Managed care has always demanded precision, but the rules are changing faster than most organizations can track. Ongoing PBM reform, more opaque pricing mechanics, and fragmented data flows across commercial, government, and 340B channels are creating new exposure. These risks often remain invisible until they surface as margin leakage, overpayments, or audit findings. 

At the same time, new transparency requirements and Medicare Part D changes are forcing access and contracting decisions into territory where existing approaches are falling short. This session brings together two Model N experts to help life sciences teams understand what is driving hidden cost and what to do about it. 

In this thought leadership discussion, Jeff Albright and David Gilpert examine critical blind spots in managed care operations that often go undetected until they become costly. The session looks ahead at evolving payer dynamics, explains why small inconsistencies at scale can create meaningful financial risk, and connects emerging trends to practical steps teams can take now to strengthen oversight, reduce duplication risk, and validate what is being paid and why. 

You will learn how to: 

• Identify the managed care blind spots most likely to create margin leakage, overpayments, or audit exposure 

• Recognize how PBM incentive models and formulary strategies are evolving and what that means for access negotiations  

• Understand why claims, membership, and eligibility signals fail to reconcile across systems and the downstream cost of that gap  

• Strengthen oversight across pharmacy and medical benefit exposure to reduce financial risk 

• Reduce cross-market duplication risk and proactively validate what is being paid and why 

• Evaluate how leading organizations are modernizing managed care operations to improve control, confidence, and resilience 

Jeff Albright

Director, Product Management

Model N

David Gilpert

Senior Director, Solutions

Model N