Save Thousands with Our Expert Industry Analysis at the MDRP Summit!

With the pharmaceutical industry limiting spend across the board, we know your resources are important. Time away from the office needs to be justified. At the 17th Annual Medicaid Drug Rebate Program Summit, we bring the leading industry experts and analysts to you, so that you go back to the office with actionable plans to move forward with your rebate systems.

Here are a few highlights from our exciting group of experts:

• - Post-AWP: Impact on Manufacturers of Multiple Mechanisms for State Reimbursement
• - Improving 340 Program Integrity Through Covered Entity Audits
• - Impacts of Actual Acquisition Cost on Contracting and Brand Reimbursement
• - Best Practices for Handling Data Growth
• - Develop Best Practices for Recalculations
• - Understand Current Updates on the Veterans Health Care Act/Federal Supply Schedule

These sessions and dozens more will leave you with analyses and information that will help you conduct your business. For more about these sessions, download 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 and use code XP1758BLOG.  Do you have any questions about the event? Feel free to contact Jennifer Pereira.

Grow Your Plan's Membership through Health Insurance Exchanges

Health insurance exchanges are a reality. States are moving forward with the exchanges and plans need to start building their exchange strategy now so they are ready to compete when the states begin enrollment. At the Health Insurance Exchange Congress on November 13 – 14, you will take away the tools you need to prepare for exchanges and increase your membership.

You will get expert insight from industry leaders including:

• - Jonathan Seib, JD, MPA, Executive Policy Advisor for Washington Governor Chris Gregoire, who will share the risks and rewards of their Basic Health Plan option so you can determine if it’s right for your plan
• - Kenneth Berklee, Senior Vice President, Marketing and Product Development at Amerigroup, who will share strategies on how to appeal to specific segments of the proposed member pool
• - Robert Smith, Senior Account Manager for Quest Analytics, who will share the expected user profile so you can begin network expansion to appeal to potential members

To view the complete list of sessions and speakers please download the agenda.

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: Tuesday, August 28

Virgin Islands Flag

In today's Health Insurance Exchange Update, we look at how many states are emerging to start considering their own exchanges.  We are also seeing the debate emerge as to how to best name an exchange in order to best encourage use from the public.

The Democratic front runner for governor in Indiana,John Gregg, also former House Speaker have recently met with current Indiana Governor Mitch Daniels to encourage a hybrid exchange powered by both Indiana and the federal government. Gregg will be formally releasing his position in a few days. According to the Courrier Press, the current running Republican Candidate, Mike Pence, is against creating an exchange should he be elected governor Indiana.

The Smart Talk Podcast, recorded in Pennsylvania, looks at how the health insurance exchange would function and also some of the views from Pennsylvania residents. As it currently stands, there are no plans for the state to create the exchange. But as the podcast guests point out the needs for healthcare in Pennsylvania vary widely from Pittsburgh to Philadelphia and many are weary of the one size fits all Exchange that the federal government would provide.

Yesterday, Nebraska encouraged it's citizens to come out and share their feedback on how they feel about the state participating in Health Insurance Exchanges according to it's news channel KOTA.

The Virgin Islands have recently hired consultants to asses their ability to IT abillities and the impact the exchange would have on their current insurances according to JSPURA.

And finally, California is in the process of choosing an name for its exchange.  Of the many names presented, the one catching headlines is "Avocado: A uniquely California approach to affordable healthcare." According to the LA Times, names presented will undergo consumer testing later this year.

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, August 27

As we grow closer to the deadline, we are seeing a number of states commit to a state-run health insurance exchagne.  We're also seeing the government continue to give out funding and grants in order to encourage states to create their own exchange.

Eight more states have received funding for their health insurance exchanges according to ExecutiveGov.  States receiving Level 1 Funding include California, Hawai, Iowa and New York.  Receiving Level 2 funding include Connecticut, Maryland, Nevada and Vermont.  These states receiving Level 2 funding are farther along in their exchange development process.  According to the article, so far, 34 states have received funding in order to create a health insurance exchange.

