Pharmacy Benefit Managers: Understanding Pharmaceutical Supply Chain Middlemen

Produced on: April 09, 2018

Course Format On Demand Audio

Taught by

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Course Description

Time 60 minutes
Difficulty Intermediate

One of the most powerful and underappreciated players in the healthcare industry are pharmacy-benefit managers, or PBMs, who oversee drug-benefit plans for employers and health insurers. Their job is to hold down the cost of providing those benefits by negotiating with pharmaceutical manufacturers to help lower drug prices, although critics of the PBM industry and it current business models argue that PBMs may directly benefit more from drug price inflation than actually holding down drug prices, and some data indicates that PBMs and their insurer clients may prevent patients and their employers from capturing the full benefit of bargaining process and contribute to affordability problems in the medical marketplace. 

PBMs impact a range of stakeholders from payers, pharma, physicians, patients, and policymakers, and present complex legal issues ranging from Fraud & Abuse, ERISA, and Antitrust, to compliance with Federal Pricing Reporting requirements.

This course, presented by Rujul Desai, Vice President of Avalere Health and Stephanie Trunk, Partner at Arent Fox, is designed to introduce attendees to the unique dynamics of the PBM industry in order to better advise clients on the legal, regulatory, and policy risks in today’s evolving healthcare landscape.


Learning Objectives:
  1. Discuss the unique role of PBMs in helping manage overall healthcare spending trends and their evolving business models
  2. Outline the core activities and financial relationships between PBMs and drug companies, payers, pharmacies, providers, and patients
  3. Identify key areas of legal risk for various stakeholders associated with the unique dynamics of PBM expansion and consolidation
  4. Review recent state and federal policy activity relating to PBM transparency, regulation, and accountability within the overall debate to address rising drug costs

Faculty

Stephanie Trunk

Arent Fox LLP

STEPHANIE TRUNK is a partner in the Health Law Group at Arent Fox LLP in Washington, D.C. Ms. Trunk counsels pharmaceutical and device manufacturers, distributors and their customers, including pharmacy benefit managers, on regulatory, reimbursement and compliance matters.

Her practice extends to counseling on drug pricing and government price reporting, HIPAA and privacy matters, counseling on Medicare Part D, developing corporate compliance programs, representing clients in contract negotiations and providing transactional support to her clients.  Prior to joining Arent Fox LLP, Ms. Trunk was in-house counsel to a pharmacy benefit management company.

 Ms. Trunk She is a member of the BNA Pharmaceutical Law & Industry Advisory Board. Ms. Trunk is the author of numerous chapters in health law treatises including a chapter on Controlling Fraud, Waste and Abuse in the Medicare Part D Program in the ABA/BNA’s Health Care Fraud and Abuse: Practical Perspectives. She received a J.D. with Highest Honors from the George Washington University Law School in 2003 where she was elected to the Order of the Coif and a member of the George Washington Law Review.

Ms. Trunk also has as a graduate certificate in health management from the George Washington University School of Public Health (2003) and she received a B.S. in Accounting Summa Cum Laude from the University of Maryland in 1997.



Rujul Desai

Avalere Health

Rujul Desai, Vice President Avalere Health, advises clients on market access, reimbursement, strategic contracting and regulatory solutions. He applies his unique combination of experience in specialty pharmacy, biopharma, PBM, legal and regulatory services. Prior to joining Avalere, Rujul has held a number of leadership roles in the specialty industry, including at CVS Caremark, UCB, and Theracom.

He was also the founder of a specialty hub services company supporting biopharma products. Rujul has significant health law experience, including practicing at the law firm of K&L Gates. Rujul holds a JD from University of Houston and a BA from Rutgers University. He is a combat veteran of the Global War on Terror, U.S. Army, Medical Service Corps, Captain (Ret.).

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