Wednesday, September 17, 2014

Texas will move to NADAC-based reimbursement methodology

Yesterday at the Medicaid Drug Rebate Program in Chicago, Andy Vasquez, Deputy Director of Texas' Medicaid/CHIP Vendor Drug Program shared that Texas will move to an NADAC-based reimbursement methodology. The state will no longer participate in monthly reporting of drug numbers - which will ,most likely be eliminated sometime in 2015. As for prices, where there is no NADAC published price for a drug, WAC will be set at - 2%. However, new drug applications will still have to be submitted to the NADAC program for product integration in to the system as well as to identify prices at the launch of the drug.




Friday, September 12, 2014

Last Chance to Register for IIR's Specialty Pharmacy Collaboration Summit

 
Hurry! There's still time left to register for
IIR's Specialty Pharmacy Collaboration Summit!
Online registration closes this Sunday, September 14th
Register Now >>


IIR's Specialty Pharmacy Collaboration Summit is in 4 days! Don't miss out on the only event in the industry offering you the opportunity to partner directly with all the key stakeholders in the specialty pharmacy value chain to increase patient adherence, expand distribution and improve bottom line.


Across three days, you will:

• Hear never-before-heard case studies on accountable care impact on payer provider relations from BCBS, Tufts Health Plan, Denver Health Medical Plan, and more!
• Learn how to overcome the four key challenges in the specialty pharmacy ecosystem:
       o Adherence
       o Managing Costs and Determining Value of Specialty Drugs
       o Distribution of Specialty Drugs and Channel Management
       o Sustainability of the Specialty Pharmacy Model
• Improve operations and enhance compliance in the Pre-Conference Workshop with TWO specialty pharmacy accreditations - URAC and CPPA
• Facilitate more face-to-face meetings to foster meaningful engagement and build relationships with the event specific partnering360 networking tool


Don't forget! Online registration closes this Sunday, September 14th! Click here to register. Please be sure to use code XP1968BLOG in order to save $100 off you registration.





Last Chance to Register for MDRP 2014

Hurry! There is still time left to register for the
19th Annual Medicaid Drug Rebate Program Summit!
Online registration closes this Sunday, September 14th.
Register Now >>
 
 
MDRP 2014 begins in just 4 days! Don't miss out on THE authoritative event for everything government pricing, rebates and regulation. Join 70+ speakers, 500+ MDRP executives, 20+ solution providers in the only event where the government programs and pricing industry comes together each year to debate and create a roadmap to operational solutions.

Don't miss out on these key highlights on the MDRP 2014 agenda:

2 Keynote speakers discussing the true impact of the ACA and Medicaid reform
Legal & Compliance Track dedicated to overcoming challenges in the current legal landscape and ensuring compliance with government program mandates affecting manufacturers
CLE Accreditation - Earn continuing Legal Education (CLE) credits
• Four pharma case studies from AstraZeneca, Mylan and GSK
• Pre-conference workshop dedicated to Generic Drug Manufacturers
Direct access to State Rebating Representatives in State Dispute Resolution Meetings
• And more!
 
 
Online registration will close Sunday, September 14th so register now! Remember to take an extra $100 off registration rates with the code XP1958BLOG. On-site registration will be available all three days of the conference.

Don't miss out! Be part of the go-to industry event and leave armed with the tools and ideas to optimize your government pricing operations.





Tuesday, September 9, 2014

The 340B Program Reconsidered

With IIR’s 19th Annual Summit on the Medicaid Drug Rebate Program just one week away, we wanted to flashback to one of our expert keynote addresses from the 2013 event. Alice Valder Curran, Partner, Hogan Lovells US LLP presented her keynote address on “The 340B Program Reconsidered: Taxpayer Dollars and Corresponding Oversight Requirements, plus some thoughts on the President's Budget proposals for MDRP”. Take a look at her session below and make sure you join us next week in Chicago to hear everything government pricing, rebates, and regulation.


Remember, blog readers receive an extra $100 off the current rate when registering with the code XP1958BLOGRegister here.

See you in Chicago!




Friday, September 5, 2014

Full D.C. Appeals Court Expected to Uphold ACA Subsidies

Source: Modern Healthcare

The District of Columbia U.S. Circuit Court of Appeals in Washington on Thursday said the full 11-member court will rehear the controversial case that ruled Americans could not receive subsidies to help pay for plans on federally run health insurance exchanges.

