Health Insurance Exchange Update: Tuesday, July 31, 2012

Wyoming State Flag

States are starting to meet with their task forces to figure out if they want to go forward with implementing the provisions in the health care law. Some states want to appear that they are at least giving an effort in figuring out what to do instead of hoping for that the president loses in the November elections. Others are starting to move ahead and implement the program to have it ready by November 16.

IBM announced that their Curam Social Program Management Platform will be used to verify the eligibility for the 1.2 million Minnesotans seeking health coverage. Minnesota, like other states, will rely on multiple technology vendors. Minnesota already agreed to a $41 million contract with Maximus to create the state’s health exchange website. IBM will work as subcontractors for Maximus in setting this up. The exchange program needs to have a robust infrastructure to support their websites where customers and businesses can compare cost online and get their own health coverage. Minnesota points out that they must achieve certification on their design and development of the marketplace by January 2013. And they hope to have the marketplace up and running by October 2013. To accomplish these goals set out to avoid a federally ran exchange program, IBM will also be working with two other subcontractors: Connecture, which is based in Wisconsin, will provide technical support the enrollment and sales function; and EngagePoint, based out of Florida, will provide financial management module for billing, aggregation, and payment reconciliation. The design of the exchange program will design information systems to see which individuals qualify for tax credits, Medicaid, or cost-sharing reductions. 

Wyoming is still mulling over what to do about health care. According to Billings Gazette, a group selected to figure out the options for the state are still left with one question: How can an exchange program work for Wyoming? Lawmakers told the Wyoming Health Benefits Exchange Steering Committee back in March to stop their work on an exchange program until the health care ruling. Since then, the committee is trying to get all the information possible and they are trying to get some information from the federal government. But some are expressing their frustration with the lack of information given to them from the government. Sen. Ben Laden said that over the last two years, they have been “shooting at a moving target” trying to get the right amount of information needed to make their informed judgment. The committee will meet in the fall. With this deadline, they are hopeful that this would give the Joint Labor, Health and Social Services Committee time to craft bills before their next session the following year. 

Idaho’s health care task force met to discuss the options going forward as well. Many leaders in Idaho are strongly against health care reform including Gov. Butch Otter. Nonetheless, they are still stuck on what their actions are going to be moving forward. One problem they are having is the inability to have credible numbers. Officials are having a hard time figuring out just how much money the exchange program will cost whether the state runs their own or the federal government steps in. In addition to being lost with exchange numbers, officials are unsure of the amount for a potential expansion of Medicaid. But there seems to be an overall agreement that even with those numbers, the minds are already made up about what to do with the provisions in this health care law.

Though states have their own prerogative, a union president voices his opinion on the idea of universal health care. The president of the Wisconsin Farmers Union argued that "rural residents often have the hardest time getting health insurance." People in these areas mostly are self-employed and have their own small businesses. They often pay way too much money on their coverage, so with this bill, it could help those who are self employed pay less for health insurance.

This November, the Health Insurance Exchange Congress will be held November 13-14, 2012 in Chicago, IL.  Here, state officials and health plans with the only opportunity to come together to discuss PPACA and strategize on how to make this a successful opportunity for all.  For more information on this year's agenda, download the program here.  As a reader of this blog, when you register to join us and mention code XP1710BLOG, you'll receive 15% off the standard rate! 

Health Insurance Exchange Update: Monday, July 30, 2012

State Flag of Oregon

States are continuing to weigh the options on what to do with Medicaid expansion and exchange marketplaces. Some governors are still hoping that the defeat of the president would ultimately put an end to the health care law as we know it. Others have decided to try and do something as long as it is till the law of the land. Others are having meetings with officials to try and figure out just how much money will be spent on the expansion and exchanges.

According to Statesman Journal, Sen. Jackie Winters schedules a two-hour meeting summit to clarify what Oregon is doing and what they are not doing with the health care law. Already approved was a new coordinated-care organizations that will bring together doctors, hospitals and other providers in the state. 

But Oregon is a select few who are actually meeting to decide on what to do. Other states like Michigan seem to want to wait although the governor wants to move forward. And the ramifications on what Medicaid expansion means for citizens of a state seem quite staggering. 

Hundreds of thousands will go without health care in Ohio. According to the Columbus Dispatch, if Gov. John Kaisch does not expand Medicaid for the poorest in the state, then 600,000 will be without health insurance. If the Supreme Court did not throw out the provision on Medicaid, there would have been subsidies and tax credits for low-income individuals. But since the expansion is not mandatory, the 789,000 Ohioans, which also includes the 600,000 low-income individuals, would have gotten health insurance but instead are going to be without insurance. The governor, like so many, is on the fence about what to do. Thought eh federal government will cover all expenses for the first three years and at least ninety percent the next year, reducing its involvement over time.  There are still concerns over how much a state will have to pay down the road. The state will be meeting to go over their budget for the next two years. 

A study done by the New England Journal of Medicine found that Arizona went as far as to say that Medicaid expansion causes fewer deaths in the state. Not all that surprising but when expansion occurred in 2001, citizens were healthier when it was expanded. The study was done to predict the future of states if they were to expand on Medicaid. 

Oklahoma is still refusing to budge on their stance when it comes to healthcare reform. According to The Washington Post, Oklahoma is a state that strongly dislikes strong arm government so much that the state cannot even get residents to buy car insurance. The state is among the highest of residents without car insurance. The state has already rejected the $54 million grant the federal government gave to start up the exchange marketplace. But the factors that are deeply rooted in the culture of Oklahoma certainly rings true to other states in this country and the most important one seems to be don’t tell me what to do. One man mentioned in the piece went as far as to say insurance is nothing but a “concept based on fear.” A notion that may be true, you fear that you would be in a car accident so as a precaution, you get coverage. Though it may be out of fear, could it also be a concept based on planning ahead? 

This November, the Health Insurance Exchange Congress will be held November 13-14, 2012 in Chicago, IL.  Here, state officials and health plans with the only opportunity to come together to discuss PPACA and strategize on how to make this a successful opportunity for all.  For more information on this year's agenda, download the program here.  As a reader of this blog, when you register to join us and mention code XP1710BLOG, you'll receive 15% off the standard rate! 

