Connecting Diverse Worlds

Avalere Health audio conferences present real-time developments in health policy and business with convenience and efficiency. Our live events include presentations by a distinguished faculty of healthcare and government leaders, session handouts, and an interactive question-and-answer period. Our audio conferences involve a simple telephone call, allowing you to stay on top of new developments in healthcare without leaving your office.

If you are unable to attend an audio conference of interest to you, purchase the recording and speaker materials to any of our 2007 Avalere Health Audio Conference Series.

Many consumers are paying for their healthcare products and services out-of-pocket, despite having insurance coverage. These cost increases come in many forms–increased copayments or use of coinsurance, advanced formulary tiering, increased premiums–and drive home the current policy and business struggle to achieve an appropriate balance between access to, and affordability of, healthcare.  These tensions have recently grown more profound against broader U.S. economic challenges, and affect patients, providers, payers, product manufacturers, pharmacists, advocates, and policymakers. 

Learn about various ways consumers insured by Medicare and commercial plans are exposed to increased cost sharing, how benefit design can affect adherence and medical decision-making, and innovative reform ideas that address both consumer and insurer challenges.   

Join Avalere Health for a 90-minute interactive audio conference that will highlight:

• How changes in the Medicare Part D marketplace have gradually shifted increased costs to consumers
• What benefit design trends in Medicare are starting to influence strategic decisions by commercial health insurance plans and vice versa
• How patients are affected by increased cost sharing across the healthcare system
• What steps the policymaking community may consider for further improving Medicare and commercial benefit structures

On May 14, 2008, Avalere Health released a self-funded research report examining CMS’ decision to drop 1,500 drug codes from the CY 2008 Part D Formulary Reference File, the tool used by Part D plans to shape their Part D drug formularies. In response, commercial health plans dropped these drugs from their Medicare offerings in 2008. The CMS action was driven in part to remove hundreds of prescription drugs that were being marketed without FDA approval.

Avalere found that CMS dropped drug codes from the Formulary Reference File that were connected to: marketed unapproved FDA drugs; over-the-counter drugs; discontinued drugs; Part A or Part B products; products with redundant codes; and products from other Part D-excluded categories, such as nonprescription medications and agents used for anorexia, weight loss, weight gain, or for cosmetic purposes. There is no definitive list of such marketed unapproved drugs, making it difficult for patients, pharmacists, and plans to determine which drugs are or are not FDA-approved.

Unapproved drugs listed in the formularies were likely older products cleared for marketing before 1962. While the FDA is making concerted progress to identify and remove products with demonstrated safety and efficacy concerns, an estimated several thousand marketed unapproved products remain on the market.

Join Avalere Health for a 90-minute educational audio conference that will highlight:

• The impact of CMS’ decision to modify the Formulary Reference File on Part D plans’ formulary designs
  
• Current FDA and CMS strategies to eliminate Part D coverage of marketed unapproved drugs
  
• Resources available to healthcare providers and pharmacists seeking additional information on marketed unapproved drugs
  
• Opportunities for further FDA and CMS collaboration to share more information about marketed unapproved drugs

The Medicare Modernization Act (MMA) required Medicare drug plans to create new Medication Therapy Management (MTM) programs, but did not set aside direct funding for this purpose. Health plans have wide latitude to define their MTM programs, including the target population and types of services covered.

Learn about plans’ varied approaches to MTM design and implementation, including private and public sector work to better quantify MTM programs’ effect on patient health outcomes and return on investment. Understand how standard setting and reporting requirements may reshape the future of MTM programs for the approaching health plan year.

Join Avalere Health and the Academy for Managed Care Pharmacy for a 90-minute interactive audio conference that will highlight:

• The current landscape of MTM programs offered by Medicare health plans, including the types of patients served and areas of therapeutic focus to date
• The emerging consensus on standards, best practices, and measuring MTM program outcomes
• CMS’ evolving reporting requirements
• The future of MTM in the 2009 plan year

The U.S. spends over $200 billion a year on nursing home and home health services and another $20 billion on assisted living. Despite this massive expenditure, the vast majority of Americans have no insurance coverage for long-term care. Families are financially and personally exhausted by caregiving duties. All levels of government are locked in contentious debates with providers and each other over questions of who should pay and how to ensure high quality care. Amidst these challenges, demographic trends are poised to generate further demands on the system.  

Please join Avalere Health for a 90-minute interactive audio conference that will explore:

• Barriers to addressing long-term care challenges, and possible scenarios for change in the future,
• Specific federal reform proposals that address system challenges, and
• Incremental state-level changes that have the potential to relieve pressure in the system and leverage existing private and government resources.

