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Pharmacy Benefit Managers: Understanding Pharmaceutical Supply Chain Middlemen

(158 reviews)

Produced on April 09, 2018

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Course Information

Time 1h
Difficulty Intermediate
Topics covered in this course: Health Care

Course Description

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

Credit Information

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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

Covington & Burling LLP

Rujul Desai advises clients on drug pricing, market access, reimbursement, strategic contracting, and regulatory solutions for drugs, biologicals, devices, and diagnostics. He brings deep experience with biopharma, specialty pharmacy, and pharmacy benefit management (PBM) companies.

Mr. Desai has held a number of leadership roles in the biopharma, PBM, and specialty pharmacy industry, including with CVS Caremark, UCB, and most recently as Vice President at Avalere Health. He has led engagements across a wide range of U.S. and global market access and reimbursement issues, including optimizing new product launches, pricing, PBM and payer formulary access, value-based contracting, distribution network design, patient access and hub services, affordability programs, e-prescribing, digital health, and the use of health economic data and modeling.

Mr. Desai is an author of the U.S. chapter of a global treatise on drug pricing and reimbursement.

Mr. Desai was a Captain in the Medical Services Corps of the U.S. Army Reserves, and served in active duty in Iraq.


Regulatory and Public Policy

Health Care
Food, Drug, and Device
Medical Devices and Diagnostics
Pharma and Biotech


Industries


Education

University of Houston Law Center, J.D., 2000

Rutgers, The State University of New Jersey, B.A., 1996

Government Service

U.S. Army

Bar Admissions

District of Columbia

Texas




Reviews

JO
James O.

Insightful. Great course.

JB
Julie A. B.

Brief and interesting introduction to the dynamics of the PBM industry in today’s evolving healthcare landscape.

KG
Kirk G.

I've already forwarded to several friends. Great overview of a complex industry.

JK
Jody K.

Enjoyed the class. Covered the material in good summary form.

MA
Michael A.

Well done.

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