Recent reports from the New York Daily News share that it costs a family to insure themselves for as much as $8462 a month, while individuals can insure themselves for $18,384 a year.  This leaves many New Yorkers to choose to go uninsured while those who choose to get health insurance, often those with chronic conditions, to pay even higher insurance bills.  As New York is one of the states going ahead with a state run exchange, it is hoped that the competition will drive health insurance costs down so that they become more affordable in the area.

The Washington Post paints a clear picture of what Republicans have in mind should they take over the White House this November.  They would like to create a budget that would cover a set amount for Medicaid and Medicare and leave the States and Patients to decide what benefits can and cannot afford beyond that point.

After receiving the grant from the US Governemnt, Connecticut has declared to official proceed with their state run exchange.  According to News 8, they have received a total of $116 million to create their health insurance exchange.

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 it is about the 340B Program that is challenging pharmaceutical manufacturer’s right now?

Chris Hatwig, Vice President of Apexus, the organization responsible for managing HRSA’s 340B Prime Vendor Program, highlights the importance of the 340B program to the MDRP community and beyond, as well as how the MDRP Summit facilitates forward thinking business development and understanding within the pharmaceutical manufacturer community in our exclusive podcast.

Today's Podcast Highlight: What is it about the 340B Program that is challenging pharmaceutical manufacturer’s right now?

Chris' answer:

As far as challenging (the key word there), obviously the manufacturers are concerned about the growth of any federal programs because there are steep discounts associated with federal programs, whether that’s the VA program, the Medicare Program, the Medicaid Program or 340B. So, all of these are federal programs and there are steep discounts involved either through rebates or through direct models that concern the industry. The industry’s margins are in question. It’s kind of like the last free market is disappearing on them in the country. It’s a global market and the industry is very concerned about that. And probably there is concern there because the Affordable Care Act, number one, expanded the number of 340B entities that are eligible to join the program. You are probably aware that there is a number of 340B hospitals, community health critical access hospitals, or referral centers and sole community hospitals that were eligible to join the program as a result of the passage of the Affordable Care Act. That is some of the growth that we’re seeing.

The other is that the entities are expanding operations. This is out of necessity. A lot of the patients in the country rely on these safety net institutions for care. Declining reimbursement in the marketplace with private physicians has driven more and more patients to the safety net institutions and they are having to expand their operations in order to care for the patients. So, that also contributes to the expansion of 340B. A good example is a number of hospitals expanding their oncology divisions, maybe buying up private physician practices. There are a lot of drivers involved with this. One is the declining reimbursement of private providers that’s causing the shift. That’s causing concern and then the hospitals are obviously having to expand their operations to meet the needs of the patients.

For the full interview, download the audio and transcript here.

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 when you register and use priority code XP1758BLOG. Do you have any questions about the event? Feel free to contact Jennifer Pereira.

The Proposed AMP Rule: What to Do While You Are Waiting

By: Chris Cobourn, SVP, Commercial Compliance, Compliance Implementation Services

As September approaches, there are a few things we can count on as summer winds down, such as football, colorful leaves in my home state of Maine, and IIR’s Annual Summit on the Medicaid Drug Rebate Program (MDRP). MDRP has long been one of the primary venues for the “GP Community” to network and get informed, (the GP community being the individuals in pharmaceutical manufacturers who fill the GP function, as well as consultants, lawyers and software vendors.

The ability for us to network within our pretty unique community is important, as we all face the same challenges. With limited regulations and guidance, it is important to know what your peers are thinking and how they are addressing common issues, especially in this very anxious period with our wait for the CMS Final Rule. A theme that you will hear me talk about is “what to do while you are waiting.” It will be an important topic at MDRP, and CIS will be talking about it in our free webinar series on September 20th.

When the CMS AMP Final Rule does hit, likely “sometime in 2013,” there will be no looking back. The impact on systems, processes and methodologies could be dramatic. Many manufacturers are evaluating their current systems and data in order to ensure that they a) will have confidence in the auditability of current (PPACA) and historical methodologies, b) have good underlying data for the new methodologies, and c) address key compliance issues and challenges. Many of the topical considerations that should be discussed include:

• • Bona Fide Service Fee evaluations, getting the documentation and assumptions in place
• • Closing recalculation and restatement issues
• • Research and documenting the Product Master
• • Evaluating the potential impact of the Proposed Rule, including impact on extension of the Medicaid Rebate to Puerto Rico and the Territories, Authorized Generics, Alternative 5i AMP, line extensions
• • 340B Program Integrity initiatives, including manufacturer audits
• • GP systems assessment and audit to validate the integrity of the calculations
• • Evaluating the accuracy of Class of Trade assignment, as well as PHS eligibility

So, we hope to see you in Chicago. As a reader of this blog, when you register to join us and mention code XP1785BLOG, you'll save 15% off the standard rate.  It is important that we all have a voice, and have the opportunity to hear how others are planning for and meeting the challenges!

