Pre-Meeting PBM Training for TPAs
at the SPBA 2025 Hybrid Spring Meeting
In-Person and Online
The Capital Hilton - Washington, D.C.
Monday, May 19 at 8:00-11:35 AM EST

(Meeting is Eastern Standard Time)

Bonus session for registered attendees.

AGENDA:

8:00 – 8:05 AM - Welcome to PBM Training for TPAs 

8:05 – 8:50 AM - Top Integration Issues with PBMs (including PBM Terminology 101). Presenters: Eric Barker + Drew Alexander, TrueRx

8:50 – 9:00 AM - Table Discussion of content

9:00 – 9:15 AM - Break

9:15 – 10:05 AM - Negotiation of PBM Contracts – TPAs are continuously asked and required by their clients to stay ahead of the curve in all healthcare topics. Pharmacy costs over the last 10 years have skyrocketed and grown to be upwards of 40-50% of the overall plan spend for many employers.  The complexity of negotiating pharmacy contracts with PBMs, as well as finding point solutions to drive lowest net costs, is a major concern for many TPAs, as they do not have internal resources with this expertise of background. Education around best practices for negotiating PBM contracts is paramount for the continued success of the TPA market.  This presentation will be focused on delivering key factors for evaluating and maintaining strong PBM contracts.

Learning Objectives:

• Clear definitions of discounts and rebates
• Understanding the impact of exclusion language on rebates
• The fine print in PBM contracts and tightening up contract language to remove red flags
• The pros and cons of traditional versus pass-through PBMs 
• The ability to evaluate and defend TPA PBM contracts versus Broker PBM contracts
• Clinical and alternative sourcing mechanisms to drive the lowest net cost

Presenters:  Brian Shonat + Monica Gindhart, Navion

10:05 – 10:15 AM - Table Discussion of content

10:15 – 10:30 AM - Break 

10:30 – 11:20 AM - Emerging Models in the Network Pricing and Rebate Ecosystem – This presentation provides an introduction to the complex and evolving landscape of pharmacy network pricing and rebate structures. It examines the relationships between PBMs, pharmacies, pharmaceutical manufacturers, and plan sponsors. Attendees will gain insights into fundamental pricing methodologies, including Average Wholesale Price (AWP), Maximum Allowable Cost (MAC), National Average Drug Acquisition Cost (NADAC), and Cost-Plus Models.  Additionally, the session will cover emerging trends such as transparent pricing, alternative sourcing, biosimilars, and manufacturer direct models. By the end of this session, participants will have an understanding of how to navigate and leverage new pricing models to drive cost savings and improve transparency for their clients. 

Learning Objectives:

• Participants will be able to:
  • Understand Key Pricing Mechanisms
    • Explain the differences between AWP, MAC, NADAC, and Cost-Plus pricing models
    • Identify how these methodologies impact plan sponsor costs
  • Analyze the Role of Rebates in Drug Pricing
    • Describe the “Gross to Net” of high-cost drugs
    • Evaluate how rebate structures affect brand and specialty drug costs
  • Assess Emerging Trends in Pricing Innovation
    • Compare the benefits and challenges of alternative sourcing models, including international sourcing and cost-plus arrangements
    • Discuss how biosimilar adoption and PBM private-label initiatives are shifting cost structures
  • Navigate the Transition to Transparency
    • Explore how full disclosure requirements and pass-through models are shaping PBM contracts
    • Assess the impact of transparency on plan sponsors and pharmacy networks

Presenter: Justin Jasniewski, Serve You Rx

11:20 – 11:30 AM - Table Discussion of content

11:30 – 11:35 AM - Closing comments for PBM Training

Please click here for the Spring Meeting agenda.