How to Address Commercial Ops, Commercial Contracting and Government Pricing

At MDRP 2013, Mark Linver, Director, Huron Life Sciences discusses addressing government and commercial pricing operations during mergers and divestitures. Below are two highlighted sessions from MDRP 2014 that will look into Commercial Ops, Commercial Contracting and Government Pricing.


Session Highlight:
Spillover Effects Between Government Pricing, Commercial Business & Contracting Strategies

• Discuss healthcare reforms impact on contracting & emerging contracting practices
• Evaluate the impact of government pricing changes on commercial accounts
• Reevaluate and restructure rebate and discount agreements

David Chan, Practice Leader, Compliance & Audit, Managed Markets Services, IMS Health


Session Highlight:
Improving Effectiveness of Revenue Analytics by Using GP Forecasting

The continual growth of the government channel has increased the importance of understanding the cross-channel impact of the commercial pricing and contracting decisions that drive liabilities. Along with increasing pressure to understand, forecast and accurately accrue for revenue line items as part of the GTN process, an expanding government channel means contracting and pricing functions have a greater need for pricing and forecasting outputs from the GP department. The “modern” GP team is tasked with providing “what if” analyses and forecasts for a wide variety of company specific and industry wide events, and is looked upon as a critical resource when pricing and contracting decisions are being made. Today’s GP team must be adept at developing quick yet sophisticated models to assess how any given event may affect Revenue lines that are driven by a Government payer.

This session will take a look at how to effectively incorporate commercial strategies and market events into the forecast of GP price points. We will explore how to:

• Manage and align data for analytical needs
• Consider price increases and commercial contracting strategies
• Incorporate channel shifts into forecasts
• Evaluate regulatory and market events in scenario modeling
• Identify what you know and what you don’t know, and how both should be considered and modeled

Jeffrey Baab, Senior Director, Life Sciences, daVIZta

Download the agenda to see a complete list of speakers and sessions.

Register by Friday 8/8 to save $300! Make sure you use the code XP1958BLOG | Register Now!

Complimentary Webinar | Moving and Improving: Using Data and Informatics to Inform Your Business Strategy, Save Lives and Improve Quality

A complimentary webinar from Healthcare Data Insights

 

Date: August 19th

Time: 11:00AM - 12:00PM EDT

Moving and Improving: Using Data and Informatics to Inform Your Business Strategy, Save Lives and Improve Quality

The University HealthSystem Consortium (UHC), the member organization of 120 non-profit Academic Medical Centers and their affiliates, encourages hospitals to integrate data into their business plans, in part by demonstrating how data can be used to save lives and improve quality scores. With transparent access to data from more than 400 hospitals (which includes more than 5 million inpatient discharges annually and 25 million outpatient encounters), learn how they make the case for member hospitals to “move and improve” with innovative programming based on data.

Speaker: David Levine, MD, FACEP, Vice President, Informatics, and Medical Director, UHC

In this seminar, David will show how members maximize hospital and physician data to measure efficiency and effectiveness. Work in both the inpatient and outpatient settings to capture performance over the continuum of care will be emphasized. The data challenges will be highlighted especially with cost and capturing all inputs to care.

• Key metrics being used to measure overall hospital performance
• How Academic Medical Centers are looking at physician variability
• How to identify key opportunities for cost reduction
• Importance of risk adjustment and using proper compare groups to engage clinicians in improvement
• Challenges of integrating databases and gaps in data

Register for the Webinar - Use Priority Code: W1BL

MDRP Lifetime Achievement Award

Each year the MDRP audience selects who should receive the “Lifetime Achievement Award.” Nominations are now open. Make sure to get your choice in for consideration now.


As the longest running MDRP conference, we are honoring the best and recognizing the dedication of those who have propelled this industry forward. Please submit your award nomination(s) here. We have divided the nominations by role in the industry, as so many have worked together to make the Medicaid Drug Rebate Program what it is today. The deadline for nominations is Monday, August 11, 2014 and the winners will be announced at the event during the networking reception on Tuesday, September 16th - So make sure you register to attend the event now. Save $300 when you register by 8/8 with the code XP1958BLOG.

To learn more about the program, download the brochure now. 

See you in Chicago this September!

Is Medicaid Expansion Feasible?

