Tomorrow: Complimentary Web Seminar: The CMS Proposed AMP Rule: What No One is Telling You

The Government Programs Summit Presents The Complimentary Web Seminar:

The CMS Proposed AMP Rule: What No One is Telling You

Presenters: Vincent G. Powell, PPS Group, Ramie Zomisky, PPS Group, Alexis Arroyo, HighPoint Solutions, Andrew Scavone, HighPoint, Solutions,
Time & Date: Thursday, March 1, 2012, 2:00PM - 3:00PM EDT





About the web seminar:
The new AMP Proposed Rule and what it means for you. We will walk through the various proposals within the rule and discuss how those changes, if implemented will impact your calculations, your systems, and your strategies. We will discuss:

• - What are the changes behind the changes that you may not have thought about, but need to
• - How those new changes will impact your calculation methodology
• - What changes will you need to make to your systems

Register to join us today!

Presented by: 

About PPS:
The goal of PPS is to assist our clients with developing and maintaining effective, efficient and compliant operations in support of profitable Managed Markets contracting activities. Towards that end, PPS offers a broad range of services in the Managed Markets Operations and Compliance arena. As a result of our industry experience in the private, public and government healthcare sectors, PPS is well prepared to assist our clients with advisory services, staff augmentation and business process outsourcing.

About HighPoint Solutions:
HighPoint Solutions solves the toughest challenges facing companies in the highly regulated life sciences and healthcare industries by providing clients with practical IT strategies and solution implementations and giving them direct access to the people and technology that get things done. Since 2000, HighPoint’s team of consultants has provided business consulting and technology solutions that continue to deliver business value and competitive advantage to more than 140 clients nationwide.

Medicaid Managed Care Congress Session Spotlight: Health Reform Implementation in a Time of Uncertainty

With the upcoming elections at the end of 2012, many aspects of the Affordable Care Act are on the line.  The Republican presidential candidates want to repeal part or all of the ACA.  Depending on the outcome of the presidential election, healthcare reform is likely to change. This year at the Medicaid Manged Care Congress, we're looking at these possibilities with expert insights from Paul Begala, Political Analyst & Commentator, CNN; Columnist, Newsweek & The Daily Beast. The Medicaid Managed Care Congress will take palce April 30-May 2, 2012, in Baltimore, Maryland. If you'd like to join us, as a reader of this blog when you register and mention code XP1726BLOG, you'll receive a 25% discount off the standard rate.  For more information on this event, download the brochure.

Featured Session: Health Reform Implementation in a Time of Uncertainty
Featured Speaker: Paul Begala, Political Analyst & Commentator, CNN; Columnist, Newsweek & The Daily Beast
About the session: There is a sense of uncertainty in the air, with healthcare being one of the main focuses of the upcoming presidential elections. It’s clear that healthcare reform will still move forward in some way, no matter who the president will be, but it will look very different depending on who is in office.

• • Look into different presidential candidates and their current stances on healthcare
• • Predict the future of Medicaid and the ACA depending on who will be in office

Electronic Healthcare Records moves to Phase 2

Source

Last week, the second stage guidelines were released by the government concerning the move to digital health records.  They can be read here.  According to Kaiser Health News, many of the objectives remain the same - increased usage, engaging patients in their care, and improving transferability between EHRs, but extended.  Companies also have until 2014 to move to Phase 2.  Included is the Summary of Care that must follow patients across referrals and be viewable by the patients online.  This document will be published March 7, then there will be 60 days of commenting.

At the 2012 Medicaid Manged Care Congress, the session "Utilize EHRs for Better Care Coordination" will examine how EHRs can benefit patients as well as look at how patient data can be kept safe with the new electronic format.  For more information on this session and the rest of the agenda, download the brochure here.  Also, as a reader of this blog, when you register to join us today and mention code XP1726BLOG, you'll receive a 25% discount off the standard rate!

For HCPs, there are numerous benefits to EHRs—what are some of the benefits for health plans?

