Prepare for VA Contract Negotiations at MDRP 2015 | Last Chance to Save $500 is Friday

Last Chance to save up to $400 to MDRP 2015 is THIS Friday, 6/26. PLUS! Take an additional $100 off when you use the code XP2058BLOG | $500 in total savings! Register now.

Your successful compliance with the VA's contractual and statutory requirements can spell the difference between profitable partnerships and drawn-out audits.

At the 20th Annual Medicaid Drug Rebate Program Summit, join us during the Pre-Conference event titled, "Pharmaceutical VA Contracting and Compliance Summit." This half-day summit is ideal for pharmaceutical and biotech manufacturers looking to comprehensively tackle the challenges of designing and complying with the complex - but highly lucrative - contracts in this sector.

You will touch upon key steps necessary to ensure you are ready for 2015 and beyond. Below are just a few session highlights:

• The Ins and Outs of a VA Audit: Comprehensive Overview of the Review Process
• Restating non-Federal Average Manufacturing Prices (NFAMP) and VA Federal Ceiling Prices (FCP)
• Panel Discussion: Prepare for Contract Negotiations

Download the updated MDRP brochure for more Summit details.

This half-day summit is part of the Platinum Pass, which gives you access to the full three days of the Medicaid Drug Rebate Program Summit - the best value! Registration rates go up after this Friday, June 26th. Save up to $500 off standard registration, be sure to use priority code XP2058BLOG | Register here.

Ensure you have the most comprehensive educational experience over three days with unparalleled access to government officials creating regulatory rules, the industry leaders interpreting them, and the pharmaceutical executives implementing them.

This is your opportunity to benchmark best practices and gain solutions to overcome new operational challenges brought on by AMP Final Rule, 340B, Medicaid Expansion, Class of Trade, Fair Market Value, FSS, VA, OIG, and other critical government programs. Reserve your seat today at the most comprehensive MDRP event to date!

See you in Chicago!

MMCC Podcast Series with Cindy Pigg of Magellan Medicaid Administration

Welcome to IIR’s Healthcare Podcast Series. Today we have Cindy Pigg, Senior Vice President of Pharmacy with Magellan Medicaid Administration. Click here to download the complete podcast. And make sure you join us at the 22nd Annual Medicaid Managed Care Congress taking place May 19-21 in Baltimore.

What are the unique challenges faced by states in Medicaid Managed Care Organizations? 

Cindy: Significant challenges and quite unique. Number one, how do you engage this population in managing their healthcare? We talked a little bit about this already, but we’ve got unique patient characteristics – the prevalence of mental health, the health literacy, the difficulty navigating the system, the cultural sensitivities. So, we’ve got opportunities to figure out how to engage this population. 

The challenge in managing their pharmaceutical care is that in this population, we lack two tools that are critical that we use on the commercial side that just don’t exist in the Medicaid space. Those being co-pays at a level that are significant enough to change behavior and mail order pharmacy – the home delivery pharmacies where we do a lot of utilization management using the pharmacists that are working in dispensing their mail order prescriptions. So, we’ve got to figure out that challenge of how to engage consumers with different tools unlike what we’ve used in the commercial market. 

I think a challenge that the states and the Medicaid Managed Care Organizations are going to face is really predicting the costs. There are so many unknowns. What is this patient population’s pent up demand that we talked about? What is the impact of specialty pharmaceuticals going to be in this population? I think the predictive modeling and the analytics to assist states in Medicaid Managed Care Organizations is an essential skill set that is going to be needed as we navigate these new waters. 

We talked about the access issue. There is going to be no access issue with pharmacies because you have probably have seen this in the press. There are actually more pharmacies than there are McDonald’s or Starbucks. If you just think about it, if you are looking at a pharmacy on this corner, there is probably a pharmacy on the other corner. So, access to pharmacies is not an issue, but access to physicians that we talked about is another unique challenge. 

Then we are seeing in the press every day now issues with Medicaid reimbursement. So, even if we did have enough primary care physicians, the payment mechanisms for Medicaid, I think, is a challenge that will be unique state-by-state in Managed Medicaid Organizations. 

I’d summarize this question by saying that the standardized PBM model just won’t work. These patients are unique. We talked about the challenges, but this need for a customized Medicaid strategy to deal with these unique needs is going to be absolutely essential to help the states and the Medicaid MCOs navigate these challenging waters for this Medicaid and subsidized exchange population. 


