MDRP 2012 Session Spotlight:Impact of Healthcare Reform and the Changing Healthcare Delivery System

The Healthcare Industry is always changing. Today, with the advent of Health Insurance Exchanges and Accountable Care Organizations, Americans have more options than they’ve had before in choosing how to receive care. While MDRP provides the most up to date information on how federal and state authorities are implementing public sector reimbursement programs, understanding the healthcare sector on a broader level is also a necessity. For that reason, MDRP will present the session, “Impact of Healthcare Reform and the Changing Healthcare Delivery System: Accountable Care and Patient Centered Medicine.” In this session, Steve Phillips, Senior Director for Health Policy at Johnson & Johnson will delve into how cost savings for insurance companies will not compromise patient care, and how patients will continue to have access to the care and providers most appropriate for their needs.

The Medicaid Drug Rebate Program Summit will take place September 10-12, 2012 in Chicago, IL.  For more information on the event, download the brochure.  If you'd like to join us, as a reader of this blog register to join us and mention code XP1715BLOG to save 25% off the standard rate!

Featured session: Impact of Healthcare Reform and the Changing Healthcare Delivery System:

Accountable Care Organizations and Patient Centered Medicine

Featured Speaker: Steve Phillips, Director, Health Policy, JOHNSON & JOHNSON

About the session: When matched with appropriate financial incentives and quality metrics, ACOs can encourage treatment options that are best tailored (based on available evidence) to meet individual patients’ needs; rather than choices that are driven by payers’ coverage and reimbursement policies. The challenge is to identify and implement the appropriate incentives and measures.

• • The goal of cost savings must be balanced with ensuring that quality patient care is not compromised
• • Ensuring patients have access to the care and providers most appropriate for their needs, inside and outside the ACO
• • Access to innovative treatments

MDRP 2012 Session Spotlight: Potential Impact of the Proposed Rule and 340B Program Updates

There is no pharmaceutical or generic manufacturer not impacted by the rules set forth by CMS and OPA. While the government representatives might not be able to discuss ongoing proposed rules themselves, the updates to the 340B program and the AMP Proposed Rule are still the most talked about topics this year and we have the most respected industry leaders on hand to discuss what these potential new rules mean to your company in 2013 and beyond.  Join us at Medicaid Drug Rebate Program Summit 2012 for the session "Potential Impact of the Proposed Rule and 340B Program Updates" to go in-depth on this topic with expert Alice Valder Curran, Partner, Hogan Lovells US LLP.

For more information the Medicaid Drug Rebate Program Summit, download the brochure.  If you'd like to join us September 10-12 in Chicago, register today! As a reader of this blog, when you mention code XP1758BLOG, you'll receive a discount of 25% off the standard rate.

Featured Session: Potential Impact of the Proposed Rule and 340B Program Updates
Featured Speaker: Alice Valder Curran, Partner, HOGAN LOVELLS US LLP
About the session: Now that you’ve heard the policy and operational updates from CMS and OPA, you will want to stay and hear how to put all of this information into practice at your company. This session will detail the hottest topics in the industry up until the last minute and how they will affect your company.

How important is the ACA to the insurance industry?

According to reports at Bloomberg, healthcare reform could bring as much as $1 trillion extra to insurance company revenues.  The excess revenue comes from insurance subsidies and Medicaid expansion.  This massive expansion will lead hto the health insurance industry staking claim in .5% of the GDP from now through 2020.  Also according to Bloomberg, 80% of all premium revenue must be put back into the healthcare system, pumping the majority of the $1 trillion revenue back into the healthcare system to doctors, hospitals and healthcare providers.

At the Medicaid Drug Rebate Program 2012, Steve Phillips, Johnson & Johnson, will present "Impact of Healthcare Reform and the Changing Healthcare Delivery System: Accountable Care Organizations and Patient Centered Medicine" looking at the goal of increased specialized care for patients balanced with coverage and reimbursement policies.  This will be ever important as the number of patients flowing into the system increases.  For more information on this session and the rest of the program, download the brochure here.  As a reader of this blog, when you register to join us September 10-12 in Chicago, and mention code XP1758BLOG,  you'll receive an exclusive discount of 25% off the standard rate!

What sector of healthcare will benefit the most from the influx of new revenue to the insurance industry from the Affordable Care Act?

How can $3,000 Save Your Company $30 Million?

Government fines are no laughing matter. The latest fine that made headlines was for a staggering $1.5 BILLION. Fines like these go well beyond the cost of doing business. With company budgets shrinking, you can’t afford to make a mistake that could cost your company millions of dollars in fines.

