Today’s Prescription Drug C overage

1. Today’s Prescription Drug Coverage Bithia Anderson, Anju Harpalani, and Lawrence Cohen

2. Today’s Prescription Drug Coverage We would like to get to know our audience. The panelists have extensive backgrounds but we want this session to be important to each of you. Which industry do you represent? • State insurance regulator • Health insurance company • Clinical professional • Consultants

3. Moderator Background Heather Harley, AMCM, FLMI, HIA, MHP, DIA, LTCP, ACIP  • Market Regulation Manager for the INS Companies. • 15 years of regulatory insurance experience and 25 years of insurance experience • Mrs. Harley joined INS in 2009 and currently serves as Supervising Examiner for examinations and compliance projects for several states. Mrs. Harley has conducted market analysis reviews, market regulation examinations, lead for special projects, training sessions, and is currently overseeing complex Affordable Care Act (ACA) health and pharmacy reviews on behalf of Pennsylvania. Mrs. Harley has extensive experience as an examiner-in-charge, supervising field examiners, complex investigations, participating in multiple examinations, managing budgets, and drafting violations for reports.

4. Panelist Background Bithia Anderson, Pharm.D., MPA, Ph.D. (c) • Co-Founder & CEO of Fidus Solutions, Founder & Principal of EntireRx Consulting, Pharmacy Consultant for the INS Companies. • As a pharmacy consultant for INS companies Dr. Anderson has worked on various pharmacy exams for multiple states. Her work included evaluating various sources of data to provide regulatory and clinical pharmacy consultation services. Some areas of focus included but were not limited to evaluating implementation and compliance with Affordable Care Act (ACA), mental health parity, QTL and non-QTL treatment limits for drugs within medical/surgical benefits as well as mental health/behavioral health benefits. • At Fidus Solutions Dr. Anderson is committed to providing dependable transparent solutions for the appropriate management of pharmaceutical and pharmaceutical related services under pharmacy and medical benefit.  At EntireRx Dr. Anderson works with start-up companies with market disruptive ideas and innovations related to pharmaceuticals and pharmaceutical services. Previously, Dr. Bithia Anderson served as the Assistant Director of the PRIME Institute at the University of Minnesota College of Pharmacy.  At the PRIME Institute, her work included managing, directing and conducting scientific and public policy investigations or experiments related to pharmaceuticals. In her role, she worked with policy makers, clinical and non-clinical practitioners, private corporations, federal and state government organizations, PBMs, health plans, pharmaceutical companies, pharmacy organizations, startups, and others.

5. Panelist Background Anju Harpalani, PharmD, MBA • Pharmacy Consultant and Clinical Pharmacist with 6 years of Medicare, CCIIO and Medicaid experience and 30 years of pharmacy experience in multiple settings. • Dr. Harpalani is the Business Area Lead of RRC’s Pharmacy & Healthcare Solutions team, providing consulting services to regulatory clients in the areas of regulatory compliance, Qualified Health Plan (QHP) formulary reviews, pharmacy claims reviews and market conduct examinations. Additionally, conducting Mental Health Parity and Addiction Equity Act (MHPAEA) compliance reviews, including formulary, medication assisted treatment (MAT) and substance use disorder (SUD) reviews. • Experience includes providing pharmacy consulting assistance to the Center for Medicare & Medicaid Services (CMS) as well as working in the community pharmacy setting and for the health insurance industry, most recently with Cigna Medical Management as Director of Specialty Strategy for their government programs, and for Magellan RX Management, where she managed the preferred drug list (PDL) for the state’s Medicaid Fee-For-Service benefit.

6. Panelist Background Lawrence Cohen, PharmD, BCPP, FASHP, FCCP, FCP, FNAP • Professor of Pharmacotherapy, Coordinator of Interprofessional Education and Coordinator of Continuing Professional Education, University of North Texas System College of Pharmacy • 40 years of clinical pharmacy experience • Dr. Cohen's scholarly interests include pharmacokinetics and pharmacodynamics of psychotropic medications, geriatric psychopharmacology, pharmacoeconomics and health outcomes, pharmacoepidemiology, and emergency preparedness (specifically, access to healthcare during times of crisis). He has served as consultant for numerous pharmaceutical companies and national managed-care organization.

7. Today’s Prescription Drug Coverage What do regulators need to know? • Traditional vs. Specialty Drugs • Pharmacy Benefit vs. Medical Benefit • Open vs. Closed Drug Formulary • Federal vs. State Rules

8. Today’s Prescription Drug Coverage: Complex Supply Chain

9. Today’s Prescription Drug Coverage • Many players • Financial relationships across the supply chain with limited to no transparency • Misaligned interests & conflicts of interests across the drug supply chain • Information asymmetry where the purchaser is at a significant disadvantage • Lack of transparency across the supply chain

10. Today’s Prescription Drug Coverage: Lack of Transparency

11. Today’s Prescription Drug Coverage What do regulators need to know about the future of Prescription Drug Coverage? • Precision Medicine • Customized and personalized to each patient • Use of genetic testing • High value vs. high cost drugs (combination formulas) • Generics vs. Preferred brand • PBMs should negotiate prices • Lower cost alternates

12. Thank you and Q & A Thank you for attending. We would be happy to answer any questions.