AMCP Nexus 2023 Preview – A Q&A with Pat Gleason and David Eckwright 

Last week, Prime Therapeutics (Prime) and Magellan Rx (MRx) released the latest Medical Pharmacy Trend Report™, and among the key findings was that managing medical drug benefit trend and spend remained top concerns for payers in 2022. It’s these same concerns that propel the Academy of Managed Care Pharmacy (AMCP) in its mission to improve patient access to therapies at affordable costs. And once again, health outcomes leaders from Prime will join this critical conversation at ACMP Nexus 2023 this week in Orlando, Florida. 

A record-setting 3,000 managed care pharmacy leaders are expected to attend the event where Prime also will present three managed care pharmacy research studies, which use integrated medical and pharmacy claims data to evaluate real-world drug utilization, managed care pharmacy programs, and associated costs of care to explore conditions, including diabetes, lymphoma, and hemophilia. These researchers also will present several sessions during Nexus 2023. 

We spoke with Pat Gleason, PharmD, Assistant Vice President for Health Outcomes, and David Eckwright, Senior Director of Specialty Analytics and Informatics, to break down the busy week ahead at Nexus 2023. 

PRIME: The 2023 spring AMCP Annual Meeting in San Antonio was the first time Prime and MRx presented research as one organization. Here we are more than six months later – how have our research teams grown to complement one another and come together for events such as this? 

David Eckwright (DE): Our research teams collaborate on methodologies and best practices, drawing from our complementary expertise in drug management across medical and pharmacy benefits to deliver industry leading insights.  

We’ve recently begun to internally socialize our findings at regular Health Outcomes meetings to promote research collaboration and learning across the organization. This collective effort, enriched by constructive feedback gathered at these meetings, enables us to showcase our unified expertise and achievements at events like this. 

PRIME: At spring AMCP, there was a poster on “on- and off-label” utilization of GLP-1 drugs, and then this summer we announced our blockbuster analysis of GLP-1 drugs that showed low adherence and increased cost of care in the first year. GLP-1s are on our radar once again at AMCP Nexus, and it seems like attention to this class of drugs has only increased – what can you tell us about the research we’re presenting at the event, but also, what’s next for the GLP-1 trend? 

Pat Gleason (PG): GLP-1s are now one of the leading and the fastest growing pharmacy expense drug categories. To ensure GLP-1 therapy is appropriate, cost-effective, and optimized, the full gamut of pharmacy benefit managers’ programs need to be applied, including utilization management; benefit design; fraud, waste, and abuse; constant therapy monitoring through programs like HighTouchRx; and care/case management.  

The GLP-1 surveillance and managed care pharmacist drug therapy optimization research we’re presenting received an AMCP Platinum Award because we were able to demonstrate how successful the HighTouchRx program is at identifying duplicate incretin therapy (e.g., GLP-1). This provider outreach, which recommended single agent incretin memetic therapy, saved more than $3.5 million.  

GLP-1 utilization and expenditures are expected to continue to grow as more data demonstrating cardiovascular event reduction is published, more products are FDA approved, and current products receive expanded indications for obesity treatment.  

For more on this study, watch a video recap of the research here. 

https://youtu.be/NUxkxnO3wWI

PRIME: Our research at AMCP Nexus will look at chronic conditions – diabetes, lymphoma, and hemophilia – which are known for their high cost of care. How do we decide what topics to explore, and what benefits do we hope members and individuals will see as a result of our research both near and long term? 

DE: We select our research topics based on knowledge gaps that occur in our industry, such as the introduction of new drugs, new formulations, new indications, or newly available data to assess previously unknown real-world utilization and/or outcomes of drug therapy. Our aim is to pave the way for innovative solutions and informed decision making that strive to enhance patient outcomes, provide cost effective care and elevate industry knowledge. Ultimately, our goal is to improve patient outcomes by ensuring access to high-quality, cost-effective therapies. 

PRIME: AMCP Nexus will mark one of the last trade shows for 2023. What do you expect to see at the show that may set the agenda for 2024 and beyond? 

PG: I hope you don’t mind, but I’ll roll-off a list: pharmacy benefit management services application to drugs billed through the medical benefit; high-cost drug therapy regimen management, including extremely expensive, one-time therapies like gene therapy and the impact on drug/gene therapy benefit affordability; health equity issues and how to use individuals’ social determinants of health data to enhance and tailor managed care pharmacy program services; and expanded medically integrated health system medication dispensing networks to improve patient outcomes and reduce drug waste. 

DE: I anticipate heightened focus on total drug management as therapies begin to move across the pharmacy and medical benefits due to formulation changes and payer strategies such as white or clear bagging. I believe there will be a continued focus on gene and cell therapy, as well as oncology, given their strong pipelines and cost implications. Weight loss drugs will remain a priority, with the challenge of balancing appropriate access while managing cost. These areas, among others, call for strategies that go beyond traditional drug management and emphasize member-centric interventions, and unique provider and pharmacy partnerships; I’m eager to discover how others are innovating in this area. 

PRIME: Thank you, both! 

Look for our leaders at the show, and if you can’t be in Orlando – or perhaps you are but happen to get caught-up with a certain mouse and his friends – keep an eye on our Perspectives Blog or follow us on X (Twitter) at @Prime_PBM and @Magellan_Rx for real-time updates.