Download the GP podcast featuring Chris Cobourn

Today's podcast features Chris Cobourn, Senior Vice President of Commercial Compliance for CIS. Cobourn discussed his thoughts on the industry, as well as the challenge of forecasting Medicaid and Medicaid Managed Care, Bona Fide Services Fees and Fair Market Values, and mergers and acquisitions.

View our highlights below:

So before we begin, what are your thoughts on what’s going on in the industry today, Chris?

Chris: We are very much all in a “hurry up and wait” mode, especially from the pharmaceutical manufacturer perspective with continued delays of the final rule. But yet it is still really important to be as proactive as possible in your planning because when it hits, it could be significant and you really have to be in a comfortable position feeling that you‟ve planned for it.

Why is it important to conduct a company-specific impact analysis of the final rule?

Chris: At a high level, I think if you were to take a look at the question that we get increasingly from the CEO and CFO level, especially in smaller-sized companies where they are more involved, the simple question is: “What will the final rule mean to us and what will it take to implement it?”

When you look at all the variables and the proposed rule, if they all happen – and some of the significant things happen like the build-up rule, expansion of Medicaid to Puerto Rico, some of those types of things – it‟s significant. It‟s significant system changes, it‟s significant data that you‟ll need, it‟s significant materiality impact. So, how do you plan when you don't know which of those components will be in the final rule?

To hear more, download the full podcast.

Want to join Chris and CIS this March at IIR's 6th Annual Government Programs Summit? Register with code XP1951BLOG and receive 15% off of the standard rate. To view our full program, download our brochure. We hope to see you March 26-28 in Philadelphia, PA!

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

Opt-in for GP updates
GP Twitter
GP LinkedIn

HRSA Cmdr. Krista Pedley Provides 340B Update Preceding June Regulation

This March, IIR’s 6th Annual Government Programs Summit will once again welcome Cmdr. Krista M. Pedley, PharmD, MS, CDR, USPHS, Director, Office of Pharmacy Affairs, Health Resources and Services Administration, who will provide an update on the 340B program. The timing could not be better as a Memorandum Report released by the OIG this week spotlights inconsistencies within the 340B program.**

With the U.S. Department of Health and Human Services publishing the 340B proposed rule in June triggering an increase in transparency to the 340B program, you'll best prepare for the impact of these changes in the track - 340B Summit for Manufacturers, in collaboration with Apexus' 340B University. Hear updates and learn about the latest details in these key hot topic areas: Contract Pharmacies, Orphan Drugs, GPO Prohibition, Covered Outpatient Drugs, Audits, and more!

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

Opt-in for GP updates
GP Twitter
GP LinkedIn

Whitepaper: Minimizing Care Gaps for Individuals Churning between the Marketplace and Medicaid: Key State Considerations

Today's excerpt has been provided by Veronica Guerra and Shannon McMahon from Center for Health Care Strategies
Of the estimated 96 million Americans eligible to receive Medicaid or Marketplace subsidies during any given year, up to 29 million are likely to “churn” between all coverage options, and seven million are likely to experience coverage shifts between Medicaid and marketplace policies annually.1 Based on past experience, adults who change health insurance coverage are less likely to have a usual source of care and report delaying care during coverage transitions.2 Those who churn between Medicaid and the newly established marketplace will, at a minimum, have different benefits and out-of-pocket expenses (e.g., premiums and cost-sharing). Further changes in plans, provider networks, and eligibility status could result in a lack of care coordination, unmet needs, and/or an exacerbation of chronic conditions.3 In addition, high rates of churn across the new array of Medicaid-marketplace coverage options will put an increased administrative burden on states and contracting health plans.

Given the likely churn between Medicaid and the marketplace, states can take steps to ensure coverage and care coordination so health status does not deteriorate during these transitions. A handful of states have begun to estimate the potential magnitude of churn on their current and newly eligible populations, and are exploring options to mitigate churn. This brief, made possible through the Robert Wood Johnson Foundation, outlines concrete strategies for states to mitigate the impact of coverage transitions.

You can view the full article here. CHCS will be joining us May 19-21 in Baltimore, MD for IIR's Medicaid Managed Care Congress. To learn more, view our agenda. Want to hear more from CHCS? Register with code XP1926BLOG. 

