As the use of biotechnology products proliferate in the healthcare system, both Medicare and private insurers are looking at how to best develop and evaluate evidence concerning the appropriate use of biopharmaceuticals and how to incorporate this evidence into their coverage decision-making processes.  Experts from Avalere Health, academia, and the federal government discussed the use of evidence in coverage decision-making beyond what is typically required for FDA approval process; challenges and rationale for coverage with evidence development (CED); trends in private sector coverage decision-making; and future policy and business implications.

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• Perry Bridger, Vice President, Avalere Health, Washington, DC
• Jamie Robinson, PhD, Kaiser Permanente Distinguished Professor of Health Economics, University of California, Berkeley, School of Public Health
• Steve Pearson, MD, Senior Fellow for America's Health Insurance Plans (AHIP) and former Special Advisor for Technology and Coverage for Centers for Medicare and Medicaid Services (CMS)
• Tanisha Carino, PhD, Director, Avalere Health, Washington, DC

1:00 pm / Welcoming Remarks and Introduction of Faculty

1:05 pm / A Case Study of Medicare’s Evidence-based Coverage Policy
Perry Bridger / Avalere Health

• Discuss the implications of evidence-based coverage policy on product commercialization
• Assess the rationale, challenges, and opportunities of the CED approach
• Analyze possible implications for access and cost to beneficiaries

1:30 pm / Implications for Private Insurance Coverage of Biologics
Jamie Robinson / University of California, Berkeley

• Discuss medical management strategies in private insurer coverage
• Assess how benefit design structure impacts consumer affordability of biotechnology products
• Discuss patient and provider involvement in coverage decision-making

1:55 pm / Analysis and Reaction to the Health Affairs studies
Steve Pearson / AHIP

• Compare CMS’ evaluation approach in coverage determination policy with emerging private sector strategies
• Review transparency and accessibility issues for consumers and providers

2:15 pm / Facilitated Panel Discussion and Questions from the Audience
Tanisha Carino / Avalere Health

2:30 pm / Audio Conference Adjournment

Audio Recording Prices :
General	$345
Government	$250
Non-profit	$250
Student	$250