Welcome to the MDRP Podcast Series. Joining us today is Grace-Marie Turner, President, Galen Institute.

Download the complete podcast & transcript here.

Is Medicaid Expansion Feasible?

Grace-Marie: I just think that it’s going to be very difficult to convince those other states that have resisted so far because more and more evidence is coming down to show that expanding Medicaid as a traditional program as it is currently structured is real harmful to people. And it’s really harmful to the most vulnerable citizens who are on Medicaid today. If people have many chronic conditions, many of them have no place else to go. They are basically not insurable in the private marketplace. If they are under 100 or 138% of poverty, Medicaid really is their only option. As a result, you wind up with more people competing for the same limited number of doctors who will see Medicaid patients and making it even more difficult for people on Medicaid today to find a doctor to see them.

I had a father write to me recently who has a daughter who is on Medicaid – many chronic conditions and in a wheelchair. He said: “It takes me sometimes six weeks to get an appointment with her urologist”. He said: “Do they even think about how much more difficult it’s going to be to get an appointment with the urologist if there are a million more people competing for those same appointments?” So, we must fix it so that it allows the safety net to be intact for the most vulnerable people and give those who have the option to get private coverage to do so, so that they are not competing.

And then finally, I think that the states who want to expand the program need to guarantee that providers will be paid enough that they will be able to see a Medicaid patient. In some states like New Mexico that have a very high match rate, Medicaid pays at very close to Medicare rates. In other states, a doctor may be paid $5 or $7 for an office visit – not even enough to begin to cover expenses. Doctors want to take care of these patients, but they can only keep so many and keep the lights on and pay their own bills. So, we’ve got to be able to pay providers more and that’s the kind of leverage that I think that the states would be able to have if they were not so constrained by an avalanche of federal rules and all the “Mother May I?” waiver requests that they have to get to make any changes to their plan.

If they had more flexibility, then they could make sure that patients on the program today could actually find a doctor to see them and also make sure that those who may be in an expansion population have the option of coverage that looks more like the private insurance and the private marketplace so that it’s a track and a platform to private coverage rather than the cliff that Medicaid is today – either in or out. If you make $1 too much money then you’re out of Medicaid or $1 less and you’re in. It needs to be a smoother ramp to private coverage and there are a lot of ideas to do that, including giving people the option of basically taking their Medicaid allotment as a voucher to buy into private coverage. There are a lot of ideas out there to improve this program, but we need to remember that we’re doing it for the most vulnerable citizens who are on the program today, who have no place else to go, competing for a limited number of appointments with a shrinking number of doctors to actually get appointments.

We can do so much better and I think you’re going to see many more governors actually demanding those kinds of changes and that kind of flexibility in exchange for any expansion.




Click here to download the rest of the podcast.

To hear more from Grace-Marie, make sure you join her at MDRP 2014 this September 15-17 in Chicago. As a reader you can save an extra $100 off the current rate when using the code XP1958BLOG. Register now to save!

See you in Chicago.

How Can We Sustain the Innovation of Biopharmaceuticals?

Welcome to the Specialty Pharmacy Collaboration Summit Podcast Series. Today we are speaking with Robert Popovian, Senior Director, US Government Relations, Pfizer Pharmaceuticals.

Download the complete podcast & transcript here.

What needs to happen in the US to sustain the innovation initiative of biopharmaceuticals?

Robert: Well, biopharmaceuticals is a complex issue and a lot of people try to make it a very simple one by saying to do regulatory reform through the FDA or provide additional NIH funding to do research. Biopharmaceutical innovation policies are very complex and inter-dependent onto one another. There is no one magic bullet.

So, there are three distinct environments that need to be addressed to really sustain the biopharmaceutical innovation marketplace in the US and that is the investment environment, which is basically appropriate and electoral property protection. For example, tax policy, ability to price medicines according to the marketplace.

There is the regulatory environment, which is the second environment, which requires that we do a better job of streamlining not only the FDA, but other regulatory bodies like the Centers for Disease Control. And then, more importantly, within the regulatory policy framework is how to better do clinical trials and clinical trial recruitment. That needs to be addressed.

