In a follow-up to the prior authorization-oriented sessions, join panelists from Medicaid FFS, MMC, and patient advocacy organizations as they offer different perspectives on the role of prior authorization in value-driven health care and discuss potential strategies to streamline the process and facilitate efficiency in coverage and reimbursement.
Listen as state representatives detail their experiences with PBMs, statewide PDL, and carve-out models for formulary management. The unique perspective of a managed care representative with a statewide PDL will be shared to highlight the ongoing operations and strategies at play in the realm of prescription drug management. A panel discussion will follow to carefully outline the similarities and differences among the different models.
The concept of consolidated or aggregate pharmaceutical purchasing through supplemental rebate pools was conceived to achieve a lower price for all those included. Learn how states could benefit by participation in such a pool and gain the perspectives of those involved in supplemental rebate pools to learn how they conduct business and administer clinical programs. The advantages and disadvantages of participation in such a pool will be discussed.
Costly, limited-use therapeutics like chimeric antigen T-cell (CAR-T) and gene therapy have completely changed the way that health care stakeholders look at covering and funding treatment. Learn about approaches that Medicaid programs are taking towards the challenges posed since the advent of this new wave of innovative therapies, including contracts and direct payments to manufacturers. Similar carve-out approaches for costly ongoing therapies will also be discussed. State and MMC perspectives will elucidate the “how” and “why” of drug carve-outs for high-cost, innovative therapies.