Monthly Hot Topic Webinars

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Previous Hot Topic Webinars

PBM Reform Part 3: The Role of State Laws & Regulations in PBM Reform

Even though PBMs control access to the most frequent healthcare encounter- prescription drugs- the states have little to no oversight over PBM operations. This has led to pharmacies, patients, and plan sponsors receiving PBM abuse. What are some of the state laws and regulations in place related to PBMs? What is the role of the state insurance commissioner? Attend this 1-hour webinar, where experts
in the field will discuss the laws and regulations in place to combat the opaque business tactics of PBMs.

PBM Reform Part 2: DIR Fees, Clawbacks & Star Ratings

Direct and Indirect Remuneration (DIR) fees, star-ratings, effective rates (GER, BER, DFER) and clawbacks have long been a subject of advocacy efforts by pharmacists. However, these exploitative methods by PBMs put undue pressure on pharmacies, patients, and communities. Register for this 1-hour webinar to understand the complex nature of these predatory practices and how they result in financial burden to pharmacies and patients.

PBM Reform Part 1: Understanding PBM

A PBM (Pharmacy Benefit Manager) is a third-party administrator of pharmacy benefits between pharmacies, payers, and manufacturers. Serving as the intermediary in the drug supply chain, PBMs are involved in determining how much the insurers pay manufacturers for a drug and how much the patients pay at the pharmacy. PBMs use several strategies to control costs for their payer clients through several strategies including: limiting patient access to care (e.g. narrow pharmacy networks) and increase patients’ out of pocket costs (e.g. list-price based copayments) while generating huge revenue for themselves in the form of rebates and “spread”. Attend this 1-hour webinar to learn about the structure and function of PBMs, rebates, spread pricing, and gag clauses.