Register Now for NLARx Winter Meeting Showcasing State Drug Pricing and Rebate Strategies January 21, 2011 in Washington, D.C.

  

Is your state poised to take advantage of new drug rebate options under the Affordable Care Act?  Make sure you have the tools you need to counter Medicaid budget shortfalls!

 

As states struggle to cut costs while maintaining quality health care for vulnerable residents, now is the time for lawmakers and agency officials to advance common-sense reimbursement reforms. Despite positive policy changes related to Federal Upper Limits and Average Whole Price, many states are still losing out and paying significantly more than other payors for pharmacy services. The result is that providers sometimes retain unjustifiable profits, and there is no accurate way to track that spread. In response, some states have successfully implemented highly effective MAC lists, and others are testing new ground using Actual Acquisition Cost, but state officials are still grappling with the question of how best to ensure Medicaid is paying a fair and transparent price for prescriptions.

 

Speakers & Presentations:

 

Medicaid Pharmacy Reimbursement Reform: Trends and Recommendations
Speakers: Mike Winkelman, Pharmacy Consultant
Nell Geiser, Change to Win Pharmacy Initiative Coordinator

Mr. Winkelman and Ms. Geiser will discuss opportunities for states to achieve a more transparent and accountable Medicaid pharmacy reimbursement system that can result in significant savings.The presentation will include recommended guidelines for reimbursement policy reform and estimates of projected savings if new benchmarks were implemented.

 

Opportunities for Pricing Reform through Pharmacy Benefit Manager (PBM) Regulation
Speaker: David Balto, Center for American Progress, former Federal Trade Commission Policy Director

 

Attorney and antitrust expert David Balto provides background on PBMs and the opportunities to address drug pricing concerns through legislation providing greater transparency and regulating conflicts of interest. Mr. Balto will also discuss whether there are opportunities to regulate PBMs through provisions in the Affordable Care Act and Department of Labor regulations.

 

What States Should Know about International Regulation of Pharmaceutical Pricing Legislation and the Trans Pacific Partnership (TPP)
Speaker: Sean Flynn, Associate Director, PIJIP, Washington College of Law, American University

 

State legislators and officials have been advocating for years that the US Trade Representative refuse the pharmaceutical industry's demands for a new international framework regulating domestic pharmaceutical pricing regulations. The US is now negotiating a new plurilateral trade agreement - the Trans Pacific Partnership - and Big Pharma is again asking for broad-ranging restrictions on domestic price regulation authority.

 

MORE ON THE AGENDA, REGISTRATION & LOGISTICS

Public Citizen Report: Pharma Industry is Largest Defrauder of the Federal Government under the False Claims Act

 

A Dec. 16 report issued by Public Citizen found that the pharmaceutical industry had surpassed the defense industry as the largest defrauder of the federal government, as measured by False Claims Act Settlements.  The report also notes the costs that pharmaceutical fraud imposes on state programs, including Medicaid. 

 

From the report highlights:

• Of the 165 settlements comprising $19.8 billion in penalties during this 20-year interval, 73 percent of the settlements (121) and 75 percent of the penalties ($14.8 billion) have occurred in just the past five years (2006-2010).
• Four companies (GlaxoSmithKline, Pfizer, Eli Lilly, and Schering-Plough) accounted for more than half (53 percent or $10.5 billion) of all financial penalties imposed over the past two decades. These leading violators were among the world's largest pharmaceutical companies.
• The practice of illegal off-label promotion of pharmaceuticals has been responsible for the largest amount of financial penalties levied by the federal government over the past 20 years. This practice can be prosecuted as a criminal offense because of the potential for serious adverse health effects in patients from such activities.
• Deliberately overcharging state health programs, mainly Medicaid fraud, has been the most common violation against state governments and is responsible for the largest amount of financial penalties levied by these governments. This type of violation is also the main factor in the considerable increase in state settlements with pharmaceutical companies over time.

More reading:

Public Citizen Press Release

Full Report: Rapidly Increasing Criminal and Civil Monetary Penalties Against the Pharmaceutical Industry: 1991 to 2010

Pharmalot: Abbott, Two Others Pay $421M Over Pricing Fraud