Drug Utilization Management: Trends, Entrants, and Developments in the Payer World
Hello, again! I’m Elizabeth Oyekan, PharmD, FCSHP, CPHQ, Vice President, Access Experience Team and editor of the All Access Newsletter.
I’m back this month, along with my ex-payer colleagues, to take a close look at the latest Drug Utilization Management (DUM) trends and share our thoughts on their potential impact across various payer segments. Here’s whats on tap for this edition:
- The Evolving Pharmacy Benefit Manager (PBM) Landscape: Sejal Jonas, RPh, PharmD – Senior Director
- Sejal discusses the evolving PBM landscape as they look to navigate recent changes to Centers for Medicare and Medicaid Services (CMS) regulations, integrate both medical and pharmacy benefits, and optimize technology to effectively manage drug costs and spend.
- DUM and the Integrated Delivery Network (IDN) Landscape: Ryan M. Cox, RPh, MBA – VP, Director Access Experience Team
- Ryan examines the increasing level of influence IDNs have over drug therapy prescribing and what tools they are leveraging to manage drug costs and spend.
- The Unintended Consequences of DUM Programs: Barbara Henry, RPh Senior Director
- Barbara points out that while DUMs are a vital cost-savings tool, the administrative burden can be extremely high. In this overview, she offers some new strategies to minimize the administrative impact while still controlling cost.
- CMS’s Current and Proposed Actions to Bend the Prescription Drug Cost Curve: Dorothy Agyemang, PharmD Candidate and Elizabeth Oyekan, PharmD, FCSHP, CPHQ
- My co-author Dorothy and I do a deep dive into some of CMS’s current and proposed actions, focusing on both offense and defense tactics to address the rising costs of drugs.
- Employers and Benefits Consultants Assess Gene Therapy Costs and Solutions: Jorge Font, MBA, Senior Advisor
- Finally, our employer expert Jorge addresses concerns about the increasing numbers of “seven-figure costs” associated with emerging gene therapy and some of the considerations undertaken to address these rising costs.
We trust you’ll find these insights helpful as you carefully navigate the ever-evolving payer landscape. As always, please feel free to drop me a note and let me know if you have a topic suggestion for the payer team to address, and we’ll do our best to cover it in a future edition.
PharmD, FCSHP, CPHQ
Access Experience Team
All Access is a bimonthly newsletter featuring key insights from our team of former payers intended specifically for market access leaders. It is published by PRECISIONvalue.
Dive into the evolving PBM landscape as Sejal explores tactics to bring new DUM tools to the market to effectively manage drug costs and spend.
Explore the increasing level of influence IDNs have over drug therapy prescribing and what tools they are leveraging to manage drug costs and spend.
DUMs are an important cost savings tool, but the administrative burden can be high. What are some strategies that can be employed to mitigate that burden?
CMS's current and proposed actions to address the rising cost of drugs employ both offensive and defensive tactics; which ones are making the biggest difference?
Employer concerns are increasing in response to the rising number of "seven-figure costs" associated with emerging gene therapies. What does the future hold for employer coverage of advanced therapies?