Health Insurance Exchange Update: Tuesday, August 21

Indiana State Flag

Many states are in the midst of a debate whether or not to  create health exchanges.  To add to the ACA's timeline challenge  is the fact that many are waiting until November.  This is both the deadline to declare an independent exchange as well as elections when new governors will be moving into power in some states.  The insurance industry is seeing a big increase in the amount of changes affecting them.

In Indiana, candidate for governor Mike Pense was the first to respond current Governor Mitch Daniels' question of whether or not to set up an exchange for the state.  Pense believes there is too much pertinacity to set up an exchange at the current moment.  The Journal Gazette does state that Indiana has taken the first preparatory steps to create an exchange.

California residents are showing great enthusiasm for the exchange.  In a recent poll from teh California Wellness Association, 54% of those who voted stated they supported the law while only only 37% opposed the law.  In California, one out of every five individuals is uninsured according to The California Report.

Madison.com reports that Ted Nickel of Wisconsin has been selected to be the Vice Chairman of the National Association of Insurance Commissioners. This committee will function as the board for all states choosing not to create an exchange and those who have not taken action by the deadline of November 16.

The insurance market is seeing a trend in acquisitions as larger insurance companies buy smaller ones in order to take advantage of the growing insurance market spurred by the Affordable Care Act.  This will put Aetna in a better position to work with the babyboomers.  According to the Hartford Courant, The acquisition is expected to be completed by mid 2013.  

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, August 20, 2012

Maryland State Flag

Last week here on the blog, we focused on creating a strong IT presence for a healthcare exchange.  In today's update, we see a number of state prepping for their exchanges by partnering with IT firms.  For those who are not, many states are delaying their discussions as long as they can to avoid creating an exchange for their state.

As IT is such an important part of the healthcare exchange, many professional services catering to the industry are seeing a boost in the contracts they are receiving.  According to the Washington Post, there have been 75 contracts awarded nationally in relation to the new health insurance exchange.  They point out that 14 of these contracts have been signed Maryland and Washington, DC.  These two states have committed to building their own exchanges to prepare for the deadline in 2014.

Utah, one of the current states already running an Exchange, has partnered with Certifi as their financial partner for their exchange.  According to Visual Strategy, they will be responsible for responsible for processing all necessary invoicing, collections and disbursements of insurance premiums and commissions.

In Missouri, a restraining order has been issued after the Secretary of State blocked a ballot summary referencing the vote for the Heath Insurance Exchange in Missouri.  Many believe that the question is misleading and will not lead to a fair vote for Missourians when they are voting for a state or federal run health insurance exchange.  The ballot question referenced is: Shall Missouri law be amended to deny individuals, families, and small businesses the ability to access affordable health care plans through a state-based health benefit exchange unless authorized by statute, initiative or referendum or through an exchange operated by the federal government as required by the federal health care act?  According to Missourinet, they believe the ballot is bias.  The courts will issue a ruling on August 28.

In Kentucky, the vote for the creation of an exchange by the Interim Joint Committee on Health and Welfare has been delayed until the next session. They claimed there was not enough information on how it would work and operate to vote properly. The federal government would pay for the exchange the first year, then pass the costs off to the states. The Lane Report claims that it would cost the states $67 million in the second year of operation.

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!

Pharmaceutical Manufacturers Industry Government Pricing Survey is Now Open

Huron invites you to participate in our Pharmaceutical Manufacturers Industry Government Pricing Survey. Frequently, we are asked what general industry trends and norms are employed, in terms of people, process, and technology, to meet these challenges. Specifically, what organizational and software approaches are being used to address the compliance and operational requirements for contracting and pricing as they relate to doing business with state and federal government programs? Commercial and government contracting, government pricing calculations and reporting, and the management of Medicaid claims seem to be areas of particular interest.