Complimentary Web Seminar: The CMS Proposed AMP Rule: What No One is Telling You

The Government Programs Summit Presents The Complimentary Web Seminar:

The CMS Proposed AMP Rule: What No One is Telling You

Presenters: Vincent G. Powell, PPS Group, Ramie Zomisky, PPS Group, Alexis Arroyo, HighPoint Solutions, Andrew Scavone, HighPoint, Solutions,
Time & Date: Thursday, March 1, 2012, 2:00PM - 3:00PM EDT





About the web seminar:
The new AMP Proposed Rule and what it means for you. We will walk through the various proposals within the rule and discuss how those changes, if implemented will impact your calculations, your systems, and your strategies. We will discuss:

• - What are the changes behind the changes that you may not have thought about, but need to
• - How those new changes will impact your calculation methodology
• - What changes will you need to make to your systems

Register to join us today!

Presented by: 

About PPS:
The goal of PPS is to assist our clients with developing and maintaining effective, efficient and compliant operations in support of profitable Managed Markets contracting activities. Towards that end, PPS offers a broad range of services in the Managed Markets Operations and Compliance arena. As a result of our industry experience in the private, public and government healthcare sectors, PPS is well prepared to assist our clients with advisory services, staff augmentation and business process outsourcing.

About HighPoint Solutions:
HighPoint Solutions solves the toughest challenges facing companies in the highly regulated life sciences and healthcare industries by providing clients with practical IT strategies and solution implementations and giving them direct access to the people and technology that get things done. Since 2000, HighPoint’s team of consultants has provided business consulting and technology solutions that continue to deliver business value and competitive advantage to more than 140 clients nationwide.

More Pharma at Government Programs Than Any Other Event

While the recently released Proposed Rule has the pharmaceutical industry scrambling to begin to strategize how it might need to adapt and change post- Final Rule, the AMP guidance is not the only thing the pharmaceutical industry is talking about.

At the Government Programs Summit, industry professionals will be on hand to discuss not only the AMP Rule, but the 340B pricing program, Medicare Part D, Medicaid Managed Care, Medicare Part B, ASP Pricing and State reimbursement. You will walk away with a thorough knowledge of how various pharmaceutical companies are addressing current challenges and questions with each program to take back and implement at your office.

Session Highlights:
→ Improve the Integrity of the 340B Program
→ Impact on Manufacturer of Multiple Mechanisms for Reimbursement from States
→ Strategies to Overcome the Implementation and Process Challenges of Part D

For more information and these sessions, download the brochure here.

The Government Programs Summit this March 14-16, 2012 in Baltimore, MD!  If you have any questions about the program, please feel free to contact Jennifer Pereira at jpereira@iirusa.com.

MMCC Session Spotlight: Medicaid and Health Insurance Exchange Integration

Questions still abound around Health Insurance Exchanges with some states moving forward with implementation while others waiting on a federal mandate. At this year’s Medicaid Managed Care Congress, hear from our keynote panel of government officials as they discuss how Medicaid relates to Exchanges including different user profiles and health plans need to do now to prepare. The speakers represent states from different stages of Exchange planning and implementation, to provide a 360-degree view of what you should be considering now, regardless of how far along your state is in planning and implementation.  The event will take place April 30-May 2, 2012, in Baltimore, MD.  For more information on the event, download the brochure.  As a reader of this blog, when you register to join us and mention code XP1726BLOG, you'll receive 25% off the standard rate.

John Kaelin,
UnitedHealth Group

Featured Keynote Presentation: Medicaid and Health Insurance Exchange Integration

Distinguished Speaking Panel:
Moderator: John Kaelin, Senior Vice President, Health Reform, UnitedHealth Group
Panelists: Julian J. Harris, MD, MBA, MSc, Medicaid Director, Executive Office of Health and Human Services, Massachusetts, Deborah Florio, Administrator, Center for Child & Family Health, Rhode Island Department of Human Services, Amy Allen, Healthcare Reform Planning Director, Department of Community Health, Michigan

About the session:Health Insurance Exchanges are a huge part of the ACA, and Medicaid’s integration with them varies by states. With a fast approaching 2013 deadline, states are scrambling to create regulations and guidance for plans. With approximately 80% of Exchange participants expecting to receive some sort of subsidy,Medicaid plans need to know how Exchanges will affect their current offerings. In this session, you’ll learn from states that are in various stages of creating Exchanges.