See why everyone is attending the Medicare Congress 2014

You have less than two weeks to register for IIR’s 12th Annual Medicare Congress. Taking place February 10-12th in vibrant New Orleans, the Medicare Congress is the ideal gathering place to learn how to improve your star ratings, network with ACOs and learn how to implement a customer-centric model.

So many of your peers have already recognized the value of the Medicare Congress and registrations are MORE THAN DOUBLE what they were last year. To join them you'll have to act quickly. Online registration closes Sunday, February 9th.

Take advantage of the only "one and done" event with content for your entire team including:

• The integration of the D.U.A.L.S. Forum at the Medicare Congress
• The reenergized Stars University
• An increased focus on creating the ideal customer experience to help you boost quality scores and member retention
• Opportunities to network with your peers, including speed networking in the exhibit hall

To learn more, download our brochure.

Register with code XP1907LINL and save 15%. If you have any questions about the agenda or event, feel free to email Kate Devery at kdevery@iirusa.com or visit the homepage. We hope to see you, February 10-12 in New Orleans!

Cheers,
The Medicare Congress Team

Opt-in for updates
Follow us on Twitter
MAC LinkedIn

Prepare for 340B Program Changes and the AMP Final Rule

As the clock ticks down on the few months left before the AMP Final Rule is released, IIR's 6th Annual Government Programs Summit in March will be your last opportunity to hear from colleagues who have prepared for the impact of each individual component of the rule:

This full day panel discussion will prepare for the individual components of the Final Rule and also address the combined GP and Finance concerns that manufacturers are facing for planning and forecasting. Because Q2 publication of the long-awaited CMS AMP Final Rule will have a financial impact and affect forecasting, gross-to-net, and accruals, it is no longer exclusively a GP issue and is just as important for a company's Finance organization to prepare for the changes.

Panelists:
Jennifer Norton, Senior Director, Pricing & Contract Administration - Managed Markets, Vertex Pharmaceuticals
Sabrina Yohai, Senior Corporate Counsel, Pfizer
Michael Hepburn, Sr. Director, Government Contract Compliance, Janssen Pharmaceuticals

CIS Speakers:
Chris Cobourn, Senior Vice President, Commercial Compliance
Erika Scholl, Senior Manager, Government Programs Consulting
Tom Evegan, Commercial Contracting Services

340B Summit for Manufacturers - In collaboration with Apexus' 340 University

The 340B universe is changing and this means various things for manufacturers. There is increased scrutiny as to the level of 340B compliance for all stakeholders, including manufacturers' compliance with pricing as well as covered entities' compliance with program requirements. OPA has begun publishing audit results from 340B covered entities, promising crucial information on covered entities' compliance with the program. Get access to the experts in an interactive session tailored for manufacturers. Learn the latest in these key hot topic areas: Orphan Drugs, GPO Prohibition, Covered Outpatient Drugs, Audits, and more!

Speakers:
Cmdr. Krista M. Pedley, PharmD, MS, CDR, USPHS, Director, Office of Pharmacy Affairs, Health Resources and Services Administration
Christopher Hatwig, MS, RPh, FASHP, President, Apexus, 340B Prime Vendor Program
Larry Stepp, Vice President, National Accounts, AmerisourceBergen
Perry Knight, Senior Counsel, Johnson & Johnson
Robert Nahoopii, PharmD, MS, BCPS, CEO/Co-Founder, Turnkey Pharmacy Solutions, A 340B Management Company

To learn more, download our agenda.

Register with code XP1951BLOG by this Friday (1/24) and receive up to $400 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

Opt-in for GP updates

GP Twitter

GP LinkedIn

Overcome Challenges to Medicaid Managed Care, FFS and Supplemental Rebate Obligations

A number of State Medicaid programs have recently adjusted their Medicaid prescription drug benefit designs stemming from the Affordable Care Act. At IIR's 6th Annual Government Programs Summit in March, understand the policy reasons for these changes and the impact they are likely to have on various rebate obligations such as Medicaid Managed Care, Medicaid Fee-For-Service and Medicaid Supplemental Rebates. Examine the legal, technical and financial accounting issues that could result:

The Impact of Medicaid Expansion on State Budgets and State Economic Growth 

Stan Dorn, J.D. is a Senior Fellow at the Health Policy Center of the Urban Institute. He's an expert on the Patient Protection and Affordable Coverage Act, Medicaid, the Children's Health Insurance Program (CHIP), federal programs to subsidize coverage for laid-off workers, and strategies to maximize coverage among individuals who qualify for subsidies.

