Focus on Managed Care Pharmacy

(M5) Managing Different Perspectives: Panel Discussion on Integrating Medical and Pharmacy Benefits

Tuesday, October 20, 2020

4:30pm – 5:30pm

ACPE UAN:0233-0000-20-015-L04-P | Contact Hours: 1 | Activity Type:
Knowledge-based

Faculty(s)

Susan L. Downard, RPh

Director, Clinical Pharmacy and Drug Utilization Management
Tufts Health Plan
Watertown, Massachusetts
Christina Link, PharmD

Clinical Program Manager, Medical Benefit Drug Utilization Management
Blue Cross Blue Shield of Michigan
Macomb, Michigan
Mitchel J. Seleznick, MD, MPH, MBA

Medical Director
Humana, CarePlus Health Plans
Tampa, Florida

With several new treatments crossing the traditional dividing lines between medical and pharmacy benefits, there are many questions on how to best manage the coverage for these medications. No clear-cut solution has emerged, as there is a complex web of perspectives to identify and evaluate. This session will bring together multiple viewpoints to discuss challenges and debate different strategies for integrating medical and pharmacy benefits and the potential impact on stakeholders such as the health plan and provider.

Learning Objectives: :

At the completion of this activity, participants should be able to:

Identify and debate various ways health plans and PBM’s categorize drugs as medical vs pharmacy benefit.
Describe potential strategies for managing benefit integration and how these strategies impact the different stakeholders.
Examine challenges facing different stakeholders related to the categorization and integration of medical and pharmacy benefits.