This survey is designed to benchmark these data points, and others. The results of this survey will provide participants with deeper insights into industry-wide variations, as well as the ability to compare their experiences and results with those from other institutions.

Please note that only participating organizations that complete the survey will receive a copy of the compiled survey results. Individual survey responses will remain confidential. Survey results will not identify specific individuals or institutions.

To participate, we ask that you (or a colleague you refer) complete the survey located at:
www.surveymonkey.com/s/GovernmentPricing

This survey will take approximately 20 minutes to complete. If you have any questions or comments about the survey, please contact Mark Linver.

Thank you for your participation!

** ** **
Huron Life Sciences is a sponsor at the 2012 Medicaid Drug Rebate Program Summit.  If you'd like to join them this September 10-12 in Chicago, IL, register today and mention code XP1725BLOG to save 25% off the standard rate!

Strengthen Your IT Systems to Prepare for Health Insurance Exchanges

Health insurance exchanges rely on coordination between various departments within health plans, as well as coordination with state and federal entities, including Social Security, Medicaid and the US Treasury. There’s also the challenge of making all of the information available in real-time, since purchasers expect verification NOW.

Health Insurance Exchange Congress speaker Kevin Yang, Chief Information Officer for the Maryland Health Benefit Exchange recently stated, “We’re working with local health plans to coordinate our IT systems, so consumers will have a seamless experience when purchasing insurance through our exchange. We want to make sure they understand what their product choices are and what benefits they qualify for, streamlining the overall enrollment process.”

Kevin Yang and others at the 2nd Annual Health Insurance Exchange Congress, taking place on November 13 – 14 in Chicago. For more about his session in addition to other IT considerations that will be shared from state officials in Oregon, Massachusetts, Rhode Island, download the agenda.  The  event 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: Tuesday, August 15, 2012

Nevada State Flag

Unlike yesterday's report, today's states are working on implementing a health insurance exchange.  Some states are focusing on the logistics of their exchanges and how they will run sustainability in the future.

At the Commonwealth Fund, they posted a podcast that looks at the current state of health insurance exchange.  Of the 34 states that have received federal aid, only 13 have started building their exchanges.  Many of these states have issued plans for their exchanges, but they remain vague enough to The final date of declaring a state will create its own exchange will be in November.

In the latest edition of the Focus on Health Reform from the Kaiser Family Foundation, they take a more in-depth look at where states are standing in terms of creating their exchange.  They also look at the partnerships some states looking to form in order to create a better exchange for their citizens such as Montana and Wyoming as well as Arkansas, Delaware and Illinois.

Governor Brian Sandoval of Nevada has approved a contract to jump start the creation of their exchange, but believes in order to be successful it needs to be built to be sustainable.  According to Business Week, he is opposed to long-term funding of the exchange due to the money it would take away from Nevada's general fun.

In Illinois, they are looking to partner with the federal government for a year, then branch off to their own exchange.  They have issued a call looking for an IT company to come in and create, operate and maintain their digital exchange platform.  According to Modern Healthcare, they expect to abandon their joint exchange for an Illinois-only exchange by 2015.

NBC Miami looks at how the poverty level in some states that are thinking of not expanding Medicaid could affect those citizens who are just above the poverty line.

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!

Podcast Exclusive: Chris Hatwig, Vice President of Apexus on the importance of the 340B program to the MDRP community and beyond

Chris Hatwig, Vice President of Apexus, the organization responsible for managing HRSA’s 340B Prime Vendor Program, highlights the importance of the 340B program to the MDRP community and beyond, as well as how the MDRP Summit facilitates forward thinking business development and understanding within the pharmaceutical manufacturer community in our exclusive podcast.

