GTN Training Courses

GTN Concepts and Accounting Implications

Course is designed to enhance fundamental knowledge of GTN Concepts.

Rapid growth in commercial & government rebates has resulted in GTN reductions above 50% of gross sales for traditional brands. Gross-to-net sales continue to be impacted by significant volatility, high risk exposure, and material true-up adjustments.

Join us to enhance your understanding of key GTN concepts and related accounting implications.

By attending this course, you’ll learn about:

  • Product and money flow in the pharmaceutical distribution system
  • Vertically integrated pharmacy benefit managers
  • Impact of payer formulary exclusions, prior authorization, and step edits
  • Implications of escalating patient out-of-pocket costs
  • Forecasting payer mix and rebate percentages to establish accrual rates
  • True-up adjustments
  • Key factors impacting rebates and market access
  • Government programs
  • Chargebacks
  • Price protection
  • Copay and patient assistance programs
  • Copay accumulators & maximizers
  • Wholesaler fees
  • GTN accounting concepts
  • Pipeline and demand liability
  • Accounting for product returns
  • Third party data sources

Government Programs and the Impact on GTN

Course is designed to enhance knowledge of complex government programs including Medicare, Medicaid, TRICARE & 340B programs. Numerical examples will be presented to illustrate key concepts and practical application.

Government programs represent a significant portion of total gross sales and are projected to continue to grow rapidly. Pressure on gross-to-net sales is escalating due to government programs having the highest prescription drug rebates.

The course will enhance your knowledge of government programs and the impact on GTN from an accounting & finance perspective.

By attending this course, you’ll learn about:

  • Medicare Part B buy & bill
  • White, brown, and clear bagging
  • Medicare Part D Prescription Drug Program
  • Inflation Reduction Act
  • Considerations for estimating Medicare Part D Donut Hole
  • Medicaid Drug Rebate Program
  • Implications of price increases on Medicaid Net Price and GTN
  • Triggering Medicaid best price penalty
  • Medicaid AMP-Cap removal
  • Charitable foundations
  • Prescriptions with negative net sales
  • Branded prescription drug fee
  • Authorized generics
  • TRICARE
  • 340B – ecosystem, double-dipping and current developments

PBM Market Access Restrictions and Contracting Challenges

Course is designed to enable participants to understand practical implications of PBM utilization restrictions, rebate & pricing pressures, and contracting challenges.

The three largest vertically integrated PBMs control approximately 80% of the market and have clout. Escalating rebates for formulary access coupled with PBM measures to limit utilization continues to put pressure on gross and net sales.

The course will enhance your knowledge of PBM Market Access Dynamics and the GTN implications. Numerical examples will be presented illustrating key concepts and practical applications.  A case study will also be presented to enhance understanding of key considerations when negotiating PBM contracts.

By attending this course, you’ll learn about:

  • Pharmaceutical ecosystem – PBMs, pharma companies, payers, and patients
  • Unique dynamics of PBM expansion, consolidation and vertical integration
  • PBM revenue sources
  • Why PBMs prefer high-price drugs with high rebates
  • Impact of PBM formulary tiers, formulary exclusions, prior authorization, and step edits
  • Key factors impacting rebate rates and formulary position
  • Copay and patient assistance programs
  • Charitable foundations
  • Specialty carveout/alternative funding programs
  • Bridge programs
  • Rebate walls and biosimilar market access challenges
  • Value-based & indication-based contracts
  • Netflix and installment-based contacts
  • ROI of PBM contracting scenarios and sensitivity analysis
  • Optimizing market access – developing a compelling value proposition
  • Case study – negotiating rebates & market access with PBMs

Understanding Provisions and Implications of the Inflation Reduction Act

The Inflation Reduction Act is a game-changer that embodies complex prescription drug provisions with far-reaching implications. The federal government is negotiating prices for high-cost drugs covered under Medicare. Medicare price increases are constrained by required inflation rebates when drug prices outpace inflation. Medicare Part D will be redesigned to eliminate the coverage gap (“donut hole”), cap beneficiary out-of-pocket costs at $2,000 per year, shift costs from the government to drug manufacturers & prescription drug plans and require pharma manufacturers to pay uncapped government rebates.

The course will enhance your knowledge of the complex provisions and implications of the Inflation Reduction Act. Numerical examples, charts and graphs will be presented illustrating key concepts and implications from a financial, market access, commercial and strategic perspective.

By attending this course, you’ll learn about:

  • AMP-Cap removal
  • Inflation Reduction Act implementation timetable
  • Medicare price negotiation – process, provisions, drug selection criteria & CMS considerations
  • Maximum fair price
  • Impact of Medicare price negotiations on competitive drugs pricing and rebates
  • Implications of Medicare price negotiations on orphan drugs
  • Potential spillover of Medicare price negotiations to Medicaid triggering best price
  • Implications of Medicare price negotiations on patient out-of-pocket costs and premiums
  • Expansion of low-income subsidies (“LIS”)
  • Impact of Medicare price negotiations on innovation and sequencing of new indications
  • Medicare Part B & Part D inflation rebates
  • Double whammy: PBM-negotiated price protection rebates and Medicare inflation rebates
  • Medicare benefit redesign restructuring:
    • Comparison – Inflation Reduction Act vs. current law: who pays what % & when
    • Estimating new 20% pharma government liability for drugs in catastrophic phase
    • Implications on market access of prescription drug plan responsibility increasing from 15% of total drug costs under current law to 60% in
    • catastrophic phase starting in 2025
    • Inclusion of LIS patients in determination of Medicare Part D rebates
  • Financial, market access, commercial and strategic considerations for pharma manufacturers

Accounting, Finance, Budgeting & Forecasting for Non-financial Executives

The course is designed to enhance knowledge of accounting and finance concepts to make informed decisions.

Numerical examples, charts and graphs will be presented illustrating key concepts and implications.

Key topics include:

Accounting – Overview of Financial Statements

  • Income Statement
  • Balance Sheet
  • Statement of Cash Flows

Key Accounting Concepts

  • Prepaid Expenses
  • Accruals
  • Matching Consistency

Implications of Behavioral Biases

  • Overconfidence
  • Confirmation Bias
  • Sandbagging
  • Group-think

Budgeting

  • Objectives
  • Process
  • Pain Points
  • Prioritization Challenges
  • Best Practices

Forecasting

  • Objectives
  • Process
  • Frequency
  • Simplification
  • Best Practices