Opponents of the Affordable Care Act greeted the D.C. court's initial ruling with praise, saying the judges upheld the text of the law. The law's supporters, however, argued the court read the text too narrowly and applied an unreasonable and inaccurate interpretation of exchange subsidies.

Much is at stake for consumers with the ruling. Without the subsidies, many would be forced to pay higher, potentially unaffordable monthly premiums. HHS said individuals with federal plans who qualified for the tax credits paid an average of $82 a month in health insurance premiums, down from the $346 monthly premium they would otherwise pay.

The healthcare industry is in a state of flux, new disruptions have altered the landscape, changed the status quo and are providing fresh opportunities and challenges for all industry stakeholders to collaborate and work together like never before.

Attend the FDA/CMS Summit for Payers to initiate the collaboration, with top government and key regulatory bodies working closely with healthcare leadership to join forces and build an open culture of harmonization to provide efficient and affordable healthcare to all patients.



Also, blog readers can save an extra $100 off the current rate when using the code XP1917BLOG - that is $500 in total savings! Register now. 







Thursday, September 4, 2014

States Not Expanding Medicaid are Paying 37% of the Cost ($152 Billion) to Extend the Program in Other States

If the 23 non-expansion states continue to do so, they will pay $152 billion to extend to program in the expansion states. Most of this money (nearly $88 billion) is coming from the taxpayers of 5 non-expansion states; Texas, Florida, North Carolina, Georgia, and Virginia.

Will this be the incentive needed for the remaining states to expand Medicaid?

With these aid initiatives looming, what will happen next? Are your states tax dollars being dished out to aid Medicaid in other states? To find out, join us at MDRP 2014 to hear our exclusive session "State Spotlight: Explore the Impact of Medicaid Expansion" with representatives from 13+ states.


Blog readers receive an extra $100 when using the code XP1958BLOG - Don't miss out on what the state representatives are saying about the future of Medicaid Expansion in these exclusive sessions, register now!

Source: Kaiser Health News




Wednesday, September 3, 2014

Is It Time to Establish Your Own Specialty Pharmacy?

Welcome to the Specialty Pharmacy Collaboration Summit podcast series.

Below is a teaser from our recent podcast with Kevin Colgan, Associate Vice President of Specialty Pharmacy, University HealthSystem Consortium (UHC)




Can you tell us a little bit about UHC?

Kevin: UHC is a consortium of 120 academic medical centers across the United States. We provide those members with many different services. We provide them with benchmarking services, group purchasing services through our supply chain program and we also supply them with specialty pharmacy services.

There’s a lot of interest among hospitals and health systems in establishing their own specialty pharmacies and one of the obvious reasons is the revenue opportunities. Can you talk a little about what the revenue implications are for these organizations?

Kevin: I was one of those who started a specialty pharmacy a few months ago (at Rush University Medical Center) before I started my current position at UHC.  I think if you look at it from a macro perspective, you see that by the year 2020, we’re looking at 50% of total US drug expenditures being consumed by specialty pharmaceuticals for just 3-4% of the population. If we just look back at the last 20 months where we’ve had 52 new molecular entities approved by the FDA, we would find that 21 of those are specialty pharmaceuticals. If we look just at oncolytics, we’d see the lowest cost drug is $5500 a month and the highest cost drug is $13,200 a month. The point is that anytime you have this high of cost with a drug therapy, you’re going to have revenue opportunities and implications. So, I think that’s an important piece.

I think the other important piece is that, still, many of these drugs are infusion therapies. If you look at an ACO model, you’re at risk for those Medicare Part B infusion therapies. So, you are not only looking at revenue, but you’re also managing risk.You have to manage risk by following evidence-based guidelines and ultimately doing what’s in the best interest of the patient.


I think the biggest incentive for hospitals, though, goes beyond all the additional revenue. It’s, frankly, just about improving care and the cost of care.


One of the big issues we have with current systems is fragmented care. I recently had a patient who, when her plan changed over, found that her co-pay for Humira was $1100. She couldn’t afford it, quit taking her therapy for three months and started having breakthrough symptoms. We found – even though we weren’t filling the prescription – that we could apply a co-pay assistance card. We worked with her specialty pharmacy and did that so she could afford her prescription.


So, again, fragmented care is a big problem. We have patients that, in an ACO environment, will be hospitalized if they aren’t taken care of under one roof. So, we see that as the overwhelming reason to move forward with the specialty pharmacy initiative at UHC.