Today's podcast highlight:  Chris looks at how the 340B Program was affected by the Supreme Court’s ruling at the end of June:

I think that’s hard to say at this point. A lot of people ask the question about if the Affordable Care Act would have been repealed if it would have had a major impact on the program. We really don’t know. There is ongoing debate on whether, with the expansion of the Affordable Care Act and everybody having supposedly insurance after 2014, that there may be less need for the 340B Program and maybe time has passed the program by; it’s obsolete – no longer needed. I don’t think that’s the case at all because the Affordable Care Act, there is probably still going to be 40 to 50 million in the country (assuming the Act was unchanged at all with Congress’s vote), there would still be 40-50 million uninsured patients in the country anyway. And then on top of that, even with insured patients and the Affordable Care Act, we all know that many patients (even if they have insurance) they are under insured or they are unable to pay for their copay. So, it’s a choice between whether or not they’re going to eat or whether they’re going to get their medications or get healthcare. And many opt to eat versus getting the healthcare. So the 340B program is needed regardless of what was going to happen with the Affordable Care Act. And after the final vote, the one thing that did change was the requirement for the Medicare Programs to engage. We could see and are already seeing many of the program expansions in doubt now so Medicaid is covering many of the uninsured patients so that puts a lot of these patients in question as to where their healthcare is going to come from. So, 340B and safety net institutions are probably --- again, the role is going to be very vital for to providing healthcare for all patients in the country.

In the coming weeks, we'll share Chris' viewpoints on some of the following topics:
- What it is about the 340B Program that is challenging pharmaceutical manufacturer’s right now?
- What can the industry prepare to expect from OPA in the coming months?
- Why should (our audience) attend the MDRP Summit?

For the full interview, download the audio and transcript here.

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 when you register and use priority code XP1758BLOG. Do you have any questions about the event? Feel free to contact Jennifer Pereira.

Health Insurance Exchange Update: Tuesday, August 14, 2012

North Carolina State Flag

In today's Health Insurance Exchange Report, we see an overwhelming trend.  All of the states today have chosen to implement their own exchange.  Their next challenge is what to cover?  And for those who have not made their statement that they intend to create an exchange, the Obama Administration is making a push for them to do so.

In California, John Ramey, the President of the Local Health Plans of California writes to the Mercury News sharing his desire for his state to consider instituting a Basic Health Plan. This would allow for more than 800,000 Californians to be eligible for the healthcare. For John's complete opinion piece, visit Mercury News.

The Oregon Health Policy Board is meeting today to discuss what they'll be covering in their state run exchange. According to Oregon Live, they will be addressing what the lowest benefits they will carry are on the Oregon Health Insurance Exchange.

The North Carolina Institute of Medicine is making headway in their quest to open their state run exchange. Adam Searing, Project Director for the Health Access Coalition at the N.C. Justice Center also believes that the state must extend their coverage to some of the poorest in the state. With the federal government paying for 93% of the expansion, expansion is necessary. News Observer also comments that in addition to helping with coverage to these poorest Americans, in turn, the hospitals in those rural areas would receive more funding as they often foot the bill for those who cannot pay.

Here's a quick Q&A with Mike Chaney, State Insurance Commissioner of Mississippi from the North Eastern Mississippi Daily Journal.

And finally, this week is the week the Obama Administration is making a big push to encourage states to begin working on their own exchanges.  It's critical to start now in order to have the exchange done by the due date set by the Affordable Care Act.  They'll be making stops in Washington, DC, Atlanta, Chicago and Denver.  With only 15 states having started on their exchange, the Federal Government is currently worried about the degree of cooperation they'll receive when coordinating the reminder of the states for a Federal Exchange.  The Chicago Tribute has more.

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, August 13, 2012

Minnesota State Flag

With the Supreme Court passing the legislation to keep the Affordable Care Act for the most part in tact, many states are still questioning what they should do. However, others are taking steps to make their exchanges a reality while others are looking at the impact of Medicaid expansion on their state and budget.

Minnesota is one of the first states to award a contract to a technology company in order to create their exchange. They have contracted Maximus for two years to help them set up their digital exchange. According to the Star Tribune,  It is expected to launch in Fall 2013.

In Arizona,Chuck Coughlin and Peter Burns were hired to create a campaign in order to encourage the state government to approve Medicaid expansion. They unite the voices of hospitals, insurance plans, providers and other players.  Should the Medicaid Expansion be approved, up to 300,000 Arizona citizens will eligible for healthcare from the program.  According to the Tuscon Citizen, they argue that without the expansion, hospitals and doctors will continue losing patients who are uninsured and money from those who are not.

