Rx Drug Pricing Boot Camp

Thursday, November 15, 2007

About

Pricing in compliance with government payor programs can be difficult and confusing. Not only do you need to know what AMP, AWP, WAC, BP, ASP, non-FAMP, and FCP mean, but you need to understand how all of your prices are related. A change in price to one customer can adversely effect your prices to other customers or the rebates you have to pay. To add to the confusion, CMS’s publication of the final Medicaid reimbursement rule changes the definition of AMP and the reimbursement formula for generic drugs.

A strong grasp of pricing methodologies, calculations and reporting requirements under programs such as Medicaid, Medicare, VA/DoD and PHS is critical to maximizing revenue and profits when working with government payor programs. Understanding the fundamentals of AMP, AWP, WAC, BP, ASP, non-FAMP, and FCP will make pricing calculations less confusing and less time consuming and will help to prevent pricing and reporting mistakes that can lead to fraud and abuse allegations.

ACI’s Rx Drug Pricing Boot Camp publication has been designed to give novices and experienced practitioners alike a complete understanding of core pricing competencies and applicable changes in reimbursement structures of key payor programs under recently enacted legislation with a strong focus on the final Medicaid rule recently issued by CMS. Take this unique opportunity to learn from pricing experts and fellow pricing professionals the challenges faced and solutions discovered after the first quarter of price reporting under the new Medicaid rebate rule. Topics covered include:

  • AWP: what is it, when it is still used, and what effect will litigation have on the continued use of this pricing methodology?
  • AMP: how is this price now calculated, and what is included in and excluded from the calculation
  • Part D pricing challenges and strategies for success
  • Fraud and abuse concerns arising under Medicare Part D

Contents & Contributors

About

Pricing in compliance with government payor programs can be difficult and confusing. Not only do you need to know what AMP, AWP, WAC, BP, ASP, non-FAMP, and FCP mean, but you need to understand how all of your prices are related. A change in price to one customer can adversely effect your prices to other customers or the rebates you have to pay. To add to the confusion, CMS’s publication of the final Medicaid reimbursement rule changes the definition of AMP and the reimbursement formula for generic drugs.

A strong grasp of pricing methodologies, calculations and reporting requirements under programs such as Medicaid, Medicare, VA/DoD and PHS is critical to maximizing revenue and profits when working with government payor programs. Understanding the fundamentals of AMP, AWP, WAC, BP, ASP, non-FAMP, and FCP will make pricing calculations less confusing and less time consuming and will help to prevent pricing and reporting mistakes that can lead to fraud and abuse allegations.

ACI’s Rx Drug Pricing Boot Camp publication has been designed to give novices and experienced practitioners alike a complete understanding of core pricing competencies and applicable changes in reimbursement structures of key payor programs under recently enacted legislation with a strong focus on the final Medicaid rule recently issued by CMS. Take this unique opportunity to learn from pricing experts and fellow pricing professionals the challenges faced and solutions discovered after the first quarter of price reporting under the new Medicaid rebate rule. Topics covered include:

  • AWP: what is it, when it is still used, and what effect will litigation have on the continued use of this pricing methodology?
  • AMP: how is this price now calculated, and what is included in and excluded from the calculation
  • Part D pricing challenges and strategies for success
  • Fraud and abuse concerns arising under Medicare Part D

Contents & Contributors

THE MECHANICS OF PRESCRIPTION DRUG PRICING REBATE AND DISCOUNT SYSTEMS
Eve M. Brunts, Ropes & Gray LLP

MEDICAID’S NATIONAL DRUG REBATE AGREEMENT
James C. Dechene, Sidley Austin LLP

AWP & WAC: WHAT YOU NEED TO KNOW
Thomas R. Bizzaro, R.PH., First DataBank
Carolyn McElroy, Pacific Pulmonary Services
Ronald G. Dove, Jr., Covington & Burling LLP

MEDICAID REBATE AND KEY PRICING TERMINOLOGY AND NEW CONSIDERATIONS AND CHALLENGES PRESENTED BY THE DRA FINAL RULE
Larri A. Short, Arent Fox LLP
John D. Shakow, King & Spalding LLP

FINAL MEDICAID REGULATIONS REDLINED AGAINST PROPOSED REGULATIONS
John D. Shakow, King & Spalding LLP

MEDICARE PART B PRICING AND THE MEDICARE MODERNIZATION ACT
Tim Hermes, Sepracor Inc.

VA FSS PRICING
Marci Anderson, Office of Contract Review

PRICING UNDER THE PUBLIC HEALTH SERVICE 340B PROGRAM: THE LINK TO MEDICAID REBATE
Edith Marshall, Safety Net Hospitals for Pharmaceuticals Access

CASE STUDY: HOW PRICING DECISIONS ARE INTERRELATED
David Ralston, Schering-Plough Corporation

PART D PRICING CHALLENGES AND STRATEGIES FOR SUCCESS
Anna L. Spencer, Sidley Austin LLP

PART D FORMULARY NEGOTIATIONS AND CONTRACTING: WHAT HAVE WE LEARNED AND WHERE ARE WE GOING?
Robert Hill, Reed Smith LLP

REGULATORY COMPLIANCE FOR MANUFACTURERS IN A POST PART D WORLD
Ellen L. Janos, Mintz, Levin, Cohn, Ferris, Glovsky & Popeo, P.C.

MEDICARE PART D-REGULATORY COMPLIANCE ISSUES
Claudia Schlosberg, J.D., Schlosberg Consulting

RECENT OIG ADVISORY OPINIONS REGARDING MANUFACTURER PATIENT ASSISTANCE PROGRAMS
Claudia Schlosberg, J.D., Schlosberg Consulting



DOCUMENT TYPES: PRESENTATIONS AVAILABLE: 0