How Health Plans Review New Diagnostic Technology: What You Don’t Know Can Hurt You

December 5, 2012
11:30 – 1:00 pm EST



Symposium Course Description:New technology and the impact of new technology on the health plan’s population is an area of growing importance to payers. With continued downward pressure on medical cost trends, plans are faced with the dilemma how to pay for promising new technology with the reality of finite resources. Plans are becoming increasingly evidence-driven in their evaluation process and the bar for those evidentiary requirements is being raised. This symposium will explain the technology review process at a typical health plan. Understanding this process and planning for the evidentiary needs necessary to secure reimbursement must an early part of a product’s development cycle in order to be successful.

Learning Objective: 

  • Gain an understanding of the financial drivers of medical cost for a health plan.
  • Develop an understanding of the criteria that health plans use to evaluate new technology.
  • Gain an understanding of the process of medical policy development at a health plan.
  • What are the evidence levels that are needed to secure a favorable technology evaluation?
  • Understand that a reimbursement strategy must begin early in the development lifecycle of a product.

Who Should Attend: 

  • Representatives from companies who have a product in early development. Now is the time to think about and plan for reimbursement.
  • Representatives from companies with a product who are experiencing reimbursement issues.

Instructor Information and Biography:
Gary Owens Gary M. Owens, MD, President, Gary Owens AssociatesDr. Owens has 25+ years’ experience in medical and pharmacy management in the Blue Cross system. Dr. Owens was at Independence Blue Cross (IBC) for 20 years with responsibilities for medical and pharmacy management, technology evaluation and medical policy. Gary managed pharmacy operations and developed the plan’s management strategy for biotech drugs. As Vice President for Medical Management and Policy, he also managed the plan’s care management and claims payment policy departments. He was responsible for the 2006 launch of FutureScripts, IBC’s wholly owned PBM.

Acting as a consultant, Gary was the lead developer of Towers Watson’s Reference Formulary System and its associated management programs; he is the current chairman of the Towers Watson Rx Collaborative P&T Committee. Additionally, Dr. Owens serves as the Chief Medical Officer for OncoMed, an oncology specialty pharmacy and consults to over 20 pharmaceutical and device manufacturers regarding launch and reimbursement issues pertaining to managed care.

He has presented extensively on managed care, including at conferences of the Academy of Managed Care Pharmacy (AMCP), the National Association of Managed Care Physicians (NAMCP), and AdvaMed. He has written more than 60 articles on managed care, pharmacy, and biotechnology, which are included in American Health and Drug Benefits, The Journal of Managed Care Medicine, The American Journal of Managed Care, Journal of Managed Care Pharmacy and Disease Management.

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