Agenda

·         Understand how Advance Notice payment signals and IRA drug costs are shaping product decisions

·         Understand the financial pressures shaping MA product decisions, including rate changes, rising utilization, and pharmacy cost trends

·         Explore how plans are adjusting benefits, service areas, and cost-sharing to maintain sustainability

·         Walk through practical strategies product teams are using to balance member value, Star performance, and financial viability

·         Examine how catastrophic liability, specialty drug growth, and IRA changes are reshaping the economics of the Part D benefit

·         Explore how plans are responding through formulary tightening, deductible changes, tier restructuring, and utilization management

·         Understand how pharmacy cost pressure is influencing benefit design, member affordability, and plan competitiveness

·         Discuss how plans are adapting their pharmacy strategy to balance cost control, access, and Stars performance

·         Understand why IRA-driven changes represent a permanent shift in Part D economics, not a temporary disruption

·         Identify which supplemental benefits are being reduced or eliminated as plans prioritize measurable clinical and financial outcomes 

·         Learn how leading plans target benefits to specific populations and clinical needs to drive impact 

·         Explore how plans measure utilization, outcomes, and engagement to justify ongoing investment 

·         Understand how CMS oversight and evolving SSBCI guidance are reshaping benefit design decisions

·         Review the major changes in Part D Star measures, adherence metrics, and quality scoring methodology

·         Examine operational challenges plans face with measures such as medication adherence, COB, and polypharmacy indicators

• Explore strategies plans are deploying across pharmacy operations, care management, and provider engagement to improve Stars performance

•      Evaluating when a C-SNP, D-SNP, or I-SNP makes sense

·         Examine how plans assess population fit, provider alignment, and enrollment potential before launching SNPs

·         Understand operational and clinical requirements needed to support specialized populations successfully

·        Disucss how tighter margins and higher care complexity are reshaping the financial viability of SNP expansion

·         Understand how the redesigned Part D benefit is changing formulary structure, tier placement, and cost-sharing strategies

·         Examine how plans are balancing member affordability, utilization management, and financial risk when selecting and structuring formularies

·         Review emerging approaches to biosimilars, specialty drugs, and preferred pharmacy networks in the new pharmacy landscape

·         Examine how plans are adjusting formularies to manage specialty drug growth, catastrophic liability, and rising pharmacy spend

·         Understand how V28 and ongoing payment updates are reducing RAF opportunity and reshaping plan revenue 

·         Examine how CMS expectations are shifting from diagnosis capture to documented treatment, proactive care, and clinical engagement 

·         Identify how declining RAF combined with flat rates is forcing product, network, and care model redesign 

Explore how plans are aligning benefit design, provider incentives, and care management to support both risk performance and member outcomes

·         Understand how growing scrutiny and transparency requirements are reshaping plan, PBM relationships and shifting control back to plans 

·         Evaluate rebate structures, formulary control, and utilization management strategies under increasing cost pressure 

·         Assess how changes in pharmacy distribution—including mail-order growth, PBM-owned pharmacies, and retail closures—are impacting network design and member access 

·         Identify how plans are restructuring PBM partnerships to balance cost control, access, and member experience