About half of the use of anticancer chemotherapy drugs is for “off-label” indications – uses not listed on the FDA-approved label.  Public and private payers typically cover off-label indications for anticancer drugs if they are listed in the compendia or supported in peer-reviewed medical literature. Coverage and payment for off-label uses of anticancer drugs has been a critical tool in the battle against cancer.

Both public and private payers are examining their choices of compendia for determining medically-accepted uses of anticancer drugs.  CMS recently established an annual compendia review process.  CMS will accept requests for changes to its approved list of compendia, and will publish final decisions by July 15 after collecting public comments.  CMS’ decisions are poised to have an immediate impact on Medicare coverage. Concurrently, private payers are endorsing specific compendia for use in making coverage decisions for chemotherapy drugs. 

Join Avalere Health for a 90-minute interactive audio conference that will highlight:

• The evolving landscape of compendia and their use in coverage decision-making by Medicare and private payers
• CMS’ current efforts to revise the official list of approved compendia
• Trends in the use of compendia by commercial payers
• Variations in use of compendia at the regional and local levels by medical directors
• Impact of state mandates on the use of compendia

Pharmaceuticals play a significant role in the U.S. healthcare system, yet the drug distribution model and the various payment systems for drugs within the U.S. are commonly misunderstood.  Several distinct drug payment indices are currently used as the basis of reimbursement for pharmacy benefit and medical benefit drugs, yet these indices are changing based upon recent legislative and regulatory changes.  As payers create and use new indices, there are significant effects for pharmaceutical manufacturers, pharmacists, pharmacy benefits managers, distributors, physicians, and patients.

Learn how the dollars flow through the drug distribution chain, what the definitions are for the commonly used drug pricing and payment terms, and how recent legislative and regulatory changes will likely cause a shift in payment indices used by public and private payers for medical and pharmacy benefits. 

 This 90-minute Avalere audio conference will cover:

• Recent legislative and regulatory changes that affect drug payment indices in the United States
• The medical and pharmacy benefit structure that payers use to cover drugs and
• How changes to the drug payment indices affect various entities within the drug distribution supply chain

This audio conference is offered in partnership with the Academy of Managed Care Pharmacy (AMCP).  Avalere clients and AMCP members receive a 20% discount on registration.

Recently, the Congressional Budget Office (CBO) released its report, Research on the Comparative Effectiveness of Medical Treatments, on comparative effectiveness research (CER).  This report, released amidst sustained legislative efforts to introduce and pass CER legislation, is CBO's first public document on CER since the release of the "Estimate of Section 904 (Comparative Effectiveness Research) of H.R. 3162, the Children's Health and Medicare Protection Act of 2007" (CHAMP). 

This new report is likely to force additional scrutiny of the impact of comparative effectiveness on the healthcare sector, and may amplify the call for federal investment in CER.  As policymakers work to define CER's future direction, stakeholders must better understand the policy and economic analysis that underpin the momentum, and the potential implications for the healthcare industry should more aggressive CER become a shorter-term reality. 

Please join Avalere Health for a 90-minute interactive audio conference that will highlight:

• CBO's recently released report on CER;
• Avalere Health's new analysis that presents a framework for understanding the drivers of costs and savings of CER programs; and  
• Potential business impact on manufacturers and health plans

Given the rise in overall healthcare and drug spending, employers are actively seeking strategies to optimize employee health while efficiently managing medical expenditures. 

Many employers are turning to value based insurance design (VBID) as an alternative to across the board cost cuts in healthcare expenditures.  As employers attempt to become more prudent purchasers of healthcare, they need value-based tools and metrics to allow the rigorous assessment of benefits in terms of improved employee health and productivity, as well as the impact on their bottom line.  This need is particularly pressing as an alternative to the common insurance practice of increasing the cost sharing burden of individuals with major chronic illness.

This 90-minute, interactive Avalere Health audio conference will explore:

• Findings from a recent in-depth examination of the metrics and tools currently available to employer decision-makers
• Perspectives from employer groups and key opinion leaders in the area of VBID
• Gaps in measure development and areas for future focus, including the validation and implementation of tools related to value
• A view on the challenges of implementing VBID from a large employer currently experimenting with a value based-health benefits program

The Medicare Part D market continues to shift in ways that significantly impact managed care companies, pharmaceutical manufacturers, policymakers, and people who rely on Medicare for their prescription drugs. With over 1.6 million low-income beneficiaries in a state of transition, questions about “intelligent assignment” have resurfaced.  The further proliferation of private fee-for-service and special needs plans sets up a potential conflict between marketplace demand and congressional concern.  As plans seek to cement their market positions, maintain customer loyalty, and strive for profitability, formulary management will become an even more critical part of health plans’ business strategies. 

