Pre-Conference Workshop

April 28, 2014 1:00pm

Government Payor Pricing 101: Primer for Professionals New to Pharmaceutical Pricing

William A. Sarraille
Partner
Sidley Austin LLP

John D. Shakow
Partner
King & Spalding LLP

This workshop will provide you with a basic overview of pharmaceutical pricing and government payor programs. This pre-conference workshop serves as a primer on the fundamentals of government pricing and will prepare you for the more in-depth discussions that will take place throughout the conference.

• Tracing the history of applicable legislation such as the MMA, DRA, and PPACA
• Tracing the flow of payments and reimbursements in the health care supply chain
– Identifying stakeholders within the chain and their roles
– Tracking the fl ow of drugs, payments and services
• Deciphering commonly used acronyms and terminology
• Overview of different pricing benchmarks and calculations
– AMP, AWP, ASP, WAC, BP, PHS, FCP, and non-FAMP
• Understanding the implications of different pricing methodologies, calculations and benchmarks for different stakeholders
• Examining the key pricing concepts and calculations for government drug pricing and rebate programs
– Medicaid Drug Rebate program
– Medicare Part B
– 340B Drug Pricing program
– Federal Supply Schedule/Federal Ceiling Price
– Medicare Part D
– TRICARE
• Identifying similarities and differences among the programs
• Considering the interactions among the programs
• Overview and analysis of the National Rebate Agreement: its origins and significance
• Review of the agreement’s terms and requirements for participation
• Understanding why participation in the Medicaid outpatient drug program is contingent on participation in the PHS 340B and VA programs
– How is the PHS program linked to Medicaid?
• Analyzing the relationship of the National Rebate Agreement to the Medicare Drug benefit? (i.e., Medicare Part D)
• Identifying the changes resulting from the enactment of the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Affordability Reconciliation Act