Beyond Buy and Bill: Managing Specialty Therapies Under the Medical Benefit

Speakers

ERIC J. CULLEY, Pharm.D., is the manager of clinical pharmacy services and is the managed care residency director at Highmark Blue Shield, an insurer with more than 2.6 million members with pharmacy benefits, located in Pittsburgh. Dr. Culley graduated from Duquesne University, magna cum laude, with his Bachelor of Pharmacy and Doctor of Pharmacy. He also earned his MBA with High Honors from Duquesne. He is currently responsible for Highmark’s pharmacy and therapeutics committee, as well as Highmark’s formulary for commercial business and Medicare Part D. Dr. Culley is also responsible for coordinating the development and the operations of implementing and maintaining drug utilization review programs, prior-authorization protocols and all other clinical management programs. He is actively involved in the education of providers through publications, generic prescribing initiatives, and other quality and pay-for-performance initiatives. His team also provides clinical support for the company’s sales and marketing division, actuarial services, compliance, pharmaceutical contracting, member services and the provider community. Dr. Culley and team are actively involved in the Pharmacy Quality Alliance and other areas dedicated to the improvement of pharmacy quality. Dr. Culley has been invited to and has given presentations regarding Highmark’s prescription drug management programs and the medication therapy management program to national and international audiences. He has published multiple peer-reviewed articles and commentaries in the Journal of Managed Care Pharmacy (JMCP) and other pharmacy journals, as well as professional and consumer reference textbooks. He is currently a peer-reviewer and editorial advisory board member for JMCP. Dr. Culley is an adjunctive faculty member at Duquesne University and the University of Pittsburgh school of pharmacy and is the pharmacy editor of Clinical Views, a Highmark publication.

DEBBIE STERN, R.Ph., is vice president of Rxperts, a managed care consulting firm in Irvine, Calif., where she is responsible for designing and implementing comprehensive programs to meet the needs of managed care clients. She is a nationally recognized speaker, meeting facilitator and consultant for a wide variety of clients, including the pharmaceutical and biotechnology industry, health plans, PBMs, specialty pharmacies and technology companies, with a focused perspective on issues related to the management of specialty pharmaceuticals. Ms. Stern initiated the concept of the EMD Serono Specialty Digest in 2004 and has been its author and editor for all seven editions. Previously, Ms. Stern was the director of pharmacy services at Prescription Solutions, a PBM in Costa Mesa, Calif., where she was responsible for managing all aspects of pharmacy benefits for her clients, including operations, clinical services, outcomes management, budgeting and forecasting and personnel management. Prior to joining Prescription Solutions, she was involved in the start-up operations of Preferred Solutions, a PBM in San Jose, Calif. As the first pharmacist at Preferred Solutions, Ms. Stern was responsible for setting up the clinical, client services, claims administration, contracting and finance departments. In addition to her managed care experience, Ms. Stern spent five years in the pharmaceutical industry and 10 years in retail pharmacy. She has a B.S. in pharmacy from the University of Cincinnati and is actively involved in the Academy of Managed Care Pharmacy, where she served a two-year term on the Board of Directors.

Moderator: Angela Maas, managing editor of AIS’s Specialty Pharmacy News

Designed Especially For

Pharmacy, clinical services and medical directors; strategic planners; product development, contracting and marketing executives; and financial and operations executives at

• Health plans
• Specialty pharmacies
• PBMs and pharmacy benefit administrators
• Pharmaceutical manufacturers
• Employers
• Group-purchasing organizations
• Physician groups
• Infusion suites
• Consulting firms
• Disease management companies
• Third-party administrators

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