This 90-minute, interactive Avalere Health audio conference will explore:

• Avalere Health’s analyses of the new CMS Medicare data, including an in-depth look at soon-to-be-released formulary-level data
• Health plan perspectives on opportunities and challenges of operating in the Medicare arena
• A view from the government of potential areas for future Medicare reforms
• How changes to health plans will bear a direct impact on the patient community

The Medicare Modernization Act (MMA) profoundly changed the long-term care pharmacy environment. While long-term care pharmacies have traditionally played a critical role in the care and stewardship of certain Medicare beneficiaries, they now do so in partnership with Part D plans who are also involved in drug delivery in these settings. Health plans have only just started to focus their energies on the long-term care space, and are eyeing a range of interventions to better meet beneficiaries’ medical needs working with long-term care pharmacists. One area of focus is development of successful medication therapy management (MTM) programs, which plans must tailor to fit the unique medical needs of nursing facility residents.

This 90-minute, interactive Avalere audio conference will explore:

• How the long-term care pharmacy space has been reconfigured post-MMA implementation and how the role of senior care pharmacy has evolved
• What challenges arise in relation to beneficiary plan selection in the long-term care setting
• How policymakers and the industry view current Part D steerage rules and if they should be reconsidered
• How MTM programs and other quality initiatives may evolve in Medicare, specifically for dual-eligible beneficiaries and those residing in long-term care facilities
• What longer-term policy developments, such as an increased push to move beneficiaries out of long-term care facilities and into the community, may further challenge this environment

This audio conference is offered in partnership with the Academy of Managed Care Pharmacy (AMCP) and the American Society of Consultant Pharmacists (ASCP).   Avalere clients and members of AMCP or ASCP will receive a 20% discount on this audio conference.

Alzheimer’s disease poses a burgeoning public health and fiscal threat to the U.S.  Beyond its impact on patients and their loved ones, Alzheimer’s significantly affects directions in long-term care and healthcare payment reform, and the future shape of the U.S. workforce. Alzheimer’s research is also a key area of current pharmaceutical industry investment; the speed at which new Alzheimer’s therapies enter the market will have a profound effect on patients, physicians, manufacturers, and long-term care providers. 

This 90-minute Avalere audio conference will discuss:

• Unique features of Alzheimer’s that impact spending across a wide range of federal agencies including the FDA, CMS, and NIH
• How long-term care reform and Alzheimer’s are integrally linked
• New Avalere analysis comparing FDA review times for Alzheimer’s, HIV/AIDS, and cancer therapies
• The FDA’s role in accelerating development and approval of new Alzheimer’s therapies

Increased commercial and government interest in accelerating adoption of HIT, as well as a number of notable security breaches are heightening public awareness of the potential benefits and pitfalls of accelerating electronic health information exchange (HIE).  One of the thorniest issues is how to efficiently share health information in ways that improve patient care and at the same time ensure consumer privacy and security.  As local, regional, and national organizations push various HIE initiatives, issues of technology, ownership of healthcare data, earning public trust, and the changing role of providers and consumers are at stake.    

This 90-minute, interactive audio conference will discuss:

• How regional health information organizations and commercial entities are tackling privacy and security issues
• How and when to best engage consumers, health plans, vendors, and providers in an environment where patients have increased access to electronic health records
• What current federal and state policy initiatives are likely to impact further directions in HIE privacy and security

Avalere recently authored a study on behalf of the California HealthCare Foundation on regional health information organizations’ varied approaches to privacy and security.  Click here to see the press release and a link to the study. 

CMS recently released its Draft 2008 Call Letter for the Medicare Advantage program and Medicare drug benefit.  The Call Letter proposes significant changes to the soon-to-be-finalized guidelines for Medicare plans’ benefits, formularies, bidding, and marketing.  In 2008, CMS plans to create new “report cards” measuring plans’ performance, and to sharpen the focus on compliance.  Learn what these changes mean for plans, manufacturers, pharmacists, and patients. 

