State Medicaid Programs and Their Relationship to the Federal Rebate System
Director, Government Contracts
Daiichi Sankyo, Inc.
• Understanding how state Medicaid programs operate
– Identifying the unique features and key differences of the various state programs
– Understanding how drugs in various states are actually reimbursed
• Complying with state reporting requirements
– What states have reporting requirements?
– What are the reporting requirements?
– How will changes to the AMP definition impact manufacturers’ reporting requirements
• Getting a drug on formulary
– What are Preferred Drug Lists (PDLs) and what criteria are evaluated before a drug is placed on a PDL?
• State Pharmaceutical Assistance Programs(SPAPs)
• Supplemental Drug Rebate Agreements
• What impact could the calculation of new URAs have on SPAPs and Supplemental Agreements?
• Understanding how Medicaid Managed Care programs operate
– Who are these entities?
– How are the formularies run?
How much control do the plan sponsors have over the formulary versus the state?
• Inclusion of Medicaid Managed Care programs in the federal rebate program
– Assessing the impact this will have on negotiated discounts/rebates between plan sponsors and manufacturers
Preparing for the possibility of double discounts
– recognizing which Medicaid managed care plans are covered under the federal statute requirements and which are not
– How will inclusion in the federal rebate program affect formularies and PDLs?
– What impact will the inclusion in the federal rebate program have on manufacturers’ rebate strategies?
• Accruing for rebates in light of changes to Managed Medicaid
• How are states planning to implement the requirements mandated by the federal government?
– Where will the money for implementation come from?
• The issues in Texas: where do they stand?