Interactive and Impactful CPE Courses for Life Science Companies to Learn and Optimize Gross-to-Net, Government Pricing, Market Access Strategies, Payer Contracting and the Inflation Reduction Act

Date: 🔸 November 2, 2023  (Booking is now closed) 


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.

By attending this virtual course, you'll learn about:

• Product and money flow in the pharmaceutical distribution system
• Sales forecasting and GTN sensitivity analysis
• Impact of payer formulary exclusions, prior authorization and step edits
• Implications of escalating patient out-of-pocket costs on prescription abandonment
• Forecasting payer mix and rebate percentages to establish accrual rates
• True-up adjustments
• Key factors impacting rebate rates
• Chargebacks
• Price protection
• Copay assistance programs
• Copay accumulators & maximizers 
• Wholesaler fees
• Accounting for product returns
• GTN pipeline and demand liability
• Third-party data sources

Date: 🔸 November 9, 2023 (Booking is now closed) 

Net sales as a percent of gross sales are generally below 50% for traditional products due primarily to higher government rebates. Government programs experienced rapid growth resulting in an increase in the percentage of total retail prescription drug costs from 20% in 2000 to over 50% in 2022. Pressure on gross-to-net sales is escalating because government programs have the highest prescription drug rebates. 

By attending this virtual course, you'll learn about:

• Medicare Part B buy & bill provider reimbursement and GTN implications
• White, brown and clear bagging
• Medicare Part D Prescription Drug Program
• Considerations for estimating Medicare Part D Donut Hole
• Fundamentals of Medicaid Drug Rebate Program
• Implications of price increases on Medicaid Net Price and GTN flow-thru
• Triggering Medicaid best price penalty
• Medicaid penny pricing
• Authorized generics
• TRICARE
• 340B – ecosystem, double dipping and current developments
• Medicaid enacted legislation
• Implications of removal of Medicaid rebate cape of 2024

Date: 🔸 November 13, 2023  (Booking is now closed) 

The Inflation Reduction Act is a game-changer that embodies complex prescription drug provisions with far-reaching implications. The federal government will negotiate prices for high-cost drugs covered under Medicare. Medicare price increases will be 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 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 virtual course, you'll learn about:

• Inflation Reduction Act implementation timetable
• Medicare price negotiation – process and government considerations
• Maximum fair price
• Impact of Medicare price negotiations on competitive drugs pricing and rebates (spillover)
• Implications of Medicare price negotiations on Medicaid best price and rebates
• Expansion of low-income subsidies ("LIS")
• 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 and current benefit design: who pays what % and when
  • Estimating pharma liabilities for drugs in catastrophic phase
  • Implications of prescription drug plan responsibility increasing from 15% of total drug costs under current law to 60% in catastrophic phase starting in 2025
• Impact of Inflation Reduction Act on drug manufacturer rebates & patient out-of-pocket costs
• Estimating flow-thru of price increases
• Financial, market access, commercial and strategic considerations for pharma manufacturers

Date: 🔸 November 30, 2023

The three largest vertically integrated PBMs control approximately 80% of the market and have a lot of 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. 

By attending this virtual 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 and impact of leveraging aggregated demand
• Impact of PBM formulary tiers, formulary exclusions, prior authorization and step edits
• Implications of escalating patient out-of-pocket costs on prescription abandonment
• Copay accumulators and maximizer
• Rebate walls
• Value-based & indication-based contracts
• Netflix and installment-based contracts
• Determining breakeven from paying higher rebates for improved formulary position
• ROI of PBM contracting scenarios
• PBM contract analytics & negotiating strategies
• Case study – negotiating rebates & market access with PBMs