2018 Next Generation Rx Forum Recap

PBMI hosted our Next Generation Rx Regional Forum in La Jolla, California in early November.  During this one-day event, we sat down with over 50 healthcare stakeholders to talk more about areas testing the traditional drug management model. We heard from national employers frustrated with the current model, consultants assisting plan sponsors in this journey, and vendors with new solutions to disrupt the traditional supply chain. Jane Lutz, PBMI’s Executive Director, emphasized how the healthcare model has not been able to keep up with innovation in drug delivery, and pharmacy is driving change more than ever before.

Opening Speaker

Bill Roth, Co-founder of the Blue Fin Group, opened the day with a candid presentation on understanding the business need for integrated healthcare.  Bill stressed three thought-provoking statements: 1) we either fix the problem of healthcare 2) hand the bag to our kids to fix or 3) the government will step in. The challenges we face today are shared by all healthcare stakeholders, and it’s no longer about market access, but affordability.  Although total pharmaceutical spend is about 10% of the cost of healthcare, employers are paying the real bill as prescription costs can represent 40% of their total healthcare spend. What can we do? We can be careful about how care is administered and think about integrated benefits.  One challenge we can approach to remedy is payer and provider linkages.  If we can control the patient and the prescriber, we could get to better care.

Key Session Takeaways

Hemophilia impacts about 20,000 individuals. The CEO and Co-founder of Audaire Health stressed the importance of diagnosing and treating these patients as soon possible as the healthcare costs for these patients can quickly escalate. The lowest hanging fruit is getting a handle on assay management and engaging employees.  The Executive Director of the Hemophilia Center of Western New York walked us through some successes they have seen. Education is essential, and they incorporate a strong communication regime. Patients are required to keep a log which is reviewed by their providers for adherence. The use of patient logs is very successful, and engagement has skyrocketed. Because, patients keep detailed records, their doctors have more information to provide better treatment, which has resulted in overall better health outcomes. Payers should ask for monthly data to ensure patients are getting the best of care. Also, work to make sure your members understand accountability and recommend they get involved in Hemophilia Treatment Centers, use logs, and find a foundation for support. 

The morning ended with a presentation and demonstration from SmithRx on how technology will change how PBMs operate.  

After lunch, an expert from Foundation Medicine gave us a closer look into the future of healthcare that focuses on genomic testing. Genetic testing can be a used to help predict the effectiveness or side effects of medications.  The science is most advanced in oncology where the testing has vastly improved clinical outcomes. Through a Next Generation Sequencing platform, time and tissue can be saved. For example, they can examine 321 genes on a few slides of tissue. However, only 0.1% of patients would benefit and qualify for this type of testing. Even though the medical community is aware of this test, use of them are not common. However, these tests should be used as a lever to manage utilization.

Milliman facilitated a spirited discussion on the drug management world without the concept of rebates.  They discussed how regulatory and other potential changes impacting rebates could affect the pharmacy benefits.  Several questions from the audience clearly validated the importance of the topic.

We also heard a consultant’s view of the employer perspective.  We must recognize that employers are consumers too and they want three things: 1) transparency, 2) trust, and 3) control. They are very frustrated and no longer willing to wait, as they advocate for their employees. It’s the big employers that will drive change. Even though shifting costs to the consumer has become commonplace, it hasn’t worked as well. Typical employer observations include: readily adoption of new technology and innovative models, unbundling PBM services to increase trust and transparency, forgoing rebate economy for lowest net cost approaches and pursuing direct-to-pharma agreements and value-based models.

The day closed out with an energetic panel discussion with two large national employers—Walmart and The Boeing Company. Affordability and quality of care and waste/ineffectiveness and misdiagnosis keeps them up at night. They echoed the frustration of the previous presentation in that employers are fragmenting the system because they are fed up. They’re uncertain about vertical integration. One employer stressed “lowest price, no rebates, and no coupons.” One of the messages that rang through loud and clear was “they are not going to wait.”

The audience truly enjoyed the Forum; check out some great feedback we received!

“Jane and team have done a wonderful job of creating a dynamic valuable forum. The speakers made me think hard about key questions/conundrums in healthcare. Great work!”

“Great forum useful information and opportunity to network.”

“Nice venue and smaller audience allowed more interaction. Provide networking session opportunities the night before or after.” 

“Wonderful location and event. Always first class – great job Jane, Linda, Julie & Team! Thank You!”

“…As much as I love the content of these meeting, the connects you guys provide within our industry is fantastic and I genuinely it improves healthcare delivery, ultimately improving patient care.”


As the day wrapped up, Lutz stressed that we are already starting to live in the next generation of drug management.  As we look into the crystal ball, it feels a bit like a snow globe instead with all of the chaos.  As an industry, we need to continue this great dialogue, work better together, and move things forward.

See you in 2019!

Make plans to join us again next year, but this time in sunny Palm Springs, California for our 2019 National Conference. The meeting will be held at the Westin Mission Hills Golf Resort & Spa Hotel, March 4-6, 2019. We hope you will join us. For more details, visit our conference website pages.  Registration will open soon! Interested in sponsoring or exhibiting? Contact Linda DeChant at ldechant@pbmi.com.