MDRP Spotlight Video: Veterans Affairs Pricing Compliance Management Improvements

Today we feature the presentation "Veterans Affairs Pricing Compliance Management Improvements" from the Medicaid Drug Rebate Program 2011.  The featured speaker in this presentation is Mark Myers, Director with the Office of Contract Review, Department of Veterans Affairs, Office of Inspector General.  Highlights of his presentation include: Reviewing the Computation of non-Federal Average Manufacturer Prices (nFAMP), Ensuring correct Commercial and Government Pricing Policies & Selling Practices and more

This year at the Medicaid Drug Rebate Program, Allison Pugsley, Counsel, Hogan Lovells will be presenting "Understand Current Updates on the Veterans Health Care Act/Federal Supply Schedule." For more information on this session and the rest of the program, download the agenda. If you'd like to join us this September 10-12, 2012 in Chicago, IL, register to join us today and mention code XP1725BLOG to save 25% off the standard rate!

Health Insurance Exchange Update: Wednesday, July 25, 2012

Idaho State Flag

The Congressional Budget Office came out with how much the health care law will save the country money the next ten years. According to the report, the health care law will save $84 billion dollars over the next eleven years. The report also indicates that since the Supreme Court ruled that it is unconstitutional for the government to withhold aid if a state does not expand Medicaid, there will be 3 million people who will be without health insurance. Even with these numbers, there is no telling what may occur ten years from now that could severely alter the numbers for better or worse.

Though the CBO came out with their budget about the health care law, states are trying to figure out what should be done about the ACA. 

Michigan’s Republicans want to wait and see what happens in the November elections. This stance leaves Gov. Rick Snyder frustrated in trying to move forward with establishing their won exchanges. Not only is it getting under the skin of the governor, House Democrat floor leader Kate Segal wants to get the exchanges set up before January 2014. According to Michigan Radio, Segal believes that the state not moving forward to create their own exchanges will not leave them a whole lot of time to set up the exchanges. Segal also wants the state to have their own exchanges instead of having the federal government using their own plan and not knowing what they will do. The governor has made attempts to talk with the Democrats in state office about setting up the exchanges but Segal thinks the Gov. Snyder should meet with them a little more. Hearings are going to be heard tomorrow to discuss what direction the state will go regarding the health care law. 

Idaho is trying to figure out how the health care law will affect the state. According to Times News, Gov. C.L. Otter hired two working groups to analyze and to make recommendations on whether or not the state should set up their own exchange program and expand Medicaid. In addition to that, there will be a legislative Health Care Task Force that will meet in the coming weeks also to discuss the what actions are needed to be taken because of the health care law. 

New Hampshire is also looking at what to do moving forward with the health care law. But according to NPHR, the pressing question which will be for all states but for their Joint Health Care Reform Oversight Committee, their problem will be Medicaid expansion. Gov. John Lynch already signed legislation blocking the creation of state-run exchanges, already rejecting one provision in the law. Senate Majority Leader Jeb Bradley, a Republican who chairs the Senate Health and Human Services Committee, says there are too many unanswered questions about who will be paying for the bill.

This November, the Health Insurance Exchange Congress will be held November 13-14, 2012 in Chicago, IL.  Here, state officials and health plans with the only opportunity to come together to discuss PPACA and strategize on how to make this a successful opportunity for all.  For more information on this year's agenda, download the program here.  As a reader of this blog, when you register to join us and mention code XP1710BLOG, you'll receive 15% off the standard rate! 

Look Who's Attending the Medicaid Drug Rebate Program Summit

Who can you meet at Medicaid Drug Rebate Program this September?

Here are a few companies that will be joining us in September:

Eli Lilly & Company, Allergan, Novartis Pharmaceuticals Corporation, Cornerstone Biopharma Inc , Lundbeck LLC, Cornerstone Biopharma Inc, Daiichi Sankyo Inc, Takeda Pharmaceuticals USA Inc, West -Ward Pharms, Prasco, Upsher Smith Laboratories, Baxter International Inc, Teva Neuroscience Inc, BD Medical Pharmaceutical Systems, Becton Dickinson Medical - Diabetes Care, Purdue Pharma LP, Alexion Pharmaceuticals Inc, Jazz Pharmaceuticals, Forest Laboratories Inc, Bio Marin Pharmaceutical Inc, Pfizer Inc - Legacy King, Mylan Pharmaceuticals Inc, Shire Pharmaceuticals, Elan Pharmaceuticals, Gilead Sciences Inc, Perrigo Pharmaceuticals, Vertex Pharmaceuticals Inc and more!

View the Complete Attendee List including Attendee titles.

So many of your peers have registered for the 17th Annual Medicaid Drug Rebate Program Summit that the Swissotel Chicago is almost completely sold out. That’s including the rooms not in our block! We’ve been able to secure some additional rooms but in order to take advantage you must register now.  As a reader of this blog, you receive an exclusive discount of 25% off of the standard rate 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.

Health Insurance Exchange Update: Tuesday, July 24, 2012

North Dakota State Flag

As the days become weeks and weeks become months, states are either waiting or moving on with the exchanges and Medicaid expansion. But some are bringing up the fact that states should go on start on the exchange program and on the Medicaid expansion. Timothy Noah of The New Republic argues that Medicaid expansion provided in the health care law should be federalized. But the Supreme Court ruled that the government cannot make the state expand Medicaid. So more states are opting not to expand if they're not forced to. But Noah writes that the expansion will not put a dent so to speak in the debt of the states.

North Dakota is going back and forth between whether or not to set up the state-run exchanges. According to The Jamestown Sun, the GOP state officials are strongly opposed to setting up the exchanges. Last November, the House voted 64-30 against setting up the exchanges. The conservative leaders did not want to be in support of a law that they saw was going Gov. Jack Dalrymple stands firmly as he will not implement any portion of the health care reform law. Supporters of the law are echoing the same sentiment as every other supporter by saying that the state is better off creating their own plan instead of the federal government. The same goes for those who oppose the law. Brett Narloch said that since it a federal program, it should be run by the federal government. 

