Health Industry Forum

June 9, 2015

The Future of Pharmaceutical Benefit Management

The pharmaceutical landscape is evolving rapidly with a growing number of high-profile therapies, particularly specialty pharmaceuticals, entering the market. This has generated strong interest from patients, providers, purchasers and policymakers, along with concerns about the acceleration in drug spending and the ability of patients to access needed medications. Many purchasers turn to pharmaceutical benefit management firms to help them navigate this complex market, negotiate prices and ensure that expensive therapies are used appropriately. The PBM industry is changing rapidly with recent mergers that have increased the size and scale of key players. Also, national and regional payment reforms that shift risk for total medical spending to providers is increasing their scrutiny of the value provided by high cost therapies.

This Health Industry Forum meeting will examine the changing pharmaceutical market, its increasing focus on specialty products and the evolving role of pharmaceutical benefit management. It will begin with an overview of the pharmaceutical and PBM markets. Next, we will hear how a major PBM is approaching specialty pharmaceutical management and discuss the impact of these strategies for patients, providers and manufacturers. With the growing interest in value, we will discuss one framework for assessing the value of specialty pharmaceuticals that considers efficacy, price, cost-effectiveness and overall spending impact. Finally, we will explore the special challenges of managing cancer therapies and examine different approaches for navigating trade-offs between access and affordability.

Speakers include:

  • Stuart Altman, PhD, Professor, Brandeis University
  • Kirsten Axelsen, MS, Vice President, Worldwide Policy, Pfizer
  • Roy Beveridge, MD, Chief Medical Officer, Humana
  • Troyen Brennan, MD, Chief Medical Officer, CVS Health
  • Robert Dubois, MD, Chief Scientific Officer, National Pharmaceutical Council
  • Dan Mendelson, MPP, CEO, Avalere Health
  • Steven Pearson, MD, President, Institute for Clinical and Economic Review
  • Edmund Pezalla, MD, VP and National Medical Director, Aetna




Specialty Trend: Drivers and Management
Troyen Brennan, MD, MPH, Chief Medical Officer, CVS Health