Maryland is a democratic state while neighboring state Virginia is republican, and the vast differences between their approaches to creating the health insurance exchange.  Virginia's governor Bob McDonnell has yet to authorize an exchange.  The District of Columbia began assessing it's options in Fall 2011, and plans thus far have not made decisions as to whether it will be an open or closed to all providers and will be mostly internet exchanged.  For more on the comparison of the three states and where they stand in the Exchange process, read the article at the Washington Post.

In Vermont, they're looking at their exchange as a bridge to what the state really wants to set up - a government run single payor healthcare system.  By taking the federal money to fund their current healthcare exchange, they're able to create that system - Green Mountain Care - which will open for business in 2017.  Read more about the plans for this exchange at the Heartlander.

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 Session Spotlight: Effect of Acquisitions and Divestiture on MDRP Operations for Large Pharma Manufacturers

Today's post is authored by Miree Lee, Principal, M. LEE CONSULTI NG

In a period of mergers, acquisitions, product divestitures and product acquisitions (collectively, "Transactions"), it can be a challenging and exciting time for the parties involved. However, amidst the excitement and closing of the "deal", those of us in GP, both on the buyer and seller side, need to be mindful of the government pricing obligations and government program contract administration associated with such Transactions.

Speaker Miree Lee

During "Effect of Acquisitions and Divestiture on MDRP Operations for Large Pharma Manufacturers" session, we will examine GP involvement in the deal negotiation process, critical data exchanges between the parties, obligations of the seller vs. buyer, different manners in which pricing calculations, submissions, and certifications are handled between the buyer and seller, how obligations may differ by government price type, government agency notifications, pitfalls and lessons learned from past experience, and so much more.

If your company is considering a merger, acquisition, product divestiture or product acquisition, be sure not to miss this session!  If you'd like to know more about this session and the rest of the agenda, download the agenda here.  If you'd like to join us in Chicago for the Medicaid Drug Rebate Program Summit this September 10-12, register to join us today and mention XP1758BLOG to save 25% off the standard rate.

Featured Session: Effect of Acquisitions and Divestiture on MDRP Operations for Large Pharma Manufacturers

Featured Speakers: 
Moderator: Miree Lee, Principal, M. LEE CONSULTI NG
Brad Wallner, Government Pricing Specialist,, GRIFOLS, INC.
Sanjida Chowdhury, Director, Business Government Analysis, APP PHARMACEUTICALS
Peggy Watson, Medicaid Drug Rebate Manager, AMGEN
Elizabeth Greco, Director, Government Pricing, PFIZER

About the session: 
While changing a company’s portfolio has numerous benefits, for large pharma, with thousands of NDCs, adding or subtracting a company’s portfolio can be a daunting task. For acquisitions especially, bringing a company’s products into the fold and dealing with their pricing and contracts can be a headache if the company didn’t have enough functionality. In this session, large pharma
insiders describe how their company handled an acquisition or divestiture.

Pharmaceutical Manufacturers Industry Government Pricing Survey is Now Open

Huron invites you to participate in our Pharmaceutical Manufacturers Industry Government Pricing Survey. Frequently, we are asked what general industry trends and norms are employed, in terms of people, process, and technology, to meet these challenges. Specifically, what organizational and software approaches are being used to address the compliance and operational requirements for contracting and pricing as they relate to doing business with state and federal government programs? Commercial and government contracting, government pricing calculations and reporting, and the management of Medicaid claims seem to be areas of particular interest.

This survey is designed to benchmark these data points, and others. The results of this survey will provide participants with deeper insights into industry-wide variations, as well as the ability to compare their experiences and results with those from other institutions.

Please note that only participating organizations that complete the survey will receive a copy of the compiled survey results. Individual survey responses will remain confidential. Survey results will not identify specific individuals or institutions.

To participate, we ask that you (or a colleague you refer) complete the survey located at:
www.surveymonkey.com/s/GovernmentPricing

This survey will take approximately 20 minutes to complete. If you have any questions or comments about the survey, please contact Mark Linver.

Thank you for your participation!

** ** **
Huron Life Sciences is a sponsor at the 2012 Medicaid Drug Rebate Program Summit.  If you'd like to join them this September 10-12 in Chicago, IL, register today and mention code XP1725BLOG to save 25% off the standard rate!