Finally, it is the access, which in my opinion is the one that is short shifted a lot of times because unless you address the access environment for biopharmaceutical, no matter if you are investing a lot of money in it or you have a very deregulatory process to get the product out, if the patients are unable to access those medicines because they are too high cost regarding out-of-pocket costs or there is no meaningful way to get access to it because there is no way to communicate that information to the providers, innovation will suffer and patients will suffer long term with that.

Click here to download the rest of the podcast.

To hear more from Robert, please join him at IIR's Specialty Pharmacy Collaboration Summit, September 15-17 in Boston. Also, you can save an EXTRA $100 off the current rate, $500 in total savings when registering by 7/25 with the code: XP1968BLOG - Register now. 

See you in Boston!

Attention All Health Plans | Buy One, Get One Free to the Specialty Pharmacy Collaboration Summit

 

Attention Health Plans! Join us at the Specialty Pharmacy Collaboration Summit and for a limited-time only, we're offering a Buy One, Get One offer*! 

Expiring this Friday, July 25th, purchase one pass and have a colleague attend for free! Be sure to use code: XP1968BOGO. To register, call Roxana Siu at 646-895-7452 or email rsiu@iirusa.com.


*Free Delegate Pass Eligibility Rules and Regulations:
1. Offer applies only to Health Plan executives
2. If the paying delegate cancels, the free delegate will receive an invoice for the amount of the paying delegate.
3. 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.
4. Offer cannot be applied retroactively to confirmed paying registrants.
5. Offer cannot be combined with any other discounts or promotions.
6. All BOGO registrants and guests are subject to IIR approval.

340B Entities: Best Practices for Pricing and Compliance Methodologies

Above, you will hear John Shakow, Partner, King & Spalding speaking with MDRP TV about 340B Entities – and the best practices for pricing and compliance methodologies. To hear more insights from John, join him at MDRP 2014, where he will be speaking again. Below you can find a highlight of one of his sessions at the event.

Understand the Implications: A Business Perspective
You’ve heard the presentations and the speeches, the panels and the analysis. In this session of the conference, we will try to tie it all together and give you a 360° view of the government pricing landscape in the coming year. The emphasis will be on key takeaways, which you and your colleagues should keep top of mind as you head back home. 2014–15 promises to be a year of great change and increasing complexity in all aspects of government pricing, and with that come the inevitable compliance, legal, business and operational challenges. Secure the benefits of MDRP 2014 with this roundup of highlights and key observations.

For more session information, download the complete agenda.

And remember as a blog reader you save an extra $100 off the current rate when you register with the code XP1958BLOG - Register by 8/8 to save a total of $300!

See you in Chicago!

360 Perspective from BCBS, Boston Medical Center, Tufts Health Plan, Denver Health Plan and more!

 

This Friday, July 25th is your last chance to save up to $500!

Use Code: XP1968BLOG 

Register Now

Due to increasing healthcare costs brought on by health care reforms and the ACA, payers need to partner with specialty pharmacies to help fill the oversight gap in compliance and to manage costs and reimbursements. Specialty Pharmacies offer their product management and patient adherence services to help fill the gaps of the payers, while meeting the needs of reduced costs.

IIR's all-new Specialty Pharmacy Collaboration Summit is the only event in the space offering you the opportunity to partner directly with all the key stakeholders in the specialty pharmacy value chain to increase patient adherence, expand distribution and improve bottom line. Learn how health plans successfully partner with specialty pharmacies and leading pharmaceutical companies and discover the impact of specialty pharmacies on bottom line profits and costs from the below experts:

The True Value of Specialty Pharmacy: A Direct Impact on Bottom Line Revenue and Profits

• Reed Melton, Executive Director, Center for Clinical Practices, Blue Cross and Blue Shield Association
• Bhavesh Shah RPh, BCOP, Clinical Pharmacy Manager, Hematology-Oncology, Coordinator - Patient Assistance Programs, Specialty Pharmacy Manager, Boston Medical Center

Payer Panel: Specialty Pharmacy Management in Commercial Health Plans

• Michelle Beozzo, PharmD, Director of Pharmacy Services, Managed Care, Denver Health Medical Plan
• David Brumley, MD, MBA, Senior Medical Director, Tufts Health Plan

Roundtables: The Specialty Pharmacy Space-Niche No More?

