Specialty Management: Keeping Up with Runaway Innovation

(EDU-S5) Finding the Win-Win: How Payers Can Ensure Appropriate Use of High-Cost Therapies While Supporting Members Through Their Care Journey

Thursday, October 13, 2022

2:45 PM – 4:00 PM ET

Location: Potomac A

ACPE UAN:0233-0000-22-044-L04-P | Contact Hours: 1.25 | Activity Type: Knowledge-based

Faculty(s)

Aravind Chodavarapu, PharmD

Clinical Program Manager
Blue Cross and Blue Shield of Alabama
Birmingham, AL
Brian K. MacDonald, PharmD

Director, Specialty Clinical Strategy
Magellan Rx Management
Middletown, RI
Amy Ware, PharmD

Director, Specialty Clinical Solutions
Magellan Rx Management
Brandon, MS

Moderator(s)

Renee Rizzo Fleming, RPh, MBA

President
PRN Managed Care Consulting Services, LLC
East Amherst, New York

The evolution of rare and orphan disease management presents an opportunity for payers to assess how they evaluate the clinical appropriateness of requests for new and established high-cost therapies. This session will provide an overview of how enhanced utilization management programs available to payers can lead to cost avoidance; as even a few instances of identifying and preventing inappropriate use can lead to significant savings annually, while providing members with the support needed for rare, complex conditions.

Faculty will begin the session by briefly reviewing the rapid growth of specialty treatments for rare, ultra-rare, and orphan disease and the substantial costs associated with them. Faculty will also review current management strategies, potential gaps, and challenges associated with them, as well as potential programs to bridge those gaps. The session will conclude by illustrating one such solution implemented within a large health plan and the successful results and outcomes.

Learning Objectives:

At the completion of this activity, participants should be able to:

Review the rise of specialty drugs for rare, orphan, and complex conditions.
Define the utilization management strategies for these treatments.
Describe how these strategies can benefit both payers and members.
Summarize how enhanced utilization management strategies for high-cost therapies has optimized therapy and cost avoidance in a large health plan population.