At the Medicaid Drug Rebate Program Summit, we gather USDOJ, HHS, OIG and industry senior in-house counsel representatives to explain who is getting caught, why, and how to avoid actionable behaviors. You might think you’re prepared, but if you haven’t been through an audit, how can you know?

Given the new complexities and number of changes in government reimbursement programs, and consequences for failing to follow and correctly implement these changes, these MDRP Summit sessions will show you if your compliance program covers all the bases:

• - Timely Updates from the Office of the Inspector General: Sources say the OIG will have some exciting new reports to discuss. The MDRP Summit is your opportunity to get these updates directly from OIG officials so you will know what to focus on in the coming year to ensure compliance that stands up to increasing OIG scrutiny.
• - Current Criminal and Civil Enforcement Activities to Improve Corporate Compliance: Avoid getting caught in the DOJ’s crosshairs and owing them millions with an update from Marilyn May, Healthcare Fraud Coordinator and Assistant US Attorney with the USDOJ, and a panel of experts who will review lessons learned from 2011-2012 civil and criminal Medicaid investigations and new trends the DOJ is seeing in current investigations
• - Industry Legal Roundtable: Current Legal Trends Affecting Pharmaceutical Manufacturers: Know how to work with your legal team on compliance issues, saving you both time and money in this first-ever session with Harvey Kaish, VP and Assistant General Counsel at BMS, Sabrina Yohai, Senior Corporate Counsel at Pfizer, and Steven Benz, Assistant General Counsel at Eli Lilly, who will identify best practices in dealing with GP-related compliance issues including changes in laws, policy documentation, and systems.

Download the brochure here to find out more about the sessions and the rest of the summit.  Last year's MDRP summit sold out early. Register now for the one event that will deliver compliance initiatives you can take back to the office and potentially save millions.

As a reader of this blog, you receive an exclusive discount of 25% off of the standard price when you register to join us this September 10-12, 2012 in Chicago, IL. Simply use priority code XP1758BLOG. Do you have any questions about the event? Feel free to email Jennifer Pereira.

MDRP 2012 Session Spotlight: Annual Update on 340B Program Regulations, Processes and Enforcement Answers from PHS

At the Medicaid Drug Rebate Program Summit 2012, our annual update will help you determine the 340B pricing as it relates to Medicaid rebate formulas for BP and AMP. Hear current issues and how to work collaboratively with OPA (and the Prime Vendor Program). Specific discussion include how to calculate the 340B Ceiling Price, the process for which OPA, wholesalers, and covered entities get pricing information, and understand eligibility verification.

For more information the Medicaid Drug Rebate Program Summit, download the brochure.  If you'd like to join us September 10-12 in Chicago, register today! As a reader of this blog, when you mention code XP1758BLOG, you'll receive a discount of 25% off the standard rate.

Featured Session: Annual Update on 340B Program Regulations, Processes and Enforcement Answers from PHS

Featured Speakers: Krista Pedley, Director, Health Resources and Services Administration, Office of Pharmacy Affairs
Christopher Hatwig, MS, RPh, FASHP, Vice President, APEXUS/340B Prime Vendor Program
Lisa Scholz, PharmD, RPh, HRSA’s Pharmacy Services Support Center, American Pharmacists Association

About the session: This session defines the Office of Pharmacy Affairs Mission/ Functions/Administration and helps you determine the 340B pricing as it relates to Medicaid rebate formulas for BP and AMP. Hear current issues and how to work collaboratively with OPA (and the Prime Vendor Program). Specific discussion surrounds how to calculate the 340B Ceiling Price, the process for which OPA, wholesalers, and covered entities get pricing information, and understand eligibility verification. Specific discussion around:

• • OPA Program Integrity Efforts
• • 340B audits of covered entities
• • FY 2013 user fee proposal

MDRP 2012 Session Spotlight: Point/Counterpoint: Impact of the Election on Healthcare Reform—What’s Coming and How Will it Affect the Pharmaceutical Industry?

The government has the power to completely overhaul the way the pharmaceutical industry does business. With healthcare reform, we saw a huge increase in the number of people eligible for Medicaid and the 340B program, a redefinition of pricing calculations, and the addition of Managed Medicaid to the rebate system. All of these things had a huge impact on the financials of each manufacturer. Healthcare reform is a hot button topic at every election and this year will likely be no different. The outcome of either candidate’s election could mean a slew of new laws on Medicaid or Medicare, significantly impacting the way government reimbursement programs function. These keynote speakers presenting the "Point/Counterpoint: Impact of the Election on Healthcare Reform—What’s Coming and How Will it Affect the Pharmaceutical Industry?" session are experts in the Healthcare landscape and will give an insider’s view to how each party will approach current healthcare legislation, and potentially move forward if elected.

