Prime/Magellan Rx featured at Medicaid Enterprise Systems Conference (MESC)

From left to right: Doug Brown, Amber Small, Tina Hawkins, Dave Rice and Jami Snyder

Prime Therapeutics and Magellan Rx Management (Prime/Magellan Rx) leaders, joined by Medicaid state government experts, presented on Aug.14 at the annual Medicaid Enterprise Systems Conference (MESC). During their panel session, titled “Managing pharmacy spend and maximizing the use of technology to support state efforts,” presenters shared innovative solutions for the unique needs of state Medicaid programs and their members.

For more than 20 years, Prime/Magellan Rx has helped Medicaid programs manage traditional drugs with its preferred drug list (PDL) and other utilization management strategies. With the advent of novel cell and gene therapies, and a higher use of physician administered drugs (PADs), Medicaid programs must evolve their drug management model with modern technology infrastructure.

Prime/Magellan Rx industry session presenters included:

• Tina Hawkins, PharmD, vice president of account management, Prime/Magellan Rx
• Dave Rice, vice president of information technology, Prime/Magellan Rx
• Gabe Schoenlein, lead business analyst, Prime/Magellan Rx
• Amber Small, PharmD, RPh, senior director of pharmacy pricing and value-based solutions, Prime/Magellan Rx
• Jami Snyder, owner, JSN Strategies LLC
• Doug Brown, senior vice president of value and access, Coeus Consulting Group

Panel discussion highlights

• Panelists discussed the changing landscape of administering pharmacy benefits for state Medicaid agencies and the resulting challenges that have emerged. Tina Hawkins shared needs Medicaid clients have identified, including strategies around utilization management for medical benefit drugs, clarification on rebates by site of service and effective management of PADs. “We designed PAD Advisor, where our team provides expertise around the Medicaid Drug Rebate Program as it applies to all prescription drugs dispensed in the Medicaid program regardless of setting,” Hawkins said, “and we help states fully understand what PADs actually cost the state net of rebates.”
• Another hot topic was the benefits value-based contracting (VBC) provides to state Medicaid programs. Amber Small spoke to state Medicaid programs’ ability to negotiate VBCs and expressed how states can leverage them to track efficacy of drugs from a quality outcomes standpoint. According to Small, VBCs generate valuable real-world evidence that’s helpful to manufacturers and helps determine drugs’ inclusion on PDLs. Small also addressed the hurdles states may face initiating and maintaining VBCs. Prime/Magellan Rx offers Value Plus, the first multi-state VBC solution designed to assist state Medicaid programs in securing access to cell/gene therapies for patients while helping to ensure the cost of therapy is linked to the value it promises to deliver.
• Prime/Magellan Rx’s Dave Rice addressed upgrades to states’ technological and systems infrastructure necessary to implement modern utilization management, claims processing and rebate tools. Rice noted the challenge involved with data sharing between partners. And he mentioned the forethought required to share data for VBCs, a particular hurdle when patients do not stay in Medicaid during the time period for measuring outcomes. Rice concluded by citing policy related considerations for authorized data sharing and a need to employ change management for new business processes.

Panelists wrapped the session with audience engagement centered around the shifting technological landscape and stakeholder considerations to ensure the maintenance of a pharmacy program that fosters access to care while also containing costs.

Prime/Magellan Rx provides person-centered support to 54 million Americans enrolled in state government programs. Learn more about Prime/Magellan Rx’s differentiated programs that meet states’ unique needs.