Annual In-House Counsel Forum on Government Regulation of Prescription Drug Pricing, comes...

Rx Drug Pricing Boot Camp

Intensive training in essential pricing concepts, methodologies, and strategies relative to key government payor programs

Thursday, May 17, 2007

About

Proposed AMP Rule Now Released! End your confusion now!
Master the essentials of key pricing concepts and methodologies, including those under the proposed AMP rule.
Learn the mechanics of pricing under Part D.

AWP...WAC...WAMP...AMP...BP...FAMP and non-FAMP...all these acronyms — a seeming regulatory alphabet soup — are connotative of critical prescription drug pricing and reimbursement methodologies under government payor programs such as Medicaid, VA/DOD and PHS. In addition, under the MMA, the Medicare program is now subject to the pricing rubrics of ASP and CAP, as well as a plethora of new pricing and reimbursement complexities through the creation of the Medicare drug benefit, i.e., Medicare Part D. The passage of the Deficit Reduction Act of 2005 (DRA) further added to the complexities of drug pricing and reimbursement with its changes and mandates for — among other things — new AMP calculations as part of the plan for Medicaid reform.

These legislative changes to key pricing concepts have left many confused — even the most seasoned pricing and reimbursement veterans — as to which acronym now applies to which program and when. Such uncertainty is especially dangerous today. Any miscalculation may lead to government scrutiny, investigations, and enforcement actions.

It is absolutely essential that you have a solid foundation in the basics of pricing methodologies and are well versed in the latest legislative and regulatory developments affecting reimbursements. How confident are you that the critical pricing calculations you have made — on your client’s behalf — relative to government payor programs are correct?

This publication from ACI’s Rx Drug Pricing Boot Camp has been designed to give novices and experienced practitioners alike a complete understanding of core pricing competencies and applicable changes in the reimbursement structures of key payor programs under recently enacted legislation.

A distinguished faculty of top pricing and reimbursement experts will provide you with practical information and insights on:

  • The Deficit Reduction Act and its impact on pricing methodologies relative to Medicaid and other payor programs
  • The role of the National Rebate Agreement in various payor programs
  • AWP: what is it, when is it still used, and what is its relationship to WAC?
  • 340B entities: how are they defined and how is 340B pricing set?
  • The essentials of Medicare Part B pricing, including the interrelation of ASP, CAP, and WAMP
  • The ins and outs of government contracting relative to GSA FSS, VA/DOD, and Tricare
  • Pricing concepts and reimbursement challenges relative to Medicare Part D, including:
    • fraud and abuse risk areas — PAPs, off-label use, and Part D marketing guidelines
    • LTC pharmacies and PBMs
    • the position of CMS on legal issues affecting the drug benefit
    • formulary negotiations
    • policy concerns

Contents & Contributors

About

Proposed AMP Rule Now Released! End your confusion now!
Master the essentials of key pricing concepts and methodologies, including those under the proposed AMP rule.
Learn the mechanics of pricing under Part D.

AWP...WAC...WAMP...AMP...BP...FAMP and non-FAMP...all these acronyms — a seeming regulatory alphabet soup — are connotative of critical prescription drug pricing and reimbursement methodologies under government payor programs such as Medicaid, VA/DOD and PHS. In addition, under the MMA, the Medicare program is now subject to the pricing rubrics of ASP and CAP, as well as a plethora of new pricing and reimbursement complexities through the creation of the Medicare drug benefit, i.e., Medicare Part D. The passage of the Deficit Reduction Act of 2005 (DRA) further added to the complexities of drug pricing and reimbursement with its changes and mandates for — among other things — new AMP calculations as part of the plan for Medicaid reform.

These legislative changes to key pricing concepts have left many confused — even the most seasoned pricing and reimbursement veterans — as to which acronym now applies to which program and when. Such uncertainty is especially dangerous today. Any miscalculation may lead to government scrutiny, investigations, and enforcement actions.

It is absolutely essential that you have a solid foundation in the basics of pricing methodologies and are well versed in the latest legislative and regulatory developments affecting reimbursements. How confident are you that the critical pricing calculations you have made — on your client’s behalf — relative to government payor programs are correct?

This publication from ACI’s Rx Drug Pricing Boot Camp has been designed to give novices and experienced practitioners alike a complete understanding of core pricing competencies and applicable changes in the reimbursement structures of key payor programs under recently enacted legislation.

A distinguished faculty of top pricing and reimbursement experts will provide you with practical information and insights on:

  • The Deficit Reduction Act and its impact on pricing methodologies relative to Medicaid and other payor programs
  • The role of the National Rebate Agreement in various payor programs
  • AWP: what is it, when is it still used, and what is its relationship to WAC?
  • 340B entities: how are they defined and how is 340B pricing set?
  • The essentials of Medicare Part B pricing, including the interrelation of ASP, CAP, and WAMP
  • The ins and outs of government contracting relative to GSA FSS, VA/DOD, and Tricare
  • Pricing concepts and reimbursement challenges relative to Medicare Part D, including:
    • fraud and abuse risk areas — PAPs, off-label use, and Part D marketing guidelines
    • LTC pharmacies and PBMs
    • the position of CMS on legal issues affecting the drug benefit
    • formulary negotiations
    • policy concerns

Contents & Contributors

Implications of Medicaid Reform
Larri A. Short, Arent Fox LLP (Washington, DC)

The Mechanics of Prescription Drug Pricing and Rebate Systems
Eve M. Brunts, Ropes & Gray LLP (Boston, MA)

Medicaid’s National Drug Rebate Agreement
James Dechene, Sidley Austin LLP (Washington DC)

Pricing Under the Public Health Service 340b Program: The Link to Medicaid Rebate
Edith S. Marshall, Safety Net Hospitals for Pharmaceutical (Washington, DC)

Medicare Part B Pricing and the MMA
Karen S. Lovitch, Mintz, Levin, Cohn, Ferris, Glovsky & Popeo, P.C. (Boston, MA)

Federal Government Contracts and Pricing
Donna Lee Yesner, McKenna Long & Aldridge LLP (Washington DC)

Part D Pricing Challenges and Strategies for Success
Anna L. Spencer, Epstein, Becker & Green P.C. (Washington DC)

Addressing Fraud and Abuse Concerns Arising Under Part D
Marci Handler, Epstein, Becker & Green P.C. (Washington DC)

PAPs, Off-Label Use and Part D Marketing Guidelines
Eileen L. Kahaner, Sidley Austin LPP (San Francisco, CA)

Part D Pricing Considerations for Manufacturers Relative to LTC Pharmacies and PBMS
Robert J. Hill, Reed Smith LLP (Washington DC)

Medicare Part D Pricing and Operational Policy Update
Colin Roskey, Alston & Bird LLP (Washington CD) (former Health Policy Advisor and Counsel, Senate Finance Committee)



DOCUMENT TYPES: PRESENTATIONS AVAILABLE: 0