment Efficacy: Program Overviews and Next Steps

WORKSHOP LEADER
Rob Clark
Senior Director, Corporate State Government Affairs
MEDTRONIC

William E. Struyk
Region Director, State Government Affairs
JOHNSON & JOHNSON

  • Washington State program background and the creation of technology assessment/reviews
  • Examination of the technologies & products being reviewed
  • Conclusions (coverage or non-coverage) that can either apply to specific programs like Workers' Comp (WC) or to all state payor programs like Medicaid
  • Potential review challenges and proposed solutions
  • Emulating the Washington State review model and a foward-looking glimpse into country-wide adoption
  • The Oregon Health Sciences program and its review of pharmaceuticals to determine coverage/non-coverage

 

10:15am
30-minute Networking & Refreshment Break

11:45pm
Workshop Concludes; Luncheon for Workshop Participants


 

MAIN CONFERENCE BEGINS - DAY ONE, Monday July 26th
12:45pm
Chairperson's Welcome and Opening Remarks


12:50pm
THE OBAMA ADMINISTRATION AND HEALTHCARE REFORM
An Update on Healthcare in the United States Under the Obama Administration: What does the Current Healthcare Reform Bill mean to the Healthcare System?

SPEAKER
Dan Todd
Executive Director, Healthcare Strategy
EMD SERONO

  • Understanding how healthcare has been altered by the bill
  • Federal price control and direct negotiation of prices with CMS
  • Examining coverage expansion
  • The change made to pre-existing condition restrictions

 


1:30
The Federal Health Care Reform Landscape: Industry Considerations for Pricing and Reimbursement Strategies

This session focuses on examining the latest national and state-level health policy changes and discusses the impact of these developments on pre-, peri- and post-launch reimbursement strategy development. New insights on how to incorporate some of these developments into your overall strategic and tactical plans are shared.

SPEAKER
Matt Sarnes, PharmD
Vice President, Managed Markets Agency Services
XCENDA

Ana Stojanovska, PharmD
Director, Reimbursement Strategies
XCENDA

  • Drug payment changes and mechanisms
  • Compedia developments
  • Quality and outcomes research opportunities
  • Follow-on-biologics
  • Expanded coverage and market reforms

 

2:15PM
Networking & Refreshment Break

 

2:45PM
PRICING LAWS
Legislative changes to the Drug Rebate Program and the Direct Industry Effect

SPEAKER
Larri Short
Partner
ARENT FOX

  • Increase in rebate rate
  • Expansion of applicability of rebates to managed care
  • Higher rebates on new formulations
  • Revisions to the FUL & AMP calculations

 

 
3:30pm
The Sustainable Growth Rate (SGR): Implications for Physician Payment

The Sustainable Growth Rate (SGR) formula was adopted in 1998 to achieve two main goals: 1) to ensure Medicare patients have adequate access to physicians' services, and 2) to control federal spending for those services. Over the last several years, however, the SGR has called for dramatic reductions in physician payments, requiring Congressional intervention for short-term fixes and resulting in widespread criticism regarding the appropriateness of the SGR system. This session will focus on the history of the SGR formula and the impact of current legislation on physician payments.

SPEAKER
Lisa Fleury, MA
Director
COVANCE

Specifically, the presentation will:

  • Explain the establishment of the SGR for physician payment
  • Outline the history of scheduled payment decreases and subsequent actions by Congress
  • Provide an update on the current legislative developments
  • Describe the implications for Medicare payments to physicians

 

4:15pm
GLOBAL MARKET ACCESS
Evidence-Based Medicine in an Evolving Landscape for Global Market Access

SPEAKER
Lujing Wang
Vice President
CAMPBELL ALLIANCE

The global landscape for market access is evolving and there are major trends taking hold that are reshaping the way payers and reimbursement bodies make reimburesement and coverage decisions.  In order to survive in the evolving environment, pharmaceutical companies must re-evaluate their current approach to access decision making, and begin thinking more strategically about how to address market access challenges.  This session will discuss:

  • The major trends that are shaping the global market access lanscape
  • Key market access barriers and how they vary by geographic market and disease area
  • Increasing focus on evidence based medicine and HTA
  • The evolving requirement for evidence to support product reimbursement and access
  •  How these trends are shaping pharmaceutical markets and how the evidence base is coming
  •  Implications for phrmaceutical companies:
    •  Overcoming the growing requirements and sophistication of payer requirements that companies think more strategically about how to address market access challenges
    •  Better integrating evidence generation and value substantiation into the commercial planning process
  •  Key takeaways for commercial planners

 

 

5:00pm
Close of Day 1 

 

DAY TWO – Tuesday, July 27th 2010

7:30am
Continental Breakfast for Conference Participants


8:15am
Chairperson’s Recap of Day One


8:20am
STATE-BY-STATE HEALTH POLICY CHANGES
High Priority Issues and Key Updates from a State-by-State Level: How has Federal Reform Begun to Effect Efforts on a Local Level?

