In stark terms, the Federal Trade Commission found in a report released Tuesday that pharmacy benefit managers — the opaque middlemen in the pharmaceutical supply chain — wield such “enormous power." https://trib.al/OC5N8Xg
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🚀 CMS has recently published guidance on the Inflation Reduction Act of 2022. Here are key insights for pharmaceutical manufacturers to navigate the impacts: 📆 Important Dates: The Coverage Gap Discount Program concludes on 12/31/2024, and will be replaced by a new Medicare Part D Manufacturer Discount Program starting 1/1/2025. For manufacturers that may qualify for Specified Manufacturer and Specified Small Manufacturer Phase-Ins, CMS requires that manufacturers submit certain ownership attestation information in HPMS by next Friday, 12/15/2023 in order to receive a non-binding preliminary decision. 📌 Next Steps: Learn more about participation in the Discount Program and submitting the required information for Phase-Ins in our latest blog. https://lnkd.in/eYFPjY-z 🤝Have questions or need assistance? Reach out anytime – we are here to support you on this journey! Richard Moore Jake Keenan #FCSinsights #pharma #pharmanews #healthcareupdates #medicarepartd #inflationreductionact #healthcarecompliance #cms #coveragegap
IRA and New Manufacturer Discount Program - Federal Compliance Solutions
https://www.federalcompliancesolutions.com
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Leveraging costs is pivotal these days, especially for high-ticket items such as prescription medications. With @CMS claim audits projected to rise in the next few years, payers must ensure the organizations they partner with are prepared with essential documentation. We’ve identified five key actions payers can take to balance pharmaceutical costs. Find them here: https://bit.ly/3xonkRt. #healthcare #healthcaresolutions #healthinsurance
Safeguard Your Pharmacy Reimbursement and Avoid Audits - TOG Network Solutions
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The Foundation for Government Accountability (FGA) is suing the Department of Health and Human Services (HHS) for failing to provide transparent drug pricing information. The lawsuit seeks to compel the HHS to provide the information required by law, which includes negotiated prices between pharmacy benefit managers and drug manufacturers. The FGA believes that greater transparency in drug pricing will help lower costs for consumers and increase competition in the pharmaceutical industry. https://lnkd.in/g7DxPkSJ #tennesseehealthadvocates #medicalbills #patientadvocate #healthinsurance #reviewyourbills #understandyourbills #reviewyourmedicalbills #peaceofmind #billingerrors #savetime #savemoney #fairprice #strategy #information #medicalbillingprofessional
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The Canadian Association for Pharmacy Distribution Management (CAPDM), represented by CEO Angelique Berg, was invited today to appear before the House of Commons Standing Committee on Health (#HESA) to discuss the impact of #BillC64. As the essential supply chain that ensures physical access to medications, CAPDM recommends that meaningful consultation takes place as a next step with key stakeholders including members of the pharmaceutical distribution supply chain. This is a necessary step to avoid further regulatory burden and to ensure all Canadians have safe, secure, and timely access to vital medications. #Pharmacy #SupplyChain #PatientsFirst #CdnPoli #CdnHealth
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In pharmacy benefit management, rebates are financial incentives provided by pharmaceutical manufacturers to PBMs like Intercept Rx. 💰 These rebates are negotiated based on the volume or value of medications purchased and are typically tied to the drug's inclusion in health plan formularies. At Intercept Rx, these rebates are channeled back to the companies we partner with, directly contributing to reducing out-of-pocket costs for consumers. This strategic approach helps make essential medications more affordable and supports better health outcomes. #PharmacyBenefits #HealthBenefitsCosts #InterceptRx #Rebates
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The table below is featured in our new piece, "The Case for Cardinal Health." ↓ https://loom.ly/NgiiBFM It highlights the key financial metrics of #CAH - a pharmaceutical wholesaler that primarily distributes medicines to pharmacies. Given the strong fundamentals and CAH’s market position, we believe investors significantly undervalue the stock. CAH trades at only a 13.4x P/E multiple, a ~35% discount to the S&P 500. KCR also believes that CAH could serve as an effective hedge against a correction. At this valuation, the market seems to imply CAH is ex-growth and ignores its normalized Free Cash Flow (FCF) of $2+ billion per year - around $8-$9 per share - or an ~8% FCF Yield-to-EV. Click the link below to subscribe to our newsletter ↓ https://loom.ly/loanBbc
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Patient Advocate | Medical Bill Master | Helping Committed Professionals Take Control of Medical Bills Without the frustrations of Medical Billing Departments
The Foundation for Government Accountability (FGA) is suing the Department of Health and Human Services (HHS) for failing to provide transparent drug pricing information. The lawsuit seeks to compel the HHS to provide the information required by law, which includes negotiated prices between pharmacy benefit managers and drug manufacturers. The FGA believes that greater transparency in drug pricing will help lower costs for consumers and increase competition in the pharmaceutical industry. https://lnkd.in/gRud2ehT #tennesseehealthadvocates #medicalbills #patientadvocate #healthinsurance #reviewyourbills #understandyourbills #reviewyourmedicalbills #peaceofmind #billingerrors #savetime #savemoney #fairprice #strategy #information #medicalbillingprofessional
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A great refresher and morning coffee read! ☕ Prescription drug contracting in the United States has evolved over decades from discounts provided to members of early health maintenance organization plans to rebate contracts to more complex value-based purchasing arrangements. This primer describes the history of contracting between pharmaceutical manufacturers and managed care pharmacy organizations and details the various contracting methods used today. #marketaccess #access #drugpricing #pricing #payer #drugcontracting #valuebasedcare #valuebasedpricing #reimbursement #valuestrategy #commercial #pbm #pharmacy #patientjourney #patientcentricity #patientoutcomes #launch #pharma #specialtypharmacy #amcp
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As the first round of MFP negotiations approach their conclusions this summer a next round of negotiations await with payers who will be armed with public knowledge of MFP levels. How will this impact contracting for MFP-negotiated products and for their competitors? Learn about our perspective on this emerging topic here:
We continue to help clients navigate the complexities surrounding the #InflationReductionAct. Today, our experts are diving into the anticipated effects of the IRA on payer contracting. While the Inflation Reduction Act will lower costs for CMS and patients, it is also likely to cause a range of second-order effects on the pharmaceutical industry, primarily around R&D investments and payer contract dynamics. How should the pharmaceutical industry be preparing for these shifts? Learn more from Thomas Marder, Matthew Riordan, and Scott Briggs in our latest piece here: https://lnkd.in/eXZMa5Xe #Pharma #IRA #Healthcare #Payers
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Check out our latest blog post if you're interested in learning about some of the downstream effects of CMS's Drug Price Negotiation Program. Thanks to Scott Briggs and Matthew Riordan for the partnership on this!
We continue to help clients navigate the complexities surrounding the #InflationReductionAct. Today, our experts are diving into the anticipated effects of the IRA on payer contracting. While the Inflation Reduction Act will lower costs for CMS and patients, it is also likely to cause a range of second-order effects on the pharmaceutical industry, primarily around R&D investments and payer contract dynamics. How should the pharmaceutical industry be preparing for these shifts? Learn more from Thomas Marder, Matthew Riordan, and Scott Briggs in our latest piece here: https://lnkd.in/eXZMa5Xe #Pharma #IRA #Healthcare #Payers
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