Government programs experienced rapid growth resulting in an increase in the percentage of total retail prescription drug costs from 20% in 2000 to 43% in 2017. Pressure on GTN is escalating since government programs have the highest prescription drug rebates.

The workshop is designed to enable participants to understand complexities and key concepts related to government pricing of prescription drugs for Medicare Part B & D, Medicaid, VA, & 340B programs. Numerical examples are presented illustrating key concepts and practical applications. The workshop provides best practices for well-designed government pricing processes supported by a sound methodology to enhance financial reporting accuracy and reduce volatile material true-up adjustments. Implications of price increases and escalating commercial rebates on Medicare and Medicaid net price is incorporated in the workshop. The Senate Finance Committee’s Drug Pricing Package and other proposed legislation will be reviewed to provide an assessment of the financial implications.

Following are the topics designed to enhance your knowledge of government programs on GTN:

  • Medicare Part B drugs administered by HCP
  • Medicare Part B Rebates
  • Medicare Part D Prescription Drug Insurance Program
  • Medicare Part D Enrollment Growth
  • Medicare Part D Rebates
  • Medicare Part D Coverage Gap (Donut Hole)
  • Fundamental of Medicaid Drug Rebate Program (AMP, BP & URA)
  • Implications of price increases on Medicaid Net Price
  • Impact of commercial rebates on Medicaid Net Price
  • Impact of authorized generics on Medicaid Net Price
  • Medicaid penny pricing
  • Negative GTN – Medicare Part D Donut Hole Coupled with Rebates
  • Development of key assumptions, forecasts and accruals for government programs
  • Value-based contracts
  • 340B government program – implications and potential abuses
  • Senate Finance Committee’s Drug Pricing Package and other proposed legislation
  • Cross-functional collaboration – best practices