AMCP Nexus: The Academy of Managed Care Pharmacy Nexus

Over time, biosimilars are gaining traction in the US and becoming preferred products, explained James D. Chambers, PhD, of Tufts Medical Center.

The US could start catching up to Europe on biosimilars if the FDA removed the need for switching studies to be granted interchangeability.

New legislation would clarify rules around value-based contracts in Medicaid, and a new model is expanding access to gene therapies, explained Adam Colborn, JD, of AMCP.

CMS is creating infrastructure to improve coverage of prescription digital therapeutics (PDTs), and new legislation would also drive uptake of PDTs.

Biosimilars offer significant cost-saving potential while expanding patient access, particularly in oncology and immunology.

Caregivers of both adults and children with Duchenne muscular dystrophy (DMD) face significant disruptions to their work productivity and personal lives, underscoring the need for better treatments and support systems.

Cost avoidance varied by clinical setting, with the largest savings occurring in hematology clinics ($73,773), followed by rheumatology ($45,330) and pediatric gastrointestinal/irritable bowel syndrome ($16,519).

There are a few unmet needs in schizophrenia that can make a big difference in the prognosis and quality of life of patients.

Kimberly Westrich, MA, of National Pharmaceutical Council, and Adam Colborn, JD, of AMCP, run through the current status of lawsuits and lawmaking at the federal and state levels related to pharmacy benefit managers and cost-shifting programs.

In addition to Cobenfy being approved for schizophrenia, there are other drugs with novel mechanisms being studied that may mean combination therapies or, at least, more options for patients in the future.

The AMCP Nexus 2024 annual meeting covered a variety of hot health care topics impacting managed care pharmacy in the present and future.

While treatment options are evolving cancer care and extending lifespans, there is still a lack of biomarkers in certain cancers that can help direct treatment or provide early detection.

Experts explored the potential impacts of a Trump or Harris administration on the future of health care.

Industry experts explore the trends, variations, and implications of utilization management practices in specialty drug coverage.

Posters at AMCP Nexus analyzed the burden of flares on patients with atopic dermatitis (AD) and the impact initiating ruxolitinib cream had on use of other therapies.

There is a role for both payers and providers to make small changes that would increase the use of biomarker testing to ensure patients are receiving the appropriate treatment, said Susan Wescott, RPh, MBA, senior director of managed care pharmacy, Mayo Clinic.

Co-pay accumulators and maximizers are 2 programs that insurers have started implementing to help them redirect financial assistance from the patient, said Kimberly Westrich, MA, chief strategy officer, National Pharmaceutical Council.

A lot of attention has been on the drug price negotiation aspects of the Inflation Reduction Act (IRA), but the implementation of out-of-pocket smoothing is something to keep an eye on, said Adam Colborn, JD, of AMCP.

The prevalence rates of metabolic dysfunction–associated steatohepatitis (MASH) and metabolic dysfunction–associated steatotic liver disease (MASLD) are likely underestimated using claims data alone.

Researchers explored innovative approaches to overcome barriers and drive sustainable biosimilar utilization.

Bipolar disorder is commonly misdiagnosed depending on the features that present, explained Stephanie Hsia, PharmD, MAEd, BCPP, of University of California, San Francisco.

Experts explored the latest trends, approvals, and pipeline developments in cell and gene therapies, rare disease, immunology, and more.

As a result of vertical integration, health plans may have 2 different coverage policies on the medical benefit side and the pharmacy benefit side for the same drug.

Patients with schizophrenia have a lot of life-changing consequences when they are being treated properly, and these are only amplified when the patient goes untreated, explained Megan Ehret, PharmD, of University of Maryland, School of Pharmacy.

Schizophrenia may be misdiagnosed as depression or bipolar disorder, which delays treatment and negatively impacts the prognosis, explained Megan Ehret, PharmD, MS, BCPP, of the University of Maryland, School of Pharmacy.

Because sickle cell disease isn’t as progressive a disease as others that have gene therapies available, there isn’t as much urgency to start on these expensive therapies, said Kevin Niehoff, PharmD, BCMAS, associate director, Market and Financial Insights, IPD Analytics.

Experts discuss pricing, utilization, and health plan strategies to drive biosimilar uptake.

Two posters compared health care resource utilization (HCRU) and financial burdens of people living with HIV with a non-HIV population and people with HIV who are heavily treated with those have experienced less treatment.

Although the cost of biomarker testing isn’t cheap, the cost of therapy for patients can be much higher, making it important to conduct these tests to start the right therapy, explained Susan Wescott, RPh, MBA, of Mayo Clinic.

Experts reevaluate coverage policies and the financial impact of antiobesity medications based on updated clinical data and key utilization trends.