AMCP Looks to the Future

Edith Rosato, RPh, began her position as AMCP’s chief executive officer in October 2011, coinciding with unprecedented change in the healthcare industry. Economic conditions were weak, and companies were preparing for provisions in the Patient Protection and Affordable Care Act (ACA).

The uncertainty remains due to the lingering effects of the recession and the ACA not fully being implemented until next year. Still, Ms. Rosato has taken steps to guide AMCP’s evolution and help its members stay abreast with the transformations.

For years, AMCP has held its annual meeting in the spring and its educational conference in the fall. Starting this October, the fall meeting will have a new name and a new format. The spring annual meeting will continue to follow the same format.

As of early May, AMCP had not officially announced the changes or made public all of the details, but Ms. Rosato revealed in an interview with First Report Managed Care that people who attend the meeting from October 16 to 18 in San Antonio will see more of an increased emphasis on healthcare delivery, the ACA, new clinical research, and specialty pharmacy.

“It will focus on the futuristic aspect of healthcare delivery,” Ms. Rosato said. “What I mean by that is not healthcare innovation because healthcare innovation is different than futuristic. We are going to be looking out 10, 15 years down the road and providing our attendees with a glimpse into the future so that they can be better prepared through their own businesses to respond to where healthcare delivery will eventually end up.”

The ACA created programs and demonstration projects to test delivery systems for potential wider spread adoption. For example, the Center for Medicare & Medicaid Innovation has developed 41 new payment and service delivery models.

AMCP meetings have typically featured sessions on new delivery models such as accountable care organizations (ACOs) that depend on collaboration among providers. Speakers have discussed the importance of teamwork and of physicians working together to be responsible for improving patients’ health and delivering quality care in a cost-efficient manner. This fall’s meeting will likely have more of an emphasis on these models.

Specialty pharmacy is another major topic in managed care and has become an AMCP priority. During the 25th annual meeting in April, there were several sessions on specialty pharmacy, including recent FDA approvals, managing the category, and pipeline drugs.

The Academy also partnered with the National Association of Specialty Pharmacy for the first specialty pharmacy conference, a 2-day meeting held in San Diego at a hotel near where the annual meeting took place. Around 500 people were in attendance and heard from industry veterans who discussed specialty pharmacy and medical benefit management, as well as other relevant topics.

In January, AMCP released version 3.1 of its format for formulary submissions, the first update since September 2009. In the ensuing 40 months, the number of specialty products increased, as did requests from managed care organizations on how to deal with the drugs for formulary placement and coverage decisions.

According to the format, products are defined as specialty if they require a difficult or unusual process of delivery to the patient as well as management of the patient before or after administration. It does not mention anything about costs of the products. However, although there is no standard industry definition or FDA designation for specialty medications, they are typically expensive, require special services, and treat chronic or rare diseases.

“Specialty pharmacy for the Academy is really core to who we are and why we exist,” Ms. Rosato said. “If you think about it, the Academy is really focused on the proper use of medications. What differentiates the Academy from any other managed care organization is the extreme focus on pharmaceuticals, medications, and how they are appropriately used for the patients. We should be the owners of specialty pharmacy. We should be the leaders in specialty pharmacy.”

Under Ms. Rosato’s guidance, AMCP has also changed its bylaws to expand its membership beyond pharmacists. Physicians, physician assistants, and nurses are now allowed to become members and serve on the Academy’s board of directors. The changes coincide with the ACA’s focus on collaboration among providers.

“If you think about all of these integrated care delivery models, and everything that the ACA is trying to foster, it is trying to foster healthcare professionals in a managed care environment,” Ms. Rosato said. “Whether it is an ACO, a medical home, whatever you want to call it, [physicians and pharmacists] will work side by side, elbow to elbow, to provide the best quality of care for the patients. That is what healthcare is all about in the United States. That is what we are moving toward.”

Other parts of the ACA that effect managed care pharmacy include biosimilars and essential health benefits. The ACA created an accelerated pathway for biosimilars, which are demonstrated to be similar to, or interchangeable with, biologics. Whereas generic drugs and branded drugs are nearly identical, there are more differences between biologics and biosimilars.

The FDA has issued draft guidance on the development of biosimilars, but the agency has not released final guidelines. However, a few states have already introduced biosimilars legislation, which Ms. Rosato referred to as “very premature” because the FDA has yet to announce its definition of biosimilars or the approval process.

AMCP is also closely monitoring legislation regarding essential health benefits. Beginning next year, individuals and small businesses will be able to purchase health insurance on exchanges or online marketplaces where they can compare plans. Each plan is required to cover certain categories, known as essential health benefits, including ambulatory patient services, emergency services, laboratory services, mental health services, and pediatric services. Approximately 8 million people are expected to purchase insurance on the exchanges in 2014, and the number will increase to 25 million in 2017, according to Bonnie Washington, a senior vice president at Avalere Health LLC.

Ms. Rosato said AMCP is in favor of most components of the essential health benefits, but the organization is also advocating for health plans to be able to develop their own pharmacy benefit for prescription drug coverage.

Ms. Rosato and other AMCP staff members are planning to meet with US Department of Health & Human Services Secretary Kathleen Sebelius in late spring to discuss biosimilars, essential health benefits, the ACA, and other issues. It is another step to help the Academy prepare for the upcoming changes and understand the role managed care can play in transforming healthcare.

“AMCP will not be the same AMCP as it is today, nor is it the same AMCP that began 25 years ago,” Ms. Rosato said. “The fact of the matter is that we are innovating, we are growing, we are flexible enough to accommodate changes in the environment and in healthcare. I think the story is still out on who AMCP will be in the future, but it is all good.”