Wyoming is a state that has decided to follow the lead of the state attorney general of Virginia: do nothing. According to the Wyoming Business Report, they along with nine others have decided not to set up their own exchanges but it seems like Gov. Matt Mead has decided to see what the options are regarding the setting up of the exchanges and Medicaid. The state created forums for individuals who are concerned about the Medicaid expansion. In addition, Wyoming has begun looking into options for exchanges. Because Wyoming has a unique situation (large state, small population) and the governor wants to make sure he sets up the right exchange for his state. He even expressed this same sentiment in a letter to the Secretary of the US Department of Health and Human Resources Kathleen Sebellius. 

Nebraska’s state insurance officials said that the state have begun efforts in implementing exchanges. But , according to CBS News, there are some who are questioning Gov. Dave Heineman can fulfill the requirements without calling a special session. Bruce Ramage, director of the Department of Insurance, has said that Nebraska is making strides to have their own exchange set up for the future. But Sen. Paul Schumacher wonders if the governor, who opposes the law, has the authority to use his executive order to have the implementations or whether they need legislation.

This November, the Health Insurance Exchange Congress will be held November 13-14, 2012 in Chicago, IL.  Here, state officials and health plans with the only opportunity to come together to discuss PPACA and strategize on how to make this a successful opportunity for all.  For more information on this year's agenda, download the program here.  As a reader of this blog, when you register to join us and mention code XP1710BLOG, you'll receive 15% off the standard rate! 

Health Care Insurance Exchange Update; Monday, July 23, 2012

State Senators and Governors are waiting November 6 to see who will be our president. Those who are beginning or have already set up exchanges for their states are in the minority. But most states are waiting and crossing their fingers to see whether or not President Obama or Mitt Romney will win the election.

Virginia State Flag

According to the Washington Post, Virginia state attorney general Ken Cuccinelli II came up with a strategy that is not new but has decided to join the bandwagon in doing his: do nothing. But, Cuccinelli believes that he has found a mistake in the wording of the law. He mentions that the law states that the penalty for those who do not have health care are not imposed if the exchanges are set up by the federal government. Cuccinelli believes that he has found the silver lining to striking down the health care law. This gaffe in wording has been identified by supporters of the bill and said that the state attorney general’s attack on the bill is nothing but wishful thinking. While others who are staunch opponents of the bill are saying this very thing could bring down the bill. 

But there is a rather surprising voice that is urging states to set up their own state-run exchanges.

Michael O. Leavitt, a top aide for Mitt Romney runs a consulting firm in his spare time when called Leavitt Partners who actually advise and help states set up their own exchanges. According to The New York Times, H\he has advised states like Pennsylvania, New Mexico, Mississippi among others despite the fact that the majority of that he is a top aide for a Republican nominee who has said on multiple occasions that the first thing he will do is to repeal the health care law. But he wants states to set up their own exchanges so that that they will not have to rely upon the federal government to use their template. And with this news, there are some questions surrounding the Romney campaign about his stance. However, in a blog post Director of Leavitt Partners Daniel J. Schuyler said that regardless of your opinion of the health care law, exchanges just make sense.

This November, the Health Insurance Exchange Congress will be held November 13-14, 2012 in Chicago, IL.  Here, state officials and health plans with the only opportunity to come together to discuss PPACA and strategize on how to make this a successful opportunity for all.  For more information on this year's agenda, download the program here.  As a reader of this blog, when you register to join us and mention code XP1710BLOG, you'll receive 15% off the standard rate! 

State Spotlight: Connecticut’s Health Insurance Exchange

Connecticut State Flag

Before the SCOTUS ruling, health plan C-level executives and government programs and policy officials could only discuss what their exchange strategy should be, as the future of exchanges was uncertain. Since SCOTUS upheld the PPACA, more departments are joining the conversation as health insurance exchanges move from strategy to implementation.

At the 2nd Annual Health Insurance Exchange Congress, you will learn how to prepare for the opportunities and challenges created by health insurance exchanges. Hear from states that are at different points of preparedness to better understand what they think is most important.

If you are still strategizing how to build an exchange strategy, the Special Advisor to the Governor of Connecticut will share how the state made up for lost time in its development of its exchange in the State Spotlight: Connecticut.

Presentation: Road to Development: From a Late Start to a Leading State from Jeannette DeJesús, Special Advisor to the Governor, Office of Health Care Reform & Innovation

The Connecticut Health Exchange held its first board meeting in late 2011, with the mission to create an innovative, competitive marketplace that empowers consumers to choose the health plan and providers that give them the best value. Although they started slowly, Connecticut is making up time with regular meetings focused on different aspects, such as QHPs, SHOP exchanges and defining Navigators.

• • Identify how CT streamlined administrative processes
• • Understand how working with outside contractors can help move the process along
• • Hear where the board could have made further improvements

For more on this event, visit the webpage to download the agenda.

The Health Insurance Exchange Congress will take place November 13-14, 2012 in Chicago, IL. As a reader of this blog, you’ll save 15% off the standard rate when you register to join us and mention code XP1710BLOG! If you have any questions about the program, feel free to email Jennifer Pereira.

Health Insurance Exchange Update: Wednesday, July 18, 2012

Mississippi State Flag

It may seem that more states are coming around to setting up exchanges. Though they may not be the biggest supporters of the law, they realize that it is the law. Mississippi is one of these states. They are done with their exchange marketplace according to the Insurance Journal. Mississippi Insurance Commissioner Mike Cheney said that the marketplace is set up and will be ready for Mississippians to be insured.  Chaney believes that nothing more needs to be done. Many people, including Gov. Phil Bryant want Cheney to stop working on the marketplace. But Cheney, who is not a fan of the law, said this is the law until further notice.

But other states are left in complex situations and uncooperative state officials regarding the exchanges.

Alaska will be another state that has opted not to create health exchanges. According to Juneau Empire, Alaska Gov. Sean Parnell stated that the state will instead allow the federal government to set up the exchanges. Gov. Parnell feels that his state should not be spending taxpayer money when “so much uncertainty exists about how to implement it.” Alaska was one of the plaintiffs in the lawsuit against the health care law. Chair of the Senate Health, Education and Social Services Committee, Sen. Bettye Davis, is not thrilled about what the governor had to say regarding the exchanges. She much rather had the exchanges be “local” rather than having the federal government use their plan. But the governor’s philosophy is crystal clear by saying that federal mandates “should be paid by the federal government.” 