• • Compare and contrast Medicaid enrollees and potential Exchange enrollees
• • Identify how your plan will need to change to better serve additional members

Complimentary Web Seminar: The CMS Proposed AMP Rule: What No One is Telling You

The Government Programs Summit Presents The Complimentary Web Seminar:

The CMS Proposed AMP Rule: What No One is Telling You

Presenters: Vincent G. Powell, PPS Group, Ramie Zomisky, PPS Group, Alexis Arroyo, HighPoint Solutions, Andrew Scavone, HighPoint, Solutions,
Time & Date: Thursday, March 1, 2012, 2:00PM - 3:00PM EDT





About the web seminar:
The new AMP Proposed Rule and what it means for you. We will walk through the various proposals within the rule and discuss how those changes, if implemented will impact your calculations, your systems, and your strategies. We will discuss:

• - What are the changes behind the changes that you may not have thought about, but need to
• - How those new changes will impact your calculation methodology
• - What changes will you need to make to your systems

Register to join us today!

Presented by: 

About PPS:
The goal of PPS is to assist our clients with developing and maintaining effective, efficient and compliant operations in support of profitable Managed Markets contracting activities. Towards that end, PPS offers a broad range of services in the Managed Markets Operations and Compliance arena. As a result of our industry experience in the private, public and government healthcare sectors, PPS is well prepared to assist our clients with advisory services, staff augmentation and business process outsourcing.

About HighPoint Solutions:
HighPoint Solutions solves the toughest challenges facing companies in the highly regulated life sciences and healthcare industries by providing clients with practical IT strategies and solution implementations and giving them direct access to the people and technology that get things done. Since 2000, HighPoint’s team of consultants has provided business consulting and technology solutions that continue to deliver business value and competitive advantage to more than 140 clients nationwide.

Call for Papers: 17th Annual Medicaid Drug Rebate Program Summit

The Institute for International Research is looking for suggested sessions for our upcoming 17th Annual Medicaid Drug Rebate Program Summit, September 10-12, 2012 at the Swissotel in Chicago.

MDRP is the industry-leading event, with more government – led sessions and government attendance, and more pharmaceutical and generic manufacturers than any other event in this space.

We invite you to submit a proposal for a speaking opportunity directly to Heather King, by March 1, 2012. Please send to hking@iirusa.com.

We are currently recruiting pharmaceutical and generic manufacturer executives, state officers, and industry insiders who can share NEW DATA through detailed case studies related to Medicaid Rebate Operations, 340B Regulations, State Contracts and Reporting, and Systems usage.

 Submission Guidelines & Details In your abstract, please provide the following:
 Proposed Title of Session: Objective and purpose
 • A descriptive paragraph of 3-4 sentences describing what is unique or special about the information you plan to share- aka Background Information
• 3-4 bullet points highlighting the strategies, tools and techniques attendees will walk away with- aka Key Takeaways

These are just a few things we cover at MDRP. Please feel free to suggest other timely and relevant topics.

For more information about the MDRP Summit, please visit the website.

We look forward to welcoming you to the event this fall.

A Message from the Medicaid Managed Care Congress Chairperson Vern Smith

Vernon K. Smith, Ph.D. , Managing Principal, HEALTH MANAGEMENT ASSOCIATES, Medicaid Managed Care Congress Chairperson, would like to share this message with you:

All who work in Medicaid and the managed care marketplace have seen major changes in the last few years. But the next few years will see some of the most significant changes in the history of Medicaid, with barely enough time to prepare for them. There are tremendous risks, and also high-stake opportunities in what lies immediately ahead, with major implications for states, Medicaid programs and the managed care plans that serve the expanding numbers of Americans who will be enrolled in the program.

More states are now relying on managed care, and more medically complex populations are being served by Medicaid health plans. The focus has turned to how to improve health care and health outcomes, while finding a way to slow the growth in health care costs, especially for the most vulnerable groups in Medicaid, including the dual eligibles.

The keywords now are innovation, coordination, collaboration, quality improvement and performance. It is an exciting time to be involved with serving the health care needs of this population.

I would like to invite you to attend IIR’s 20th Annual Medicaid Managed Care Congress, taking place on April 30 – May 2 in Baltimore. As you may already know, I have chaired this event for the past few years, and have seen how this even , year after year, has consistently been a place where health plan leaders, and state and federal officials, have come together to share best practices and lessons learned as they seek to make Medicaid better.