Developments in the Split between Managed Medicaid and Fee-For-Service 

Moderator:
Josh O'Harra, Asst. General Counsel, Eli Lilly and Company

Panelists: Andy Vasquez, Deputy Director, Texas Health & Human Services Commission (Invited)
Steve Liles, Pharm.D., Senior Director, Pharmacy Services, Goold Health Systems 
Patricia Tietbohl, Director, Government Rebate Operations, Johnson & Johnson

Continually Strengthening Collaboration between States and Manufacturers

Monderator:
David Buckley, Contract Operations Mgr, Contract Management and Operations US, GlaxoSmithKline

Panelists: John Grotton, R.Ph., Executive Vice President, Goold Health Systems
Lisa Marchisello-Norton, Associated Consultant, Managed Healthcare Services, Lilly USA, LLC
Cemeria M. Ehis, Pharmacy Rebate Analyst, Alabama XIX, HP Enterprise Services

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

Opt-in for GP updates
GP Twitter
GP LinkedIn

CMS Keynotes at MMCC 2014

The 2014 Medicaid Managed Care Congress taking place May 19-21 in Baltimore, MD is designed to provide you and your company with what you need to implement changes brought about by the ACA implementation. Attend Medicaid Managed Care Congress to get inspired by our visionary keynote speakers:

CMS Shares Insights into the Future of U.S. Healthcare 

Patrick Conway, MD, MSc, Deputy Administrator for Innovation and Quality; Chief Medical Officer, CMS

Barbara Coulter Edwards, Director of the Disabled and Elderly, Health Programs Group in the Center for Medicaid and CHIP Services, CMS.

Identify lessons learned from pilot programs implemented in the past year, and hear where CMS is focusing their effort in the upcoming year. Discuss 2014 growth, inclusion of long-term services and supports, and the application of The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) to Medicaid.

FROM TV TO MMCC! 

Jonathan Karl, Chief White House Correspondent, ABC News

Hear Jonathan’s vantage point of the front row at the White House. From Healthcare Reform to a behind-the-scenes look at the leading political personalities, Jonathan provides a unique view of Washington’s political scene and the type of political analysis you can’t find anywhere else.

To view our full list of speakers, download our brochure.

Register with by 2/7 with code XP1926BLOG and save up to $500. If you have any questions or need any further information, feel free to email kdevery@iirusa.com or visit the webpage. We look forward to seeing you next May 19-21 in Baltimore!

Cheers,
The Medicaid Managed Care Congress

Opt-in for updates
Follow the MMCC Twitter
MMCC LinkedIn

The Medicare Congress Challenge

So you think you’re a CMS expert? The first ten people to answer our question correctly and will receive 20% off of the standard rate for the 2014 Medicare Congress, taking place February 10-12, in New Orleans. Email kdevery@iirusa.com with your answers. Good luck!

Question: What CMS region has the highest number of enrollees as percent of population? Which has the lowest?

Session Spotlight: From Wall Street to the Hill: The Financial & Political Outlook this Year and Beyond

According to the CBO, Medicare spending over the upcoming years is expected to decline. With healthcare reform going into effect and Medicare programs changing over the upcoming year, there are new opportunities for Medicare plans. Decreasing inefficiencies and reducing waste is great, but we still have a ways to go to make Medicare more sustainable in the long-term. So where do we stand in terms of financial solvency?

Session: From Wall Street to the Hill: The Financial & Political Outlook this Year and Beyond

Moderator: Murray N. Ross, Ph.D., Director, Institute for Health Policy; Vice President, Kaiser Permanente

Panelists:
Court Houseworth, Managing Director, Cain Brothers
Chris Rigg, Senior Analyst, Managed Care, Susquehanna Research Group

Want to learn more about improving your financial stability while decreasing inefficiencies and waste through innovative new Medicare programming? Join us February 10-12 in New Orleans for IIR's Medicare Congress.  To learn more, download our agenda. Register by 1/17 with code XP1907BLOG and save up to $200.