Indiana Gov. Mitch Daniels is stuck in a quagmire with the setting up exchanges for the state. Ventura County Star reports in his second term and unable to run again for office, Gov. Daniels is now talking with his potential successors to see whether or not he should set up the exchanges for the state. States must send in a plan to the federal government by November 16. Gov. Daniels does not want to put other governors in a bind when the law goes into action in 2014. Daniels will be meeting with Libertarian Rupert Boneham, Democrat John Gregg, and Republican Mike Pence to figure out what they want to do with setting up the exchanges. 

Michigan’s Republican lawmakers have decided that they will not act on whether or not to accept federal aid. According to the Detroit News, the government gave Michigan Gov. Rick Snyder $9.8 million to set up the state’s exchange marketplace. But the House Republicans have elected not to act on the issue when they meet today. The Republican controlled Senate allowed the governor to take the money but with the need of bipartisan support, the House decided to go the opposite way. The state cannot spend the money unless they have legislature approval. 

This November, the Health Insurance Exchange Congress will be held November 13-14, 2012 in Chicago, IL.  Here, state officials and health plans with the only opportunity to come together to discuss PPACA and strategize on how to make this a successful opportunity for all.  For more information on this year's agenda, download the program here.  As a reader of this blog, when you register to join us and mention code XP1710BLOG, you'll receive 15% off the standard rate! 

What does the Affordable Care Act mean for Drug Manufacturers?

This post was authored by the Medicaid Drug Rebates Program Summit Producer, Heather King. You can follow her on Twitter at @HeatherIIR.

Did you breathe a sigh of relief on June 28 when the Supreme Court left PPACA mostly as it originated?

Do you think that decision means things are status quo? After all, there’s no Final Rule for the AMP Guidance yet and PPACA was (mostly) upheld, so why take time out of your busy schedule to attend an event like ours?

The answer is simple: There is no such thing as the status quo when it comes to public sector reimbursement programs for the pharmaceutical industry.

Anyone who has been working in this space for long enough knows that little technical, policy or operations changes can make a huge difference in doing business. And not only do we have these “little” changes, but the one provision in PPACA that SCOTUS did amend will have a huge impact on how you do business in the coming years – States’ participation in the expansion of Medicaid is now OPTIONAL.

We work in Medicaid Drug Rebates. Every person in every state (and DC) that uses Medicaid affects our prices, our forecasting, and our bottom lines. How can we anticipate an expansion and all its implications when we don’t even know which states will choose to expand the program? The figure can be upwards of 17 million additional Americans that we have to provide products for. This uncertainty could be crippling to our organizations.

At the 17th Annual Medicaid Drug Rebate Program Summit, we pride ourselves on bringing a clarity to our audience unsurpassed in the industry from every side of the MDRP Space.

• - If you have policy, technical or operational questions about a government program, we have CMS, OPA, Part D and OIG representatives on hand to answer them.
• - If you have questions on interpretation of rules, or best practices for dealing with all the paperwork involved in rebating, or accruing and accounting for liability, we have the leading legal and financial consulting firms, and service providers in the business.
• - If you have questions on what your peers are doing and what’s working and what’s not, we have more senior branded and generic manufacturer executives on hand to give you practical information than any other event in the country.
• - And if you want to know what the States are doing, and how they see the next few years playing out in their state regarding the expansion, we have more State Medicaid Rebate specialists than any other event, and we are the ONLY event that assists with dispute resolution.

Find out more about this year’s program by downloading the agenda.

As a reader of this blog, you receive an exclusive discount of 25% off of the standard rate 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.

Health Insurance Excahnge Update: Tuesday, July 17, 2012

Ohio State Flag

States are beginning to set up their exchanges to meet be prepared in case of another four more years of the current president. But while some are more open, others have gotten some backlash even when they receive federal grants for the exchanges.

Ohio recently received $1 million from the federal government and then is receiving some backlash. According to the Columbus Dispatch, Supporters of the health care law are saying that Gov. John Kasich’s administration is playing politics with the taxpayers. However, the governor previously stated that the state will take the federal option because it would cost less. 

Minnesota reached an agreement with a Virginia-based firm Maximus firm to design health insurance exchange. According to Minn Post. The agreement will total $41 million. Maximus will be responsible for developing the technology to support the exchanges. Maximus will also include elements like eligibility determination, account determination, and health provider information. In addition, the contract instructs Maximus to improve the technology for Medicaid. The Commerce Department says that the exchange will help lower premiums, provide coverage for 300,000 by 2016 and significantly expand federal Medicaid coverage. But Republicans in the state are wondering whether the exchanges will produce any good that the governor’s administration says will happen. They also wonder whether an exchange can be implemented without legislation approval. The contract is expected to run through 2014 but that could continue. Commerce Commissioner Mike Rothman said that the state actually got a great deal to set up the exchanges. 

California wants to make buying health insurance easy. According to the Sacramento Bee, Peter V. Lee, head of the California Health Benefit Exchange, wants buying health insurance to be equivalent to “buying a book to Amazon.” He envisions that in 15 months, uninsured California residents will log onto computers to shop for their health care. The plans will have the “platinum” plan which has higher premiums to “bronze” plan which offers lower premiums. The exchanges are expected to reach 2 million uninsured people by 2019. California now is trying to figure out ways to get people using the exchanges. The exchanges are set to have people registered by October 2013. To get people insured, they have thrown around ideas such as having ads in English and Spanish, banners on Facebook, and have churches distribute literature. But, they also want to go even more outside the box. They have an idea of pitching to popular television like “Modern Family” and incorporate healthcare changes in story lines.

This November, the Health Insurance Exchange Congress will be held November 13-14, 2012 in Chicago, IL.  Here, state officials and health plans with the only opportunity to come together to discuss PPACA and strategize on how to make this a successful opportunity for all.  For more information on this year's agenda, download the program here.  As a reader of this blog, when you register to join us and mention code XP1710BLOG, you'll receive 15% off the standard rate!  