Without question, one of my favorite aspects of the Medicaid Managed Care Congress has been the quality of the faculty and the participants. When you download the agenda, you’ll see more than 40 exceptional speakers. There is plenty of opportunity for interaction and informal discussion with the speakers, and many attendees place great value on what they learn from more than 350 fellow participants in the world of Medicaid managed care.

New for 2012:

• - An increased focus on managing care for the dual eligibles
• - Greater state representation than ever before
• - In-depth discussion on health insurance Exchange integration with states from various stages of implementation
• - Tracks especially focused on benefit design excellence, enrollment and retention, and improving clinical outcomes for chronic care management
• - Insight presented by health plan Presidents into building a robust provider networks

Personally, I am very interested in the plenary session focused on the 2012 election, and the implications its outcome will have on Medicaid managed care.

For more information about this conference, visit the website.

As a reader of this blog, when you register today and mention code XP1726BLOG, you’ll receive a discount of 25% off the standard rate. If you have any questions about this program, feel free to contact Jennifer Pereira at jpereira@iirusa.com.

Thank you very much, and I look forward to seeing you this spring in Baltimore!

Sincerely,
Vern

Vernon K. Smith, Ph.D.
Managing Principal, HEALTH MANAGEMENT ASSOCIATES, Medicaid Managed Care Congress Chairperson

AMP Proposed Rule – The Wait is Over

Insights from Katie Lapins, Principal, Government Pricing Specialists:

On Friday, January 27, 2012, CMS issued a Proposed Rule to implement the necessary provisions to the Medicaid Drug Rebate Program (MDRP) as a result of the Affordable Care Act (ACA) and other associated legislation dealing with healthcare reform. The Proposed Rule is on the GP Navigator is here.

IIR's GP Summit is the FIRST conference following the issue of the Proposed Rule and includes more speakers from CMS than any other event. This is the conference to attend to find out what the officials are saying as well as your peers within the industry.

Below are some items of interest after a first reading. As always, please remember that this does not constitute legal or management advice and all manufacturers should consult their own counsel and determine how to handle the items that are relevant to their specific organization, products, etc. It is certainly not comprehensive and will inevitably morph as we all re-read it and share our thoughts and interpretations.

• → It is only a Proposed Rule which means nothing has changed.
• → Pages 1 – 160 include many areas of discussion by CMS regarding their proposed changes; pages 161 – 200 include the actual Proposed Rule.
• → Comments are due April 2, 2012.
• → The definition of “States” and “United States” includes the 50 States, the District of Columbia, Puerto Rico and the U.S. Territories.
• → The ACA listed specific fees that could be treated as “Bona Fide Fees for Service.” CMS has incorporated this language as examples into the criteria originally included under the Deficit Reduction Act (“DRA”).
• → Line Extensions/New Formulations are broadly defined and CMS provides a table (Table 1) detailing those delivery forms that constitute “Oral Solid Dosage Forms.” Both the initial brand name drug and the line extension must be an oral solid dosage form to qualify for the Alternate Rebate/URA.
• → With regards to the AMP calculation, CMS’s guidance is unclear with regards to the “inclusion” or “exclusion” methodology. (Read the discussion on Pages 46 – 49 for the actual, although vague, wording.)
• → Retail community pharmacies are defined to include specialty pharmacies, home infusion centers and home healthcare providers.
• → 5i products will be identified using the FDA’s Routes of Administration (Table 3) and AMP includes sales to those COTs included in non-5i products plus sales to physicians/outpatient facilities, PBMs, mail order, HMOs/MCOs, insurers, hospitals, long-term care providers, hospices and other manufacturers.
• → 5i products will be determined using the VA 90/10 Rule and manufacturers will be required to review this monthly and quarterly.
• → Orphan products voluntarily sold at 340B prices to new covered entities would not be excluded from a manufacturer’s Best Price.
• → As with the DRA, manufacturers will be able to restate Base Date AMP within four quarters of the Final Rule if they have the actual/verifiable data to do so.

We invite you to join the Government Programs Summit this March 7-9, 2012 in Baltimore, MD! Download the brochure here for more information on this year's program and speakers.  If you have any questions about the program, please feel free to contact Jennifer Pereira at jpereira@iirusa.com.