Health Insurance Exchange Update: Wednesday, August 8, 2012

Oklahoma Flag

Setting up exchanges is a topic some legislatures do not want to deal with until the election. The name has even come under fire lately which will be explained further. But there are three states are setting up CO-OPs, California is having an issue with legislation that could hurt their exchange program, and Oklahoma seems to have been a victim of politics in the health care decision.

Tulsa World writes that Oklahoma, along with 28 other states, has decided not to set up their own exchanges. But the article tells that the legislature had every intention to set it up but they came under pressure from others not to set up the exchanges. But the state is looking at a possible expansion of Medicaid, sending letters to Health and Human Services Secretary Kathleen Sebelius with possible scenarios. 

In the west, three states are leading the charge with Consumer-Oriented and Operated Plans (CO-OPs). Allowed under the Affordable Care Act, CO-OPs are mean to stimulate more competitive rates for health plans offered through exchanges. Three states that are going forward with CO-OPS are Nevada, Arizona and Colorado. But there are questions about what would happen. If it is a success, then it could be a new sales channel for drug companies. But if it fails, costs could spiral out of control because CO-OPs cannot reject applicants and those applicants could possibly have expensive medical problems.

California has been leading by example, setting up one of the first exchanges in the country. But now there is news that this could be derailed somehow. Sacramento has legislation that would create a Basic HealthPlan. This will pose a potential threat to the California Health Benefit Exchange. The Basic Health Plan would take people who make less than two times federal poverty level out of the marketplace. It would put these individuals into a system that is run by the state’s Medicare called Medi-Cal. If this legislation is passed, it would rob about 40 percent of consumers and lose half of federal funding. The legislation is supported by public health plans, safety net providers and county workers. Those who oppose this legislation are private health plans and conventional provider network that would rather compete for consumers through exchanges.  But this plan would lead to more problems besides competition. The Basic Health Plan is affordable only because it pays doctors and hospitals less than their underlying cost for providing care. In addition to that, there could unforeseen financial risk. The amount of federal funding that would be needed for the plan will not be determined until the end of the year, which is when the state sets their premium costs. This could lead to overestimating and a difference that could lead to $500 million. 

Never mind the fact that states are still opting not to set up most of the Affordable Care Act, there are some contemplating actually changing the name of exchanges.  In an article written for the Wall Street Journal, the word exchange is said to “raise suspicion of loopholes.” So with that, other states are now trying to come up with different names like Washington may be leaning towards Washington Healthlink, and Minnesota with two options: Health choices and Minnesota Health Insurance. As long as the exchanges are being applied, the name seems to be a minor issue though to appeal to consumers it may have to be welcoming.

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, August 7, 2012

Tennessee State Flag

Health exchanges are going to be set up. Despite the fact that governors are not willing to set up their exchanges, the government will step in and handle the situation. States like Tennessee are trying to see what their options are regarding exchanges. But there are not that many outlets for states to take. The Washington Post echoes that same sentiment, discussing various states and their situation but Medicaid is a different issue.

The health care law says that the federal government waned to withhold money from states if they choose not to expand their Medicaid. It was found unconstitutional. So now states can receive the money for what Medicaid without expansion. And with that The Atlantic offers the strict Medicaid requirements in Florida. But it also gives insight into what Medicaid may look like for individuals because of the unconstitutionality of the Medicaid expansion provision in the Affordable Care Act. 

The cost of Medicaid has taken up most of the state budget in New York. So in order to get some leeway Gov. Anthony Cuomo has submitted a waiver request to use as much as $10 billion in savings from cuts to the program to find more money spent on health care for the poor. Cuomo used an executive order to get the state-run exchanges set up but now he wants to figure out a way to improve upon Medicaid. New York wants to reinvest over a five year period the $10 billion of the $17.1 billion in savings generated by Cuomo’s Medicaid Resign Team plans. With these savings, the state wants to get care costs under control for individuals with more than one chronic illness. The waiver has several purposes which include: expanding access to high quality care; grants to establish health homes; and expanding resources to transform safety net providers. 