Health Insurance Exchange Update: Monday, July 16, 2012

Kentucky State Flag

States have little time to sit back and weigh options as it pertains to setting up exchanges. There are deadlines that need to be met and they are approaching fast. Nonetheless, some governors are still waiting until the November election, some are doing number crunching to find out what this will do to the state budget, others are trying to get the ball rolling as soon as possible. Other than Wisconsin not doing anything regarding implemented the exchanges, states like Virginia and Nebraska are now waiting until this November according to the Chippewa Herald. Fearing over hurting state budget combined with hope of a new president, governors are not budging from their stance. But the more times passes, the less time states have to create a marketplace tailor-made for their state.

Met with the reluctance from health care opponents, Michigan Gov. Rick Snyder will have to get the House Republicans on board with creating the exchanges. According to the Daily Press, the House blocked the administration’s effort to receive $9 million dollars in federal money until after the ruling. But now that the state was granted the money, the governor is hoping that the House like the Senate will approve of the exchanges to put the funding in use. Even while Michigan is attempting to run their own exchanges, they are in contact with the federal government about a possible partnership.

Wyoming will take cautious steps in implementing the exchanges. According to Wyoming News, the state wants to gather information and see what are the necessary steps are needed to make the right decision for the state. Anne Ladd, the chief executive officer of the Wyoming Business Coalition on Health brought up the fact that Wyoming was far behind other states. She believes that the State and federal government will have a partnership for 12 to 36 months and then the state will be on their own. 

Kentucky Governor Steve Beshear alerted the federal government that he will set up state-run exchanges according to ABC News. Gov. Beshear sent the letter to Health and Human Services Secretary Kathleen Sebellius to tell her of his plans for the exchanges. After the Supreme Court ruling, the governor said that the state would move ahead in creating the exchange for Kentuckians. The governor also had some of his Kentuckians that they wanted the exchanges set up for their benefit. Kentucky is the 16^th state to set up the state-run exchanges.

This November, the Health Insurance Exchange Congress will be held November 13-14, 2012 in Chicago, IL.  Here, state officials and health plans with the only opportunity to come together to discuss PPACA and strategize on how to make this a successful opportunity for all.  For more information on this year's agenda, download the program here.  As a reader of this blog, when you register to join us and mention code XP1710BLOG, you'll receive 15% off the standard rate! 

Learn How Government Drug Pricing Affects Your Bottom Line

Pharmaceutical financial executives have a lot on their plates. You are responsible for understanding how each expense impacts your company’s bottom line. With government rebate programs affecting those bottom lines, it is imperative that you understand how major events like Healthcare Reform can be quantified and how those quantifications have financial and operational impacts on your company.

At the 17th Annual Medicaid Drug Rebate Program Summit, September 10-12, 2012 in Chicago, IL, you will learn from industry experts how to apply your knowledge - and theirs – of the rebate area to improve your financial forecasts.

In our exclusive track, “Financial Implications of MDRP and Other Government Pricing Programs,” you will hear from leading industry experts on these topics:

• - Understand and Predict the Financial Opportunities and Impacts of Medicaid Compliance
• - Understand the Impact of Actual Acquisition Cost on Contracting and Brand Reimbursement
• - Learn Best Practices for Handling Data Growth
• - Develop Best Practices for Recalculations

For more information on the sessions in this track and the rest of the agenda, download the brochure. 


As a reader of this blog, you'll 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 contact Jennifer Pereira.

MDRP Session Spotlight: Legal Roundtable—Current Legal Trends Affecting Pharmaceutical Manufacturers

If there is one thing that is certain in the pharmaceutical industry, the in-house counsels have their hands full. Regulations are changing all the time and they have to make sure they understand every nuance to ensure their companies remain compliant. At the 17th Annual Medicaid Drug Rebate Program Summit, in-house counsel from Bristol-Myers Squibb, Pfizer, and Eli Lilly will participate in an exclusive panel discussion on the issues they find the most challenging. They will discuss:

• • The challenges raised by CMS’ Proposed AMP Rule and any agency updates available
• • Discreet legal issues affecting branded and generic products
• • Best practices in dealing with GP-related compliance issues, including changes in laws, policy documentation, system issues and making GP more accessible to colleagues

It’s a session not to be missed, especially since they will be following sessions from the OIJ and DOJ on criminal and civil enforcement activities happening in the MDRP space. Come join us in Chicago September 10-12!


For more information on this session and the rest of the program, download the agenda.  As a reader of this blog, when you register to join us and mention code XP1725BLOG, you'll save 25% off the standard rate!  If you have any questions about the Medicaid Drug Rebate Program, feel free to email Jennifer Pereira.

Health Insurance Exchange Update: Wednesday, July 11, 2012

Nevada State Flag

Today, the House will vote on repealing Affordable Care Act. This will not be the first time the House has voted to repeal this according to the Washington Post. This has occurred 32 times already, this will be number 33. There are however those in state offices who are electing to take action or gather all the information to figure out the full implications regarding the exchange marketplace.

The letter sent to 12 Senators and 61 House Members minutes after the health care law was upheld was signed by those who opposed it, Nevada elected not to sign the letter. As one of the 26 states that challenged the constitutionality of the law, Nevada will go ahead and begin to set up health insurance exchanges. Gov. Brian Sandoval moved forward with implemented the law his first day in office back in January of 2011. The governor expressed some concern over the constitutionality of certain parts but he realized that as long as the law is enacted, there were deadlines to meet. Nevada was awarded approximately $24.7 million in grants for to set up the exchanges. Nevada’s exchange is set to be operational by October of 2013. 

Gov. Mark Dayton of Minnesota sent a letter to Republican legislators to ask them to participate in helping create health insurance exchanges. However, a key senate leader wants to wait until the November election to begin implementing the provisions in the healthcare law. Gov. Dayton wants to urge state officials to act on this provision now or they will be forced to having to use exchanges set up by the federal government. But there are still proponents of the bill who want answers. Sen. David Hann wants to know how this is going to be affordable. Sen. Hann believes that exchanges will cost anywhere from $300 million to $400 million per year. Regardless of the opposition, the governor will be trying to move forward. 

Idaho Gov. Butch Otter wrote an op-ed piece sent out to various media outlets explaining that he will get all the facts about the exchanges before he does anything. He does not want to join other GOP governors who will continue to fight against the law and hope for a Mitt Romney win in November. But as Otter expressed in his piece, he wants to do what’s best for his constituents. 

