Optum Sponsored Breakfast

Title: Identifying Pharmacy Cost Reduction Opportunities 
When: Thursday, April 25 7:30 – 8:15 am 
Location: Key 3-4

Description:  Increasing pharmacy cost and utilization, especially with high cost specialty therapies, have transitioned to a ‘top of mind’ issue. With our recent work with ACOs and hospitals, we found many organizations struggle to identify and prioritize pharmacy cost reduction opportunities. Our past work in this field identified organizational misalignment, lack of data infrastructure, off-formulary use, and the rapid increase in use and cost of specialty drugs as major contributing factors. This discussion will focus on approaches taken to identify savings opportunities and lessons learned when developing an implementation plan.

Speaker Bios: 
Jeremiah D. Reuter, ASA, MAAA, MS, is a vice president in the Denver office of Optum. He has eighteen years of experience in the health care actuarial field. His primary career focus has been in the area of U.S. healthcare consulting for providers. He has worked with health insurance plans, health care providers, Accountable Care Organizations (ACOs), Clinically Integrated Networks (CINs), Medicare Advantage Organizations, Centers for Medicare & Medicaid Services (CMS), and state and national regulatory agencies. Mr. Reuter currently serves provider organizations in identifying and managing risk, often in the Chief Actuary role for ACOs and CINs. He is also currently consulting with health plans and health care providers on the impact value based arrangements as they continue to expand their risk portfolios started by the Affordable Care Act (ACA) legislation and Medicare Access & CHIP Reauthorization Act (MACRA) legislation. 

Kevin Ashpole, MBA, is senior director for Optum Pharmacy Advisory Services.  He brings 30 years of leadership experience across numerous areas within the health care industry. Since joining Optum in 2011, he has consulted for biopharmaceutical organizations, medical device manufacturers, Accountable Care Organizations, health systems, specialty pharmacies, health plans, and CMS. He has assessed pharmacy utilization and specialty drug spend, developed market entry strategies for biosimilar therapies, designed product portfolios including formulary, supported risk-based contracting, and worked with health systems to create implementation plans for oncology and specialty drug protocols. Prior to joining Optum, Mr. Ashpole was general manager of individual products for BCBS of Tennessee.

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