To hear more about this topic and many more, please join us at the 22nd Annual Medicaid Managed Care Congress, May 19-21 in Baltimore, MD. 

To save 15% off your registration rate, use the code: XP1926BLOG - Register Now!

Full Speed Ahead!

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

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

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

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

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

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

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

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

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

Look Who’s Attending the Medicaid Managed Care Congress 2012

With the ACA appearing in the news almost daily, you need to know what your company needs to do now so you can take advantage of new opportunities, such as Medicaid expansion and health insurance exchanges. There is a lot at stake and the timelines are tight. We invite you to join us at the 20th Annual Medicaid Managed Care Congress, taking place on April 30 – May 2 in Baltimore.

Don’t let your company fall behind. Join top executives from the following companies to achieve better quality and better care at lower costs. More people are registered to attend than ever before, so space is limited. Make sure you reserve your spot today!

2012 Attending Companies:

3Cinteractive * Access2Care * Aegis Sciences Corporation * Aetna Medicaid * Altegra Health * Amerigroup * AmeriHealth Mercy * Amgen * Arbor Healthcare * Association for Community Affiliated Plans * Assurance Wireless * AstraZeneca Pharmaceuticals * Bayer Healthcare Pharmaceuticals * Bio-Reference Laboratories Inc * BioRx * Blue Cross Blue Shield Northern Plains Alliance * Blue Cross Blue Shield of Tennessee * BMC Healthnet Plan * Boehringer Ingelheim * CalOptima * Cardon Outreach * Care Systems Design LLC * CareCall Inc * CareSource * CenCorp Health + Solutions * Cenpatico Behavioral Health * Central California Alliance for Health * Children's Hospital and Health System * CMS * Community Health Choice Inc * Comprehensive Behavioral Care * Connolly Healthcare * Cook Childrens Health Plan * Covidien * DC Health Care Finance * DentaQuest * DMoller Associates * DST Output * Excellus BlueCross & BlueShield * Express Scripts Inc * Fallon Community Health Plan * Forest Laboratories Inc * Geisinger Health Systems * Genentech Incorporated * Georgia Department of Community Health * Gilead Sciences Inc * Gorman Health Group * Government of the District of Columbia * Health First Health Plans * Health Management Associates * Health Partners * Health Services for Children With Special Needs Inc * HealthHelp * HealthPlus of Michigan * HealthPort * HealthSpring * Hemophilia of Georgia * Horizon NJ Health * HSMA * Hudson Health Plan * Humana Inc * InstaMed * ISG * Johns Hopkins Healthcare Inc * Krames A MultiMedia Company * Lilly USA LLC * Loving Care Agency * LVHN * MDwise Inc * Medicaid Health Plans of America * Medimpact * MedSolutions * Merck & Company Inc * Michigan Department Community Health * Molina * Monroe Plan for Medical Care * Montgomery County Government * Mostly Medicaid * Myers and Stauffer LC * National PACE Association * Navitus Health Solutions * NC Divison of Medical Assistance * Neighborhood Health Plan of Rhode Island * Network Health * Newkirk Products Inc * Novo Nordisk * Nurtur * OCCMHA * OptiCare Managed Vision * Optimetra Inc * OptumHealth * OptumInsight Life Sciences *Pfizer * Physicians Pharmaceutical Corp * Piurek & Associates * Plasma Protein Therapeutics Associates * Prestige Health Choice * Prolacta Bioscience * Purdue Pharma Minnesota * QualityMetric Inc * RI Department of Human Services * Sanofi Aventis * Schaller Anderson Inc * Senior Link * South Florida Community Care Network * Sprint * State of Maryland * State of Michigan * State of Mississippi * State of New Jersey * State of New York * State of New Hampshire * State of North Carolina * State of Pennsylvania * State of Texas * Sunovion Pharmaceuticals * SXC Health Solutions * Teva Pharmaceuticals * UCB Managed Markets * UnitedHealthCare Community Plan * US Government Accountability Office * Utah Department of Health * Varis * Vertex Pharmaceuticals Inc * Visiting Nurse Service of New York * VITAS Healthcare Corporation * VNSNY CHOICE Health Plans * Walgreens * Wellpoint * ZOLL LifeVest *

Also, as a reader of this blog, you can receive 25% off the standard registration rate with Priority Code XP1726BLOG. For more information on the Medicaid Managed Care Congress and to register, visit our webpage.