Maryland’s governor, Martin O’Malley, is on track to establish the state run exchanges according to Youth Today. The early action taken by the governor has led to the creation of Maryland Health Benefit Exchange as a public corporation back in April 2011. Maryland Legislature approved policies for the state run exchanges. 

This November, the Health Insurance Exchange Congress will be held November 13-14, 2012 in Chicago, IL.  Here, state officials and health plans with the only opportunity to come together to discuss PPACA and strategize on how to make this a successful opportunity for all.  For more information on this year's agenda, download the program here.  As a reader of this blog, when you register to join us and mention code XP1710BLOG, you'll receive 15% off the standard rate! 

Health Insurance Exchange Update: Tuesday, July 10, 2012

Delaware State Flag

House Republicans are going to vote on the Patient Protection and Affordable Care Act tomorrow. It will most likely be ruled in favor of repeal but they need the Senate. The House’s motion will be dead on arrival. Besides the battle still being waged on Capitol Hill, there is a state that is having internal issues.  

Missouri's state officials are arguing over the semantics of their ballot summary. The state are holding a vote in November on a bill that would stop Democratic Gov. Jay Nixon from setting up health insurance exchanges without the consent of state legislature or state voters. So now the Lt. Gov. Peter King said that he will file a lawsuit citing that the summary is biased.

So with staunch opponents of the bill will wait until the November election to do anything and a state fighting amongst themselves, other states are beginning to set in motion their own exchanges. 

In Indiana, JA Benefits, a benefits provider, has begun creating their own health insurance exchange. Called JA Exchange, the exchange will help individuals compare options. The exchange will receive quotes in seconds by filling in the right information. Private exchanges like JA Exchange will be the force in the marketplace. 

Kansas seems to be in a bit of a bind with the outcome of the ruling according to Kansas Watchdog. Gov. Sam Brownback decided not to accept the $31.5 million provided by the federal government to establish exchanges. He and 22 other governors involved in the lawsuit against the bill banked on the Supreme Court striking down the law. And that did not work out too well. So now what? That is the question the governor is up against at the moment. A scramble would be on to create the exchanges themselves but the Head of Insurance Department Accident and Health Division Linda Sheppard believes that there are three choices to be made. One choice is to use the amount of time they have left to set up their own exchanges. There second choice is to cut a deal with the federal Health and Human Services regulators. With this, the federal government will set the rules and then Kansas would enforce. The third choice is to allow federal regulators to run the exchanges. 

Delaware has one foot in and one foot out. Democratic Gov. Jack Markell is unsure whether they want to expand Medicaid in their state. And since the Supreme Court ruled that the government could not withhold money if a state does not expand Medicaid, the state is weighing their options. As far as setting up the exchanges, the process is underway. But because of the state’s small size, it intends to have federal regulators take over operational duties. 

This November, the Health Insurance Exchange Congress will be held November 13-14, 2012 in Chicago, IL.  Here, state officials and health plans with the only opportunity to come together to discuss PPACA and strategize on how to make this a successful opportunity for all.  For more information on this year's agenda, download the program here.  As a reader of this blog, when you register to join us and mention code XP1710BLOG, you'll receive 15% off the standard rate!

MDRP Spotlight Video: Current Civil and Criminal Enforcement Activities to Improve Corporate Compliance

Last year at the Medicaid Drug Rebate Program 2011, Viveca D. Parker, Assistant United States Attorney, United States Department of Justice, F. Elizabeth Lepic, Assistant Attorney General, MFCU, Office of Attourney General,  Virginia A. Gibson, former Executive Assistant U.S. Attorney for the Eastern District of Pennsylvania Litigation, Arbitration and Employment Practice Group, Hogan Lovells US LLC presented "Current Civil and Criminal Enforcement Activities to Improve Corporate Compliance."

In their discussion, they look at the current state of Medicaid Fraud and current enforcement activities from the Fraud Enforcement Recovery Act and other issues and reasons why the government starts investigations into Pharma companies.



This year at MDRP 2012, Marilyn May, Healthcare Fraud Coordinator, Assistant United States Attorney, United States Department of Justice and returning speaker Virginia "Ginny" Gibson, Partner, Hogan Lovells , LLP will be on hand to present the current state of legal enforcement in 2012, "Current Criminal and Civil Enforcement Activities to Improve Corporate Compliance."  For more information on this presentation and the rest of the program, download the agenda.  If you'd like to join us this September for the event, register today and mention code XP1725BLOG and save 25% off the standard rate!

Health Insurance Exchanges Update: Monday, July 9, 2012

Arizona State Flag

Now that the law has been upheld, there are still some mixed feelings among politicians. Described in a write-up in the New York Times, state officials opposed to the law are turning their attention to the exchanges. Critics are trying to figure out if subsidies are still offered if a state fails to set up their own exchanges.

And now that there will be a vote on the bill in the House this coming Wednesday, critics of the bill are trying anything to strike down this law. 

In New York, Gov. Cuomo said that he is not open to revisiting health insurance exchanges according to the New York Daily News. The statement came after Republican State Senate Health Committee Chairman said that there may be legislative approval to set up the exchanges. This is relatively odd since the GOP decided not to pass a bill and when Cuomo decided to use his executive order, there
 were no objections.
 

In Arizona, the idea of health exchanges is still left for grabs according to the Arizona Capital Times. House Speaker Andy Tobin said that he would like to wait for the November election to set up the exchanges. But the Gov. Jan Brewer has decided to go the other way on this. Arizona has taken $30 million to startup the state run exchanges. Her administration had been setting up their own exchange for months but to try and persuade legislatures will be a difficult task for the governor. But by the looks of the work of the governor, she does not want the federal government to have their exchanges in Arizona.

 

In Texas, Governor and former Republican presidential hopeful Rick Perry made his stance crystal clear when he issued a statement to the U.S. Health and Human Services Secretary. Under the law, if a state refuses to set up the exchanges, they will instead have to use the plan the federal government has set up. As for the expansion of Medicaid, the Supreme Court found it unconstitutional for the government to withhold money if it is not used to expanding Medicaid. So according to the Houston Chronicle, Rick Perry like so many others have decided not to do anything regarding setting up exchanges or expanding Medicaid in his state. Perry believes that state exchanges nor Medicaid expansion will result in affordable care.

