MDRP 2013 Track 3: State

This week we'll be featuring MDRP 2013 event posts from our content partners, Huron Life Sciences. Today's author, Sam Woronoff, recaps day 2 Track Session: State

A Panel of manufacturers and state representatives shared their thoughts on the recent online surveys were sent to states regarding how the states are validating the MDRP rebate claims data. Based on 32 states’ responses, the survey suggested that in regards to FFS claims data, majority of the state had confidence in their claims data validation process. However, when it comes to the MCO claims data, majority of the states responded that either no validation process was in place or had serious deficiency. As for the 340B claims, some states are relying strictly on voluntary disclosure from contract pharmacies participating in stock replacement as an only source for excluding claims. With the growing trend of MCO claims in MDRP and serious lack in states’ ability to validate the MCO claims data, the manufacturers need to be aware of this gap and be proactive in their invoice validation efforts.

Kudos for the MDRP Collaborative Workgroup for their efforts to create and standardize the electronic formats for claims level details (CLDs) and ROSI/ PQAS! Their efforts will accommodate both the manufacturers and the states to improve invoice validation and dispute resolution efforts, as well as efficiency in processing quarterly invoices! It was great to see the collaborative efforts of the manufacturers and states. Thank you guys!

To this date, the workgroup has developed a standardized CLD format as well as improving the electronic data file for ROSI/ PQAS. The standardized CLD format will be using common language for CLD data to decrease data manipulation, improve operational efficiencies, resource management and compliance control. In addition, they have included 340B indicators into the CLD format. The improved electronic ROSI/PQAS data file was created to minimize both manufacturer and the states’ manual efforts and speed up the rebate process and reduce operating costs. The proposed data file will include the EFT payment information as well.

The workgroup now needs manufacturer’s participation and assistance in pushing this effort into the next level by reviewing and providing feedback for the CLD and ROSI/PQAS data file drafts and reaching out to CMS directly to enforce the importance of this effort for the benefit of the entire MDRP rebate stakeholders.

For more information or to review the proposed CLD format, contact:

Stefano Paoloni Stefano.paoloni@dhs.state.nj.us 
Lynn Lewis llesix@us.imshealth.com  

One pharmaceutical manufacturer has shared their experience in implementing the Texas reporting process and their effort in overcoming challenges. They shared their stance and their methodology for addressing the timing issue, price change definition, and the price point determinations. For detailed information, reach out to IIR for a copy of Michael Hepburn’s presentation deck.

A representative from a leading manufacturer shared their vast insights and experiences in Medicaid Supplemental Contracting. There are many details and nuances in each state’s supplemental bids to understand and to consider. She has shared detailed tips and examples useful for manufacturers to refer to when completing a bid.

Also, some great tips and tools for disputing questionable utilization in Medicaid rebate invoices were shared today. Be sure to know your product, communicate readily with states, and be proactive for the effective dispute resolution process. States are just as eager as manufacturers to reach resolution. The industry is moving forward in the positive direction to work together to become more efficient and knowledgeable as well as resourceful. This track provided great insights and practical knowledge applicable to manufacturers involved in the day to day operation of MDRP.