This 90-minute, interactive Avalere-AMCP audio conference will:

• Discuss CMS’ Call Letter, and specific changes for 2008 with respect to formularies, benefits, quality monitoring, marketing, and compliance
• Place the new rules in context with the 2006 and 2007 plan marketplace, using Avalere Health’s DataFrame™ database
• Identify how new formulary and quality monitoring rules will affect patients, plans, pharmacists, and manufacturers
• Offer perspectives on how the 2008 Medicare plan market will take shape
• Examine how the new rules will impact specialized Medicare plans, including private fee-for-service and special needs plans

This audio conference will help you position for 2008 and stay abreast of developments in the Medicare marketplace.  

AMCP members and Avalere clients will receive a 20% discount on this audio conference.

Congress has intensified its interest in opening a regulatory pathway for follow-on biologics (FOBs).  Strongly supported by some healthcare organizations, met with deep reluctance by others, FOBs raise critical legislative, clinical, budgetary, and marketplace dynamic questions.  Given the rapid growth of biologic product use in the US market, FOBs' potential entry into the marketplace has become a significant issue for patients, providers, manufacturers, and payers. 

This 90-minute, interactive audio conference will discuss:

• Current legislative activity on FOBs
• The unique features of biologic products that distinguish them from small-molecule drugs, and how these features might affect legislative and regulatory action
• Assessment of the likely budgetary impact of FOBs and the key assumptions underlying differing estimates
• How FOB entry into the marketplace might impact manufacturers, payers, and patients over the short- and longer-term.

The Agency for Healthcare Research and Quality (AHRQ) recently began producing consumer-oriented versions of its evidence-based comparative effectiveness research reports; the guides publish costs of various over-the-counter and prescription drugs in addition to other decision-making information.  Learn how these guides are developed, how they have impacted the physician-patient relationship, and about the government’s role in influencing decision-making at the patient level.   

 This 90-minute, interactive audio conference will discuss

• The challenges with translating comparative effectiveness research into meaningful decision tools
• The impact of the consumer and clinical guides on patient care and on changing consumers' healthcare decision-making habits
• How AHRQ's tools may evolve in the future as part of its overall Effective Health Care Program

Changes in drug pricing affect pharmaceutical industry revenues, the operations of pharmaceutical benefit management (PBM) companies, the stability of federal programs, and ultimately beneficiary costs.  CMS recently released a proposed regulation that makes fundamental changes to a widely used price benchmark in the Medicaid system – Average Manufacturer Price (AMP) – but also includes significant changes to other Medicaid policies such as nominal price and Medicaid rebate collection for physician-administered drugs.  Audio conference participants learned about these changes, and what they mean for operating health care businesses, the Medicaid program, and other government health care systems.
The 90-minute, interactive Avalere audio conference provided:

• An overview of the changes to drug pricing outlined in the proposed rule;
• Likely reactions to the federal proposal from major stakeholders; and
• Discussion of the potential impact on pharmacy, pharmaceutical, and PBM communities.

This expert session was also designed to prepare organizations for the submission of comments to CMS by a Feb. 20, 2007, deadline.

SCHIP reauthorization is a pressing legislative priority for the new Congress.   At present funding levels, most states will face a budget shortfall in the next five years, which could lead to increases in the number of uninsured children.  The upcoming SCHIP debate will likely shed light on the issue of the uninsured as a whole, and this legislation may become the vehicle for considering federal support to significant state-based program expansions. 
The 90-minute, interactive Avalere audio conference focused on these core issues:

• How will SCHIP reauthorization affect each segment of the health care industry?
• What is the state, federal, and beneficiary perspective on the looming congressional debate? 
• Are premium assistance programs working well in SCHIP?
• What broader reforms might be considered within the context of the reauthorization process?

The Centers for Medicare and Medicaid Services recently launched the Medicaid Integrity Program (MIP) as a new effort to combat theft, inappropriate use, and simple mistakes that drain critical Medicaid program dollars. 

In order to understand implications of the MIP as CMS’ first national Medicaid financial oversight effort focusing on Medicaid providers, Avalere opened registration for an audio conference titled, “Combating Medicaid Fraud and Abuse: Implications of the Medicaid Integrity Program.”  The acting director of the CMS Medicaid Integrity Program, experts from state government, and industry will discuss MIP implications on current state Medicaid fraud, waste, and abuse efforts. 

Learn how CMS plans to:

• Devise and implement new processes for reviewing Medicaid provider billing practices
• Conduct audits
• Develop strategies to identify overpayments

Two new studies in the upcoming September/October biotechnology issue of Health Affairs evaluated how private and public sector payers are tackling coverage-making decisions for new, often costly emerging products. The event was cosponsored by Avalere Health and Health Affairs in support of these upcoming studies.