The Medicaid Drug Rebate Program Summit will take place September 10-12, 2012 in Chicago, IL.  For more information on the program, download the brochure here.  If you'd like to join us, register today and mention code XP1758BLOG and save 25% off the standard rate!

Featured Session: Point/Counterpoint: Impact of the Election on Healthcare Reform—What’s Coming and How Will it Affect the Pharmaceutical Industry?

Featured Speaker representing the Democrats: Paul Begala, Political Analyst & Commentator, CNN; Columnist, Newsweek & The Daily Beast
About Paul:  He is a political analyst for CNN, and part of a political team that won an Emmy for its coverage of the 2006 elections and a Peabody Award for its coverage of the 2008 Presidential election. He served as counselor to President Clinton in the White House, where he helped define and defend the Administration's agenda, from the State of the Union Address to the economic, domestic and International issues the White House faces each day. He helped launch the political magazine George and is the author of several New York Times best-selling books, including Is Our Children Learning? The Case Against George W. Bush and Buck Up, Suck Up, and Come Back When You Foul Up. He is also a columnist for Newsweek and The Daily Beast.

Featured Speaker representing the Republicans: Dan Crippen, Fmr. Director, Congressional Budget Office, Executive Director, National Governor’s Association
About Dan: Dan Crippen serves as the executive director of the National Governors Association (NGA). As executive director, he works with governors to identify and prioritize the most pressing issues facing states and oversees the day-to-day operations of the association. Prior to his work at NGA, Crippen served as the director of the Congressional Budget Office from 1999 to 2002, supporting the Congressional budget process and providing expert analysis to guide and inform economic decision making. Since CBO, Crippen has worked in the private and nonprofit sectors primarily on health care—including Medicaid, health IT, and health care for elderly and complex patients.

There is Something For Everyone at the 17th Annual Medicaid Drug Rebate Program Summit!

The government reimbursement landscape is constantly changing. Policy, operations, and data challenges are in constant influx, and each change affects the pharmaceutical and biotechnology professionals working in the public reimbursement space.

What has remained constant for 17 years, is that IIR's Medicaid Drug Rebate Program Summit, is the go to event for everyone in the industry.  This year, it will take place September 10-12 in Chicago, IL.

Every year the audience grows and this year we’ve expanded the program to ensure that MDRP has something for everyone.

Are you NEW to MDRP?

• • You will learn how to make calculations, the status of various government programs, and maintain basic compliance at your organization at the MDRP Compliance Academy.
• • Don't miss a full track on Medicaid Rebate Operation Implementation for Manufacturers where industry leaders from King & Spalding, Hogan Lovells, Amgen and Johnson & Johnson will walk you through some of the biggest challenges in operations today.

Are you an experienced drug pricing executive?

• • Identify new approaches to improve operations and enhance governance at the 2nd Annual Senior Leadership Forum.
• • CMS representatives will clarify your pressing questions at the annual CMS Policy and Operations Update session.
• • Hear from North Carolina, Illinois, Kansas, and more at the full track on State Contracts, Reporting and Operations Issues and Strategies and learn how their states are dealing with invoicing and contracting for both FFS and MMC.

Are you a financial executive?

• • The Financial Implications of MDRP and other Government Pricing Programs track, is where you will hear insights from some of the leading consulting firms in the space
• • The inaugural Life Science Financial Leadership Forum, where pharmaceutical finance thought leaders discuss on a macro-level how government pricing and contracting ties to the health and stability of each pharma company.

Are you a generic drug manufacturer?

• • Hear from the top generic companies at the half day symposium MDRP and Other Public Sector Reimbursement Programs for Generic Drug Manufacturers as they discuss key topics including how to maintain Federal and State compliance and managing the portfolio when there are Generics and Authorized Generics at the same company.

Are you a woman working in GP?

• • The Women’s Government Programs Leadership Forum is for women at all stages in their careers to meet to exchange, share and hear lessons learned from the industry’s most seasoned leaders. Keynoted by Carolyn Buck Luce, Global Pharmaceutical Sector Leader and the Healthcare Businesswoman’s Association Woman of the Year, it is an event not to be missed.

For more information on this year’s program, download the brochure.

