Rising Drug Costs

Welcome to this FDA/CMS Summit for Payers podcast.

Below is a teaser from our podcast with Bill Winkenwerder, Former CEO, Highmark Inc.

Access the complete podcast and transcript here.

How should manufacturers determine drug prices and what consideration should there be?

Bill: Well, certainly manufacturers need to recover their costs – their investment in R&D – and it’s important that they make a profit. Nobody can be in business for any period of time without being able to make a profit. Now, more recently – especially with respect to certain manufacturers that have brought very expensive medications to the market – have been criticized and have been identified as charging too much. That’s the common perception, but I see the immediate evidence that the prices for these medications – given the relatively small population of people that would benefit from them – that there is a serious over-charging that’s going on. But, certainly we need to sit down and talk and determine if there is a better way to arrive at the price. What is a fair price? What is a good, market-based price? That’s what this Conference is about.


To see more from Dr. Winkenwerder, download the complete podcast here.

Download the updated event brochure here. 

Bill will be joining us at the FDA/CMS Summit for Payers in Washington D.C. for his closing keynote address "An Industry Perspective: Payment Policy for Clinically Valuable But Very Expensive Pharmaceuticals" on Friday December 12th.

Register now to save an extra $100 off the current rate with the code XP1917BLOG.

See you in Washington D.C.

Specialty Pharmacy Collaboration Summit Limited-Time Special Offer for Health Plans Only!

For a limited-time only, we’re offering health plans a special VIP $595 offer* expiring on Friday, August 22, 2014, to attend IIR’s all-new Specialty Pharmacy Collaboration Summit. To register, email Roxana Siu, Marketing Manager at rsiu@iirusa.com. Be sure to mention code: XP1968HPSOCIAL

Due to increasing healthcare costs brought on by health care reforms and the ACA, specialty pharmacies are critical in determining the sustainability of the specialty pharmacy business model. Payers, providers, pharma manufacturers, and even patients need to partner with specialty pharmacies to help fill the oversight gaps in compliance, manage costs and reimbursements, and to gain access to closed distribution channels. Specialty Pharmacies offer their product management and patient adherence services to address these challenges with minimal cost implications.

Don't miss out on the only event offering you the opportunity to benchmark against other health plans and partner directly with specialty pharmacies and pharma manufacturers.

Download the updated brochure for the full agenda and speaker details.

Plus! With the partnering360 networking tool, easily connect with all key stakeholders in the specialty pharmacy value chain and achieve not only your personal objectives, but also your company's collaborative aims. Available exclusively to registered attendees, you will be able to pre-plan for the event, identify and schedule meetings with potential partners, and foster deeper peer-to-peer engagement via discussions.

Health Plans - don’t miss out on this limited-time $595 offer* to attend the entire conference! This offer expires Friday, August 22, 2014. Be sure to use code: XP1968HPSOCIAL. To register, email Roxana Siu, Marketing Manager at rsiu@iirusa.com.


*$595 Offer Eligibility Rules and Regulations: Offer applies only to Health Plan executives. $595 offer is for the whole conference and expires on August 22, 2014. Tiered pricing is valid through expiration date. New pricing takes effect at specific dates indicated. All fees must be paid in full by expiration date or your price will increase to the next level tier. Offer cannot be applied retroactively to confirmed paid registrants. Offer cannot be combined with any other discounts or promotions. All registrants and guests are subject to IIR approval. 

Part D Coverage Gap Discount Program Challenges

This year, new price and coverage dynamics kick-in for the Coverage Gap Discount Program (CGDP), which means all beneficiaries who enter the coverage gap will pay less for generic and brand-name drugs, with providers, manufacturers and CMS making up for the change. As most plans offer no Part D Prescription Drug gap coverage, this leaves some manufacturers little or no time to validate submitted invoices, its corresponding detail data, and prepare for the subsequent forecasting and rebates.

At the upcoming IIR's 6th Annual GP Summit in March, hear from Shannon Bermudez, Principal Consultant, Revenue Management, Life Sciences at Paragon Solutions in the session, Practical Solutions Manufacturers can use to Manage Coverage Gap Discount Program Challenges. Understand the challenges the Coverage Gap Discount Program has presented to pharmaceutical manufacturers and get practical solutions to manage these challenges to efficiently process payments under the CGDP within these deadlines.

To learn more, download our agenda.

Register with code XP1951BLOG and receive 15% off of the standard rate. If you have any questions about the event, feel free to contact Kate Devery (Kdevery@iirusa.com) For more information visit our homepage. We hope to see this March!

Cheers,
The Government Programs Team

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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.