Kevin will be joining us at the Specialty Pharmacy Collaboration Summit for the presentation “Pharmacy Practice Accreditation and Health-System Specialty Pharma” on Monday, September 15th. It is not too late to register! And remember, blog readers save $100 off the current rate with the code: XP1968BLOG - Register here.




Tuesday, September 2, 2014

Baby Boomers and Medicare Part D

As Baby Boomers begin to age, many are becoming confused about Medicare. A survey of 377 Baby Boomers born between 1946 and 1964, done by the NAIC, found that less than half of the participants knew eligibility for Medicare for those who are not disabled begins at age 65. And more than half of the participants were unfamiliar with Medicare prescription drug coverage.

Yet despite these findings, more than 37 million Medicare beneficiaries are enrolled in Medicare drug plans this year. That's an increase of 2 million compared to 2013 and 15 million since 2006.

As the nation's largest health insurance program, Medicare currently covers more than 40 million Americans. But many are growing more and more concerned over what will happen when these Baby Boomers become eligible.

As enrollment of Baby Boomers into Medicare increase, cost will continue to rise for the next 20 years, this is due to many factors such as; increased life expectancies as well as the increasing prevalence of chronic diseases.

Since 2011 and continuing for the next 19 years, 10,000 Americans will turn 65 everyday. With this Medicare enrollment boom and the variety of programs available, these Baby Boomers need to start their education about Medicare coverage years prior to retirement, to ensure they make the best choices for future coverage.

Source: Huffington Post




Friday, August 29, 2014

One Last Thing Before that Out Of Office Goes Up…


Enjoy your day off AND extra savings! Register for any of the following IIR events and receive a 25% discount off the standard rate*

Mention code LABORDAYBLOG when registering for each or any of the following:

Register here for IIR’s Specialty Pharmacy Collaboration Summit event taking place September 15th-17th, 2014 in Boston, MA, visit the website for full details.

Register here for IIR’s 19th Annual Medicaid Drug Rebate Program Summit event taking place September 15th-17th, 2014 in Chicago, IL, visit the website for full details.

Register here for IIR’s FDA/CMS Summit for Payers event taking place December 11-12, 2014 in Washington D.C., visit the website for full details.


Have any questions? Email Jennifer Pereira.

*This promotion is only valid August 29- September 1st, 2014. Offer cannot be applied retroactively to confirmed paying registrants and cannot be combined with any other discounts or promotions. All registrants and guests are subject to IIR approval.





Thursday, August 28, 2014

Your First and Only Chance to Hear the FDA & CMS Address Payers and Pharma Under One Roof

 
Introducing the FDA/CMS Summit for Payers


The Full Agenda is Now Available | Download Now! 
 
 
Hear the challenges and opportunities on key issues in order to succeed in a patient-centric environment. Plus:

• Get face-to-face access to the top regulatory thought leaders and policy makers from FDA and CMS
• Hear about critical trends and changes so you can create successful strategies for dealing with FDA and CMS
• Walk away with practical, real life lessons from some of the most experienced payers and healthcare executives on how they are dealing with the changes
• Benchmark your operational, regulatory and strategy against all the major health plans

Meet Regulators from FDA and CMS:

• Janet Woodcock, MD, Director, Center for Drug Evaluation and Research, FDA
• John K. Jenkins, MD, Director of the Office of New Drugs, Center for Drug Evaluation and Research, FDA
• Tamara Syrek Jensen, JD, Deputy Director, Coverage and Analysis Group (CAG), CMS
• Niall Brennan, Acting Director, Offices of Enterprise Management (OEM), CMS


Collaborate with C-Level Healthcare Leaders:

• Dr. Trent T. Haywood, MD, JD, Chief Medical Officer & SVP, Office of Clinical Affairs, Blue Cross and Blue Shield Assc.
• Dr. Claire Levesque, Chief Medical Officer for Commercial Products, Tufts Health Plan
• Dr. Richard Migliori, MD, Executive VP, Medical Affairs, Chief Medical Officer, UnitedHealth Group
• David Polakoff , MD, M.Sc, Chief Medical Officer & Associate Dean, Commonwealth Medicine Director, Center for Health Policy and Research, University of Massachusetts Medical School   
• William Winkenwerder, Jr.,  Former CEO, Highmark, Inc.
• Kevin Volpp, MD, PhD, Founding Director, Center for Health Incentives and Behavioral Economics, Leonard Davis Institute


Register now with the code XP1917BLOG and take an additional $100 off the current rate - $500 in total savings. Register here.