Oklahoma is doing the exact same thing when it comes to rejecting the exchanges, according to the NewsOK. Directly after the health care ruling, Rep. Michelle Bachman and Senator Jim DeMint sent a letter out to the National Governors Association telling them to not implement any of the provisions in the health care law. Sen. Tom Coburn of Muskogee in Oklahoma was one of the many state officials who signed the agreement. Reportedly, he told the co-chairman of the legislative committee back in 2011 to look into setting up an exchange program reminiscent of Utah’s. But Coburn had a change of heart and said that the state not starting up exchanges is not a cause for concerns. Governor Mary Fallin however, has not decided on what to do exactly with exchanges and Medicaid expansion. Though not a fan of the exchanges, she did at one point in time accept the money to start up an exchange program but nothing has been done since.

This November, the Health Insurance Exchange Congress will be held November 13-14, 2012 in Chicago, IL.  Here, state officials and health plans with the only opportunity to come together to discuss PPACA and strategize on how to make this a successful opportunity for all.  For more information on this year's agenda, download the program here.  As a reader of this blog, when you register to join us and mention code XP1710BLOG, you'll receive 15% off the standard rate!

Where do governors stand on the expansion of Medicaid?

The one part of the Affordable Care Act that was struck down was the automatic expansion of state's Medicaid or being penalized by the government. Healthwatch recently profiled where state governors stood on the matter. There have been seven Republican governors that have said no: Florida, Iowa, Kansas, Louisiana, Nebraska, South Carolina, and Wisconsin. Many of those governors, in addition to the eight who seem unlikely to expand, believe it will cause significant distress to their states budgets. In the original form of the Affordable Care Act, the government would have subsidized the expansion of Medicaid for several years. The states that have confirmed they will expand Medicaid are California, Connecticut, Hawaii, Illinois, Massachusetts, Minnesota, Maryland, New York, Oregon, Rhode Island, Vermont and Washington.

This expansion - or lack thereof - has a direct impact on pharmaceutical manufacturers' bottom lines. The number of people who will be added to the Medicaid program will significantly impact the rebates and reimbursement sector. At the 17th Annual Medicaid Drug Rebate Program Summit, not only will the leaders from the major pharmaceutical manufacturers be in attendance to discuss how they are anticipating the expansion, but many states, including Florida, Illinois, Oregon and and North Carolina will be on hand for face to face discussions.  For more information on the program, download the agenda.  If you'd like to join us in Chicago September 10-12, 2012 in Chicago, as a reader of this blog when you register and mention code XP1725BLOG, you'll save 25% off the standard rate.

What does the exchange actually look like?

Yesterday at NPR, host Melissa Block sat down with Adam Weil, executive director of the National Academy for State Health Policy. They discussed the current state of health exchanges and what they'll look like. They cover how the exchanges will be set up and the dynamics of the exchanges.  They also discuss how stats will have to manage the exchanges - whether or not they have begun creating them.

Listen to the podcast here:




This fall at the Health Insurance Exchange Conference, learn directly from the
states and plans with the most experience in exchanges as they share best practices and lessons learned, which will speed up your exchange strategy so market share is secured from the outset. HIX will take place November 13-14, 2012 in Chicago, IL. For more information on this program, download the agenda. If you'd like to join us, register today and mention code XP1710BLOG and save 15% off the standard rate!

Health Insurance Exchange Update: Thursday, July 5

Virginia State Flag

In today's update, we see many states putting off the exchange. We also see how other professionals such as accountants are directly affected by the law. To see the progress of each state exchange, visit Kaiser's Health Reform Source.

In Maine, there is no strategy to create an exchange before 2014.  The Bangor Daily News believes that the state will ultimately have to rely on the federal exchange.  This opinion piece urges the state law makers to begin looking into an exchange, as they believe a federal exchange would not take into account many of the state-specific healthcare demographics such as small businesses.

Virginia has created a committee Sen. Richard Stuart, R-Stafford, was appointed to Virginia Health Reform Initiative’s advisory council, along with Joe Wilson, a Fredericksburg businessman. According to Fredrickburg.com, they've been working with everyone affected (including insurance companies, businesses, advocacy groups, patients’ rights groups, doctors, hospitals) in the state to develop an action plan for the exchange. They believe they have the bare skeleton to the future exchange.

There will be a new face of the law according to Accounting Web.  CPAs will be put in the center of healthcare reform.  Every income tax the prepare will now have to include the question "Do you have health insurance?"  They will be the ones adding the line item of the tax and will ultimately be put at the center of political discussions, which CPAs have never had to deal with before.

This November, the Health Insurance Exchange Congress will be held November 13-14, 2012 in Chicago, IL.  Here, state officials and health plans with the only opportunity to come together to discuss PPACA and strategize on how to make this a successful opportunity for all.  For more information on this year's agenda, download the program here.  As a reader of this blog, when you register to join us and mention code XP1710BLOG, you'll receive 15% off the standard rate!

Health Insurance Exchange Update: Tuesday, July 3, 2012

Florida State Flag

In an effort to exercise their ability to be the uncooperative partner, 12 senate and 61 House members sent out letters to governors telling them to rebel against the Affordable Care Act. One man in particular is taking this to heart where as some are weighing options and very few are ahead of the curve. 

Florida Gov. Rick Scott stated soon after the health care ruling said he rejected health insurance exchanges. Now the governor has come out and said that he will also not be expanding Medicaid as well according to The New York Times. The governor cites that the state will have too much of a burden expanding Medicaid for his citizens. Even though the government will cover all costs for new people under Medicaid from 2014 to 2016, he believes that after those three years the tax payers will have the burden of paying a substantial amount. But there are some who have begun to critique what exactly Scott said while making his rounds on national television. Whether it is from the amount of money Florida will pay to the idea or rationing of the health care, there are some regarding his comments as false on off base with what the health care law actually does. 

North Dakota is one of 36 states that must decide whether or not to take the lead in creating health insurance exchanges, according to the Jamestown Sun. Their legislator decided to have the federal government lead them in establishing exchanges. Under the current deadlines, North Dakota may not have enough time unless they receive conditional approval from the government. Blue Cross Shield of North Dakota are exploring the possibility of having a standby template incase the government offers an extension. But if the state is not offered an extension, then the state will have to use the federal government’s exchange program. 