• Independent Retail Community Pharmacies
Nick Calla, VP Industry Relations, Community Specialty Pharmacy Network
• Regional and National Chains Launching Specialty at Retail Programs
Christopher Benz, Business Development Director, Armada Health Care
Brian Burke, Vice President, National Accounts, Armada Health Care
• Private, Independent Specialty Pharmacies
Rebecca M. Shanahan, Esq. Chief Executive Officer, Avella Specialty Pharmacy

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

Don't miss out! This Friday, July 25th is your last chance to save up to $500! Click here to register or call 888-670-8200 to register. Be sure to use code: XP1968BLOG

Best Collaborative Practices for Resolving or Avoiding Medicaid Disputes

MDRP 2014 Session Spotlight: 

Best Collaborative Practices for Resolving or Avoiding Medicaid Disputes

 

The complexities involved in identifying and resolving Medicaid disputes have only grown since the ACA with the additional claims from Managed Medicaid Organizations. In this session we will discuss some common best practices related to working collaboratively with your state contacts to either avoid disputes or resolve them quickly.

• Communications and documentation required to avoid putting units into dispute
• Key information needed by the states/manufacturers to research and resolve a disputed claim
• How best to avoid recurring unit of measure issues
• The value of informative state invoice cover letters for states and manufacturers
• An update on the work group’s efforts to standardize electronic reporting across the MDRP

Panel:
Lisa Norton, Associated Consultant, Managed Healthcare Services, Lilly USA, LLC
Kelly Geissler, Sr. Analyst, Government Rebate Operations, Johnson & Johnson Health Care Systems Inc.
Daksha Bogdon, Govt Pricing and Contracting, Genentech
Cindy Laclair, Drug Rebate Specialist (HP), Kansas
John Grotton, Sr. Director, Medicaid PBA Operations, Goold Health Systems


For more session information, download the brochure now. 

Blog readers receive an extra $100 off the current rate when you use the code XP1958BLOG. Register by 8/8 to save $300!


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What is the Future of Specialty Pharmacy?

Welcome to the Specialty Pharmacy Collaboration Summit Podcast Series. Today we are speaking with Nick Calla, VP of Industry Relations, Community Specialty Pharmacy Network (CSPN)

Download the complete podcast & transcript here.

What is the future of specialty pharmacy and the impact on the key stakeholders?

Nick: When you look at specialty pharmacy, in my mind it is still an evolving area of pharmacy. Specialty pharmacy really came into being, I would say, at least 20 years ago where it was the very beginning of specialty pharmacy with products like betaseron in the Multiple Sclerosis space, as well as products like Crixivan in the HIV space back in the mid-80s.

The model has evolved and has evolved dramatically over the last 10 years or so. At this point in time, it is really quite dominated by the Big 4, Big 5 large PBMO and health plan owned specialty pharmacies. Therefore, when you look at a model like the one that I represent or CSPN – quite honestly the smaller pharmacies are being shut out of a number of opportunities.

Now, there are a number of good reasons for that. Many retail-based or community-based pharmacies simply have not developed the infrastructure to support a specialty product which, as I mentioned earlier, is a high-touch model. Many of these pharmacies have not developed the benefit investigation needed, the reimbursement support infrastructure needed and really the clinical support needed to truly manage dictation. However in our model, for example, there are a number of community players – smaller, independent pharmacies – that have developed all of these resources. They have also developed accreditation through some of the accrediting groups like URAC and ACHC. As well, they’ve become members of organizations like NASP – National Association of Specialty Pharmacies. So, they have truly developed the model over time.

As I said, the industry is still dominated by the Big 5 and Big 6 and again, I think what’s going to happen over time as this model starts to develop is that you are going to need more pharmacies with the capabilities to handle the special dictation. There are many, many products. Development on the oncology side, for example, on the Multiple Sclerosis side and the Rheumatoid Arthritis side that I think will require a larger group of pharmacies that truly have the capability to manage that patient.

So, that’s where I see it. I see the future of specialty pharmacy really expanding and creating opportunities for stakeholders beyond the few that have truly taken advantage of this space up to this point.

Click here to download the rest of the transcript and podcast.

To hear more from Nick, please join him at IIR's Specialty Pharmacy Collaboration Summit, September 15-17 in Boston. Also, you can save an EXTRA $100 off the current rate, $500 in total savings when registering by 7/25 with the code: XP1968BLOG - Register now.

See you in Boston!