ICYMI: Highlights From AMCP 2023

Interviews from the leaders in managed care and articles focusing on treatments in cancer highlighted the coverage for the Academy of Managed Care Pharmacy (AMCP) 2023. Topics covered by this content included pharmacy benefit manager reform in state managed care policy, breakthrough drugs in the ophthalmic space, and the benefit of using surrogate vs clinical end points in drug approvals.

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These were the highlights of the AMCP 2023 conference coverage.

AMCP’s Adam Colborn Talks Major Trends in State Managed Care Policy

In an interview with the American Journal of Managed Care® (AJMC®), Adam Colborn, the director of government relations at the Academy of Managed Care Pharmacy, described pharmacy benefit manager reform and what managed care policy trends would be affected. Network adequacy requirements could be part of it, he said, along with copay caps, with a focus on drug price affordability for patients. He also explained state-level government isn’t seeing too much push from policymakers regarding value-based care policy, which could be due to policymakers not knowing which policies are the best for achieving value-based care efficiently.

Jeffrey Casberg on Breakthrough Ophthalmic Drugs That Payers, Pharmacists Should Pay Attention to

Jeffrey Casberg, the senior director of pharmacy at IPD Analytics, spoke about specialty drugs in the ophthalmic space that could make an immediate impact. Syfovre is a drug that can be used for dry age-related macular degeneration (AMD), which makes up about 85% of all AMD cases in the United States. This medication, he said, can prevent blindness in patients by administering the medicine every 25 to 60 days. He also mentioned Regeneron, which is dosed every 16 weeks for the treatment of dry AMD and can act as an alternative to Eylea.

Is Dose Rounding the Answer to Cancer Drug Waste?

Drug costs can be decreased, drug waste can be minimized, and treatment efficiency could improve by implementing a strategy that would focus on dose rounding for chemotherapies, according to a panel held at AMCP. Overall drug costs have increased by 88% in the past 5 years, which makes controlling the cost of new cancer therapies vital. Dose rounding in chemotherapy is estimating the amount of chemotherapy needed based on the weight and the body surface area of the patient. Instead of using just one, rounding the dose by incorporating other parameters in dose calculations could be helpful in this area.

Dr Yuqian Lin Discusses Surrogate End Points, Formulary Management in the Accelerated Approval Pathway

The use of surrogate end points could provide earlier access to drugs compared with using clinical end points, but efficacy of the drug could be in question, Yuqian Liu, PharmD, senior director of specialty clinical solutions at Magellan Rx Management said. Liu explained that a surrogate end point is a prediction of what the clinical outcome will be rather than the actual outcome. Although the patients will be able to see the medicines come to market sooner, payers are more cautious in believing the surrogate end point can actually predict the clinical end point and the overall safety and effectiveness of the drug. Medicare and Medicaid each have their way of covering these accelerated medicines regarding formulary management.

What Are Some Health Plan Best Practices Surrounding Oncology Therapy Coverage?

There were 13 best practices identified to improve the outcomes of patients in oncology in health plans. These 13 best practices were identified after AMCP conducted 8 in-depth interviews with experts and surveyed 59 managed care and oncology professionals. These were summarized into 3 main buckets: careful evaluation of literature, practice guidelines, and emerging evidence on a targeted therapy; collaboration among health care professionals; and general patient support by health care professionals. The panel focused on all best practices identified and how these practices can help bridge health inequity.