Gov. Chris Christie of New Jersey is deciding whether or not he will also use the federal government in order to set up exchanges, claiming that this would be good for the state. He has also mentioned that Medicaid in New Jersey is already inclusive and that the federal government should give money to states for Medicaid with no strings attached, according to NECN.

Taking the initiative into his own hands, New York Governor Andrew Cuomo decided to use an executive order in order to comply with the health care law back in April. Now they are one of the few states ready for when most of health care law goes into act in 2014. Of the 2.7 million people who are uninsured, 1 million will be able for exchanges, 700,000 are immigrants who will not be covered and the remainder will receive Medicaid coverage according to Democrat and Chronicle.

This November, the Health Insurance Exchange Congress will be held November 13-14, 2012 in Chicago, IL.  Here, state officials and health plans with the only opportunity to come together to discuss PPACA and strategize on how to make this a successful opportunity for all.  For more information on this year's agenda, download the program here.  As a reader of this blog, when you register to join us and mention code XP1710BLOG, you'll receive 15% off the standard rate!

Continued Uncertainty after ACA Ruling: Questions remain but IIR's healthcare events offer answers

Following the Supreme Court’s historic ruling on June 29th on the Patient Protection and Affordable Care Act, some very important questions still remain that affect all sectors of the healthcare and life science industries. IIR’s 2nd Annual Health Insurance Exchange Congress and 17th Annual Medicaid Drug Rebate Program Summit will delve into these important questions.

As a whole, the ACA was kept almost entirely intact, meaning health insurance exchanges will be a large part of the future healthcare landscape. There are still questions about how different state-run exchanges will look, what the federally-facilitated exchange will look like, and how everyone can get exchanges running by 2014. At the 2nd Annual Health Insurance Exchange Congress state officials with first-hand experience building exchanges will share their insight. Health plan executives who have experience crafting and implementing financially sound benefits for exchanges will share what works and what doesn’t when competing on an exchange.  If you'd like to join us in Chicago November 13-14 for this event, as a reader of this blog, when you register to join us and mention code XP1710BLOG, you'll save 10% off the standard rate!  For more information on this event, download the agenda.

One provision of the ACA was restricted, which could mean the difference in billions of dollars to the federal government, each state government and the pharmaceutical industry. SCOTUS’s opinion says, “the Medicaid expansion violates the Constitution by threatening States with the loss of their existing Medicaid funding if they decline to comply with the expansion.” This decision gives states some flexibility not to expand their Medicaid programs, without paying the same financial penalties that the law called for. What is uncertain, is which states will choose to expand Medicaid and which won’t, meaning how many Americans will be added to the Medicaid program, and how much more rebating will branded and generic manufacturers have to do?

According to the Kaiser Family Foundation, if all 50 states participated in the program, in aggregate, between 2014 and 2019, they will spend $21.1 billion to extend Medicaid, while the federal government will spend $443.5 billion. But if some states choose not to participate in the expansion, the cost to the federal government is still very uncertain. The cost to the pharmaceutical industry, is also hard to estimate. At the 17th Annual Medicaid Drug Rebate Program Summit, expert industry analysts, federal and state government representatives, and pharmaceutical executives will be on hand to discuss what the ACA means for each segment of the industry, and how it will affect bottom lines.  Don't forget, as a reader of this blog, when you register to join us this September 10-12 in Chicago and mention code XP1725BLOG, you'll save 25% off the standard rate!  For more information on this event, download the agenda.

Health Insurance Exchange Update: Monday, July 2, 2012

Well, it is now official, the President’s Affordable Care Act (ACA) was found constitutional by the highest court in the land, the Supreme Court. But, many across the aisle still do not believe this is true. So, instead of living with this ruling, Republicans in the House will vote on July 11 to repeal (ACA). State officials are protesting as well, waiting and hoping for a Romney win. But, November 16 is the deadline to submit a plan to the Department of Health and Human Services. So there wishful thinking may not end well for them.

Kansas seems to be torn in two separate directions according to Ark City. Kansas Insurance Commissioner Sandy Praeger is at odds with other Republicans in her state to setup the health insurance exchanges. Gov. Sam Brownback wants to delay the setup of exchanges until after the November election. Kansas has not done anything to go forward with some plan. They went so far as to reject the millions of dollars in aid in order to finance the project. Stephen McAllister, who once served as a clerk for Clarence Thomas, said that this wishful thinking by Republicans is a far stretch. If Romney is actually elected in November, he needs Congress in order to overturn the (ACA). So with that being said, there needs to be a Republican Senate and House just to get the right number of votes and while they are waiting for all that to happen, here it will be 2014 when everything goes into effect.

Idaho is in a tight bind after the Supreme Court ruling according to CBS News. The state rejected the $20 million in grants in order to establish the exchanges. They were banking on the ruling of the health care ruling but now that it has been ruled constitutional, Idaho now has to figure out what it will do next in order to comply with the federal government. The state will need lenience from the federal government and quick action in order to meet the November 16 deadline. With little time to set up their own exchanges, the state will have to use the federal government for support.

Michigan is now deciding that they will take their medicine and establish the exchanges according to Detroit Business. Michigan House Speaker Jase Bolger said that the state will move forward with implementing the healthcare law. Gov. Snyder said he will sign bill to allow Michigan to operate its own exchange. However, the Attorney General Bill Schuette said he too wants to wait until the November election.

But there is someone who has a plan. 

Montana will now be moving forward with the implementation of the after the ruling of the Supreme Court according to Great Falls Tribune. Montana insurance commissioner Monica Lindeen said that the state will help the U.S. Department of Health and Human services to establish Montana’s health insurance. This coming after Republican-led state legislature to help design Montana’s own plan was rejected last year. 18 percent of uninsured people in Montana will now be able to buy coverage from private insurers with the help of state-run exchanges.

This November, the Health Insurance Exchange Congress will be held November 13-14, 2012 in Chicago, IL.  Here, state officials and health plans with the only opportunity to come together to discuss PPACA and strategize on how to make this a successful opportunity for all.  For more information on this year's agenda, download the program here.  As a reader of this blog, when you register to join us and mention code XP1710BLOG, you'll receive 15% off the standard rate!