A solid grasp of government payor programs is essential for manufacturers navigating VA FSS pricing and contracting. This session will break down two major federal drug pricing programs, Medicare and Medicaid, explaining how they interact and influence VA pricing. Key discussion points include:

• Reviewing the Medicaid Drug Rebate Program (MDRP), including Average Manufacturer Price (AMP), Best Price (BP), and Unit Rebate Amount (URA)
  • Examining how changes in Medicaid rebate calculations may affect VA FSS pricing and Non-FAMP
• Reviewing the 340B program: covered entities, duplication discounts, and diversion concerns
  • Exploring Medicaid’s relationship with the 340B program and the impact on pricing strategies
• Differentiating between Medicare Part B (Average Sales Price (ASP)-based reimbursement) and Part D (private plan negotiations)
  • Exploring how Medicare’s payment structures affect pricing strategies
• Defining how federal purchasing programs interact with Medicare and Medicaid pricing policies:
  • VA FSS pricing and statutory discounts (VHCA section 602)
  • The significance of Non-FAMP and FCP in VA contracts