Prescription Drug Rebates and Evolving Reimbursement Methodologies

Table of Contents Photo of Book Written By Written For Shipping Information Related Publications		Order Now (Secure Site) Print Version  PDF Version* View Cart
Place an order or get more information at 800-521-4323
Price: $84 Pages: 61 PDF Version: 252 KB ISBN: 1-933801-30-1 © 2007 Pub Code: BPREB		*PDF Version After you submit your order, a link will appear directing you to download the PDF file of the book. This link will be accessible only for 24 hours, so be sure to save the file to your computer. Shipping will NOT be charged for this item.

Prescription drug rebates are a hot topic of debate — with questions ranging from how to measure the true rebate dollars received by PBMs, to who should benefit from such rebates, and how much each should receive.

Prescription Drug Rebates and Evolving Reimbursement Methodologies is a primer on prescription drug rebates — how they have evolved over the years and continue to change. This report, from the editors of Drug Benefit News, examines how the health care industry has reacted to new reimbursement methodologies, and details strategies that have been successful, as well as ones that have increased confusion or conflict.

With a mix of information that runs from introductory material on the nuts and bolts of rebates (including a highly useful glossary that supplies definitions of common industry terms) to in-depth articles about ongoing issues or conflicts, this report will provide the comprehensive background you need to be competitive in this field.

Whether you’re new to the PBM industry or an expert, you’ll gain valuable insight from Prescription Drug Rebates and Evolving Reimbursement Methodologies. Order your copy today!

 

Table of Contents

Preface
Methodology

Rebate Basics

• Uncovering the Mysteries Behind Rebates
• PBMs’ Revenue Sources and Rebate Accounting Procedures Explained

AWP, ASP and Other Reimbursement Methodologies

• CMS: More States Could Save With Supplemental Rebates
• Proposed Medicaid Reimbursement Legislation Could Hurt PBMs, Pharmacies
• Long-term AMP Impact on Rx Pricing Looms Large
• PBM Industry Reacts to CMS’s AMP Rule
• Tennessee Blues Rx Executive Doesn’t See AMP Replacing AWP
• CMS Final Rule Revises Method for Medicare ASP Estimations
• Does ASP Do More Harm Than Good?
• ASP Impact on Margins of Various Sectors
• CMS’s Incorrect Calculations Mark Road Bump for ASP
• Examples of Drugs Impacted by OIG Study of ASP Calculations
• Commercial Payers Using ASP Reimbursement Methods
• OIG Report Illustrates Reimbursement Methodology Issues

Rebate Contracting

• MCOs With Local Market Share, Control, Bring Rebates In-House
• Selected MCOs With In-House Rx Rebate Management
• Employer Coalition Seeks to Circumvent PBMs, Directly Contract for Drug Rebates
• Hewitt Exec Explains Why Coalition’s Direct-Contract Plan Failed
• MCO Direct Contracting With Drug Firms Has Potential to Net Gains
• Pittsburgh Employers’ Deal With PharmaCare Shows Advantages of Group Contracting
• Web-Based Rebate Management Tool to Improve Contracting Process
• PBMs, Health Plans Eye ‘Access Rebates’ Over Other Rx Rebate Methods, Survey Finds
• PBMs’ Ratings of Interest in Selected Tactics of Pharmaceutical Manufacturers

Rebate and Reimbursement Methodologies for Specialty Pharmacy

• Keystone Gets Specialty Rx Rebates With Aid of Effective Plan Design
• Many Insurers Eye Changes to Oncologist Reimbursement, but Few Follow CMS Lead
• MN Blues Infuse Medical Injectables With Pharmacy-Type Reimbursement Strategies
• Payers Use Drug Discounts, SP Networks to Curb Oncology Costs

Legal Issues Surrounding Rebates and Reimbursements

• First DataBank’s AWP Agreement Could Hit PBM Profits, Save Plans Billions
• First DataBank Settlement, Price Inflation Case Highlight AWP Controversy
• Seven States Oppose First DataBank Deal; Wholesaler Rx Survey Eyed to Replace AWP
• Drug Company Rebates Could Expose Payers, PBMs to Fraud Investigations
• Medco Settlement May Make Pharmacy Rebates Slightly Less Mysterious
• Union Lawsuit Heralded Changes to PBM Industry
• Labor Department Suit Highlights Rebate Issues
• Lawsuit Highlights AWP Price Inflation

Glossary of Terms

 

Written By

This book was written by the editorial staff of AIS, with contributing authors:

Dr. Chris Nee is President of PharMedQuest, a health care consulting company providing pharmaceutical care management services to national clients. Nee’s areas of interest include value generation of pharmaceutical care, managed care management, health care benefit design and integration, and strategic marketing of pharmaceutical products and services.

Bill Sullivan is president of Specialty Pharmacy Solutions, LLC, a company that serves the pharmacy industry by providing consulting support and business development services. Sullivan has more than 25 years of experience managing pharmacy risk and is a member of the Academy of Managed Care Pharmacy and has an MBA in Healthcare Administration. He specializes in managing clinical outcomes for patients with chronic illness.

 

Written For

 

Shipping Information

PDF Version:
If you place your order through our secure shopping cart, a link will appear directing you to download the PDF file of the book. This link will be accessible only for 24 hours, so be sure to save the file to your computer. If you place your order via phone, fax or mail, the PDF version will be e-mailed to you when your order is processed (usually within 1 business day). Shipping costs will not be charged for this item.

Print Version:
This item is shipped via UPS. Please give us your street address when you order (UPS does not deliver to PO boxes). You should receive your order within 5-7 business days. Shipping cost is $5 per item.

Print Rush Orders:
Please call us at 800-521-4323 to place a rush order. We will overnight your order for an additional charge of $30, or you can give us your FedEx or UPS account number and we will charge the shipping to your account. Rush orders placed after 3:00pm EST will not be shipped out until the next business day.

 

Related Publications

Drug Benefit News
Specialty Pharmacy News
Specialty Pharmacy: Stakeholders, Strategies and Markets
Pharmacy Benefit Trends & Data

 

For further information call 800-521-4323 or e-mail customerserv@aispub.com