As a reader of the Healthcare: From Policy to Practice blog, you receive an exclusive discount of 25% off of the standard price when you register to join us at the Medicaid Drug Rebate Program Summit this September 10-12, 2012 in Chicago, IL. Simply use priority code P1758BLOG. Do you have any questions about the event? Feel free to contact Jennifer Pereira.

Full Speed Ahead!

By Richard Yadon, President and CEO, Managed Medicaid Services, Host of Medicaid Matters talk show

Yesterday I visited the Navy Memorial in Washington DC. Being a Navy veteran it has special significance to me. Being there brought back a flood of memories from my days of active duty and reserve service. Those days weren’t always easy. I can remember being on the naval gunfire line off the coast of Beirut supporting the Marines at the airport in 1983. This was just a few day after the devastating terrorist attack which killed over 200 Marines. Nobody knew if or when something bigger might be aimed at the US military. Despite the uncertainty and anxiety, our ship’s crew always operated with precision and success.

It would be easy to let the uncertainties and anxieties in Medicaid managed care get you down. There are many challenges being discussed here at the Medicaid Managed Care Congress. In the sessions I attended this morning I’ve heard from everyone from state officials to health plan presidents. Topics such as provider capacity, ambiguous exchange regulations, and the integration of behavioral care in the community have all been discussed. Each topic represents a significant operational and financial challenge.

At the back of everyone’s mind is what will happen with the Supreme Court ruling. It could mean the end of the federally mandated expansion of Medicaid. This only adds to the uncomfortable atmosphere of uncertainty. Not an easy thing to manage given the amount of money entrusted to Medicaid managed care organizations and the millions of people they serve. I can think of several industries in which similar challenges and uncertainties would cause businesses to stop in their tracks.

That is not the case here. This broad collection of Medicaid health plan and state leaders has no intention of letting the uncertainly stop them. They are all moving forward as if nothing were threatened, as if there was no uncertainty. It is clear that they intend to continue to succeed, and serve, in spite of the challenges in front of them. Listening to the speakers and the questions from the audience suggest only one thing – Full Speed Ahead.

#MMCC 2012 Live: Thurston Howell III vs. the Professor

By Richard Yadon, President & CEO, Managed Medicaid Services and Host of Medicaid Matters talk show

Thurston Howell III vs the Professor is how political analyst and commentator Paul Begala characterized the upcoming presidential election during his comments at the Medicaid Managed Care Congress today. This was in response to a question from the audience about whether health care is a Right or a Privilege. As pointed out by Mr. Begala, it is not a constitutionally guaranteed right; however, most Americans recognize that access to health care is the right thing to provide.

The real question being asked here is “What will happen with Medicaid this year?” There are two big events coming in the next several months that have potentially significant impacts on the future of Medicaid. One event is the Supreme Court’s decision in June about ACA and the second is the presidential election. Mr. Begala’s answer to this question is that no one really knows. One thing that could happen, however, is that we all lose sight as to what Medicaid is really about.

Whether it is a right or a privilege is immaterial to the Medicaid population. They are people who need help accessing and affording essential health care. The debate about how to best pay for this is a legitimate discussion. We have the means and expertise to help those who need it most. That is what everyone at this Congress is focused on. We will be hearing a lot about Block Grants, budget proposals, eligibility limits, constitutional considerations, and campaign promises for the rest of this year. Let’s not let all that talk take away from the real mission at hand.

#MMCC2012: The ACA as an Opportunity for Pharma Companies to Increase the Proper Use of Medication

Monday at the 20th annual Medicaid Managed Care Congress, Cindy Pigg, SVP of Pharmacy at Magellan Medicaid Administration shared that the ACA is the largest opportunity for the pharmaceutical industry since Medicare Part D. By 2019, there’s expected to be more than 25 billion dollars spent on pharmaceutical drugs. This is a huge increase, especially considering during the recession, a lot less people went to the doctor’s office, and of those, a fair amount got prescriptions but never got them filled. Therefore, as a part of the ACA, pharmaceutical organizations have not only the opportunity to grow, but also to give lifechanging medical access to those who have not had access in years.

However, funding is limited, so pharma companies need to demonstrate the increase in the value of the drug (the trifecta of access, quality and cost). States are increasingly looking for comparative effectiveness studies, although at this point the data is quite limited. It doesn’t matter how your drug may hold up against the placebo, what matters is how it increases the patient’s overall health, including patient adherence. Judi Grupp, CEO of Physicians Pharmacy Alliance, suggested that PCMHs and ACOs are one way to increase the patient’s health, and ensure they’re taking the right amounts of the right prescribed medications.

What are other ways pharmaceutical organizations and MCOs can work together to increase adherence?