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 Keynote Presentation: OIG Work Updates

This week we'll be featuring MDRP 2013 event posts from our content partners, Huron Life Sciences. Today's author, Rajiv Mehrotra, recaps our day 3 Keynote Presentation on OIG Work Updates 

The last day at the 2013 MDRP Annual Summit saw Mr. David Tawes from the OIG present on the “Recent OIG Work Involving Prescription Drug Pricing and Payments”. The presentation discussed the recent work and analyses that the OIG is performing especially around the Medicare Part B program.

As part of its recent work, the OIG looked at the current Medicaid Drug Rebates Program and evaluated how a similar program might work in a Medicare Part B setting with respect to rebate recoupments (unlike Medicaid, Medicare has no requirement for manufacturers to pay rebates for prescription drugs). To perform the analysis, the OIG included 60 drugs that accounted for 85% of Part B expenditures (approx. $13.9 billion) in 2011 and performed a rebate calculation similar to the Medicaid Drug Rebate Program using AMPs or ASPs for these drugs. The analysis showcased that such a program could potentially provide anywhere from 21-26% recoupments of the Part B expenditures for these drugs using a Medicaid Drug Rebate Program structure.

Though this recommendation was not entertained by the CMS at this time (CMS could not devote the necessary resources for a Part B rebate program evaluation ) it, nonetheless, doesn’t take away from the fact that this is something really big that was suggested by the OIG and this could be a huge deal for manufacturers. Manufacturers should definitely keep an eye out if something like this or a variant thereof picks back up in the future.

This is a must-have presentation for manufacturers. For more information, either grab a version from the MDRP website or visit the OIG website at for more details. See you all next year!