But the state that is said to be the prototype for the blueprint for universal health care is continuing to move forward with provisions. Massachusetts will be the nation’s first Health Information Exchange after receiving a $17 million grant from the federal government. The project will allow hospitals, doctors and others involved in patient care to exchange clinical data through a secure statewide network. There will be an encrypt information to ensure safety and require patient consent. The technology in the project will allow doctors and hospitals to log into any location to share notes, talk and post patient records.

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, August 6, 2012

Missouri State Flag

Despite the fact that a fight is waged against the new health care law, there are measures insuring what will be done on creating health care exchanges. Some states are voting for a consensus among the people, others want to get going but they do not have an idea of what the exchanges run by the government will entail and how much money will be used for the program. While others are standing, arms folded and refusing to play. Regardless, one way or another, the exchanges are going to be set up.

Missouri is so divided on the measure that there will be a vote to see if they should set up the exchanges or not. Though this news is a few months old, they are not even fighting over the exchanges anymore; they are still fighting over the wording of the referendum. The Washington Post reports that back in May, the General Assembly approved a ballot measure to set up the exchanges. The Republican-controlled legislature wanted to try and block Gov. Jay Nixon, a Democrat, from establishing the exchanges by executive order. But Nixon stated that he does not plan to do that. Now the language used on the ballot was deemed biased and inaccurate by Lt. Gov. Peter Kinder supposedly within minutes of its publication. So now not only will the people be voting for a president in November but also whether to set up exchanges. But the legislative body may be forgetting one thing: the federal government will set up their own exchanges.

With the bickering happening back and forth in Missouri, there are some states that are moving on in case the president remains in office.

The New York Times reports that the federal government will be covering more states than it had anticipating. The government will not have a one-size fits all exchange program set up, this will vary from state to state. But the article makes it clear that the federal government is not so transparent as other states. California, Mississippi, Minnesota, and Nevada have websites that show documents pertaining to their exchange marketplace. These documents show cost estimates, minutes of public meetings and information about goods and services.

The government, however, is vague about financing the exchange program and they have disclosed little information about their plans. This leaves officials like Thomas M. Hate, president of Landmark Benefits in New Hampshire, says that they have no idea what the federal government’s exchange will look like. He goes on to say that they have not been much communication between the state and federal officials.

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: Wednesday, August 1, 2012

Idaho State Flag

Meetings continue to be conduct in states who are trying to figure out how much money will go towards setting up state-run exchanges. But there are some states (sixteen at the present time) are moving forward with their own exchange program. But one is head and shoulders ahead of the pack.

California is the farthest ahead of other states in creating their exchange program. According to the San Jose Mercury News, the state is so far ahead that they are going ahead and will have major marketing campaigns to attract Californians. California’s exchange marketplace is said to be like the Amazon of health care purchases. But there are some who are skeptical about the makeup of the exchange marketplace. They wonder if this will be something like the Department of Motors instead of a consumer superstore. John Graham, director of health care studies for Pacific Research Institute, states that he has yet to see “a government agency that works like Amazon.” The state is going on with the exchange program that will be an active purchaser. That means that state lawmakers will set the criteria, negotiate with insurers and decide who can offer plans. Out the sixteen states that created exchanges, only a few have this power. But some still believe that this will not be a good option. Some feel that this will actually limit the options for the consumers. But California will be moving forward with this plan and it will be able to go live October 2013.

The administration of Tennessee Gov. Bill Haslam met Tuesday to give their input on what to do with the new health care law. The meeting was centered round what health conditions should be covered under essential health benefit package that is included in the health care law. The essential health benefit package is set to include emergency services, hospitalization, maternity and newborn care, prescription drugs among other things. Though essential health benefit package is not part of the expansion of Medicaid, however the tier in health insurance exchange must have sixty or seventy percent of the essential health benefit package. 

As a follow up to the meeting that was conducted in Idaho Monday, they have come up with a decision. The state has opted not to take federal money to start their state-run exchange program. The lawmakers were met with three options regarding state-run exchanges: they can apply for grant money; they can allow the federal government to set up their exchanges; or they can have an option of partnership of sharing it with the federal government. But no matter what the state does, there are some who say that there will be a need of money from the government. The next time the state can apply for a federal grant will be in November. 

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!