The Battle of Accumulators and Maximizers: What You Need To Know for 2024
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Step edits. Ever-expanding exclusion lists. Increasingly complicated prior authorizations and appeals processes. And of course, accumulators and maximizers.
By design, branded specialty drugs are becoming increasingly more difficult for patients to access, and it can feel like an uphill battle to wade through all the red tape to get your drug to those who need it.
Tune in as we take an in-depth look into the current and future state of copay adjustment programs, and what is being done to overcome them. Experts discussed some of the biggest legal battles over cost shifting strategies, and what manufacturers can expect after the dust settles.
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Featuring a conversation with:
Executive Director, HIV+Hepatitis Policy Institute
A national policy and advocacy leader in the HIV community for over 20 years, Carl Schmid in 2019 formed the HIV+Hepatitis Policy Institute, which promotes quality and affordable healthcare for people living with or at risk of HIV, hepatitis, and other serious and chronic health conditions.
Mr. Schmid leads advocacy efforts to ensure domestic HIV and hepatitis programs are based on sound public policy and fully funded.
Mr. Schmid has served as Co-Chair of the Presidential Advisory Council on HIV/AIDS. He serves as a consumer representative and a member of the NAIC/Consumer Participation Board of Trustees.
Senior Director, Executive Branch Strategy Team, Bristol Myers Squibb
Katie Verb is currently the Senior Director of the Executive Branch Strategy team at Brystol Myers Squibb. In this role, she leads a policy team working on issues across the health care system include IRA implementation, Medicare, 340B, and PBM reform. Prior to this role, Katie was the Head of Public Policy at Horizon Therapeutics where she led a team handling reimbursement and coverage policy across all payers, as well as FDA regulatory policy. As a Director of Policy & Research at PhRMA, Katie worked on Medicare Part B, biosimilars, and cell & gene therapy policy. Prior to that, Katie led the Government Affairs team at the Hemophilia Federation of America, dealing with access, safety, and coverage issues that impact the rare disease community. Katie has a J.D. from Michigan State University and a Bachelors from Loyola University Chicago.
Partner, Healthcare Privacy and Cybersecurity
William Sarraille is a senior member of the Healthcare practice group and a nationally-recognized lawyer in healthcare law. Bill concentrates on a variety of healthcare matters, including Medicare and Medicaid reimbursement, coverage and coding, pharmaceutical price reporting, issues related to the marketing and promotion of pharmaceuticals and medical devices, internal investigations, clinical research issues, Stark and Anti-Kickback Law analyses, Medicare and Medicaid audits, healthcare acquisitions and due diligence, compliance program audits, managed care matters, healthcare contracts, administrative litigation, legislative matters, privacy and security, coverage for new devices and services, the Foreign Corrupt Practices Act, international compliance and healthcare contracting, the representation of witnesses and companies before Congressional Committees, and the defense of healthcare criminal and False Claims Act matters. He has also been lead counsel in important Administrative Procedure Act matters concerning Medicare coverage, and reimbursement, patient assistance, the Anti-Kickback statute, price reporting, and risk adjustment issues. Bill has defended clients in some of the largest healthcare fraud investigations brought by the U.S. Government.