SPEAKER
Shaun Meehan
Regional Account Executive, Managed Markets
UCB

  • Changing/destabilizing current private health insurance markets
  • Expanded public programs and driving lower prices
  • Generic utilization on a state-wide level: Massachusetts Case Study
  • Increased reporting and oversight of manufacture relationships with providers

 

9:00am
HEALTH OUTCOMES
Drug Discovery Strategy: Using Health Outcomes Studies to Demonstrate Value & Support for Pricing & Reimbursement

SPEAKER
Edward Kim, MD, MBA
Director, Health Outcomes
EISAI, INC.

  • Integration of HEOR and clinical development - beyond PROs
  • Strategic vs. consultative roles of HEOR
  • Making your product relevant in a world of CER, performance measures and guidelines

 

9:45am
RISK-SHARING AND INNOVATIVE CONTRACTING MODELS FOR LIFE SCIENCES
Evaluating the Advantages and Challenges of Outcomes-Based Risk Sharing Programs

SPEAKER
Jim Furniss
Director, Market Access Solutions
BRIDGEHEAD INTERNATIONAL LIMITED

  • Risk-sharing as a way of reducing uncertainty
  • The triggers for risk-sharing agreements and how different drug categories can effect contracting agreements
  • Examining outcomes and non-outcomes based scenarios to best position performance based agreements
  • Risk-sharing proposals in the EU and how cost effectiveness is being assessed
  • Challenges to implementation - including the gathering of medical and pharmacy data and relevant costs
  • Potential future scenarios for new agreements


 

10:30am
Networking & Refreshment Break

 

11:00am
THE IMPACT OF PAYER STRATEGIES ON DRUG COMMERCIALIZATION

 

SPEAKER
Charlie Bell
Director, Service Offering Development
EXPRESS SCRIPTS 

  •  Explore the differences in the approach payers and manufacturers use when positioning new drugs
  •  Take a close look at the various tools payers use to manage drug spend
  •  Walk through examples of drug launch scenarios that highlight the impact of payer strategies on new drug launches
  •  Provide an understanding of the importance of manufacturers aligning with payers to maximize the realistic opportunity at launch

     

 

11:45am
COMPARATIVE EFFECTIVENESS RESEARCH
The Growing Demand for Comparative Effectiveness Research to Determine the Clinical & Economic Value of a Product to a Payor

SPEAKER
Jean Gagnon
Senior Director
SANOFI-AVENTIS

  • Taking into account the interests of payors and demonstrating the clinical and economic value of a product
  • Relative product value and measuring against a gold-standard treatment
  •  Challenges to producing data for the payors - just how many comparative effectiveness studies are currently taking place
  •  Role of industry sponsorship

 

 

 

12:30pm
Luncheon

 

1:30pm
ULTRA-ORPHAN MARKETS
Ultra-Orphans Drug: A US EU5 Primer

SPEAKERS
Kevin Patterson, MA, CPA
Vice President & Partner
MEDICAL MARKETING ECONOMICS, LLC.

Jack Mycka
President & Partner
MEDICAL MARKETING ECONOMICS, LLC.

  • Understand the pricing and reimbursement trends in the US and EU5
  • Review the implications of US health care reform
  • Addressing the new factor in ultra-orphan markets: direct competition

 

 

2:15pm
SPECIALTY PRICING
How to Maximize Specialty Pricing and Distribution Strategies

SPEAKER
Kent Rogers
Senior Director, Managed Markets
ACORDA THERAPEUTICS

  • Examination of how manufacturers price a specialty product
  • What constitutes a "value proposition"?
  • The negotiation landscape with Specialty Pharmacies
  • How healthcare reform is going to affect the specialty market 

 

3:00pm
Conference Concludes