Overview of the New MedicareEndorsed Prescription Drug Discount Card Program - PowerPoint PPT Presentation

Loading...

PPT – Overview of the New MedicareEndorsed Prescription Drug Discount Card Program PowerPoint presentation | free to download - id: 1e419f-ZDc1Z



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Overview of the New MedicareEndorsed Prescription Drug Discount Card Program

Description:

Target market: Consumers who have no or limited insurance coverage for prescription drugs ... organizations (e.g., AARP, AAA); pharmacy benefit managers (PBMs); retail ... – PowerPoint PPT presentation

Number of Views:60
Avg rating:3.0/5.0
Slides: 7
Provided by: Josep262
Learn more at: http://www.ehcca.com
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Overview of the New MedicareEndorsed Prescription Drug Discount Card Program


1
Overview of the New Medicare-Endorsed
Prescription Drug Discount Card Program
John Richardson National Medicare Prescription
Drug Congress February 27, 2004
2
What is a Prescription Drug Discount Card?
  • Commercial products that lower retail price of Rx
    drugs
  • Target market Consumers who have no or limited
    insurance coverage for prescription drugs
  • Individual generally must sign up to enroll, may
    pay enrollment fee
  • Sponsors Membership organizations (e.g., AARP,
    AAA) pharmacy benefit managers (PBMs) retail
    pharmacies health plans states pharmaceutical
    manufacturers
  • Operations Sponsor or subcontracted PBM will
  • Negotiate with other entities in supply chain
    that affect retail price
  • Provide IT infrastructure to deliver negotiated
    discounts at point of sale when enrollee presents
    their card

3
How Do Card Sponsors Secure Retail Price
Discounts?
  • Card Sponsor (or PBM subcontractor)
  • Negotiate rebates and/or discounts with
    pharmacies and manufacturers (if applicable)
  • Pass portion of rebates and discounts through to
    card holders retain portion to cover own costs
    and profit
  • Retail Pharmacies
  • Negotiate with card sponsor/PBM for inclusion in
    cards pharmacy network and level of dispensing
    fees and mark-up
  • Pharmaceutical Manufacturers
  • Negotiate rebates with card sponsors for
    preferred drug status (if applicable, i.e.,
    there is some form of drug list)

4
Price Offered by Card Programs is Influenced by a
Number of Factors
Regional Variation
Pharmacy Type (retail, mail order, Internet)
Generic vs. Brand Drug
Price
Negotiating Power of Card Sponsor
5
Key Dates in Implementation of Medicare Drug
Discount Card Program
  • Dec. 8, 2003 MMA is signed into law
  • Dec. 15 CMS publishes interim final rule for
    discount card program
  • Dec. 18-19 CMS holds pre-application conference
    for potential card sponsors and other interested
    parties
  • Jan. 14, 2004 Deadline for public comment on
    interim final rule
  • Jan. 30 Deadline for card sponsor applications
    to CMS
  • End of March Card sponsor contracts finalized
  • April 1 Card sponsor information and outreach
    may begin
  • April 30 CMS launches Discount Card Price
    Comparison Web site
  • May 3 Card sponsors may begin enrollment
  • June 1 Discount card program begins
  • Nov. 15 - Dec. 31 Enrollees may elect to switch
    cards for 2005
  • Jan. 1, 2006 Part D benefit starts discount
    card program ends

6
Concluding Thoughts and Questions
  • Nature of drug price disclosureshow well will
    beneficiaries understand and process drug pricing
    information?
  • Will CMS-mandated therapeutic categories
    produce manufacturer rebates and thus added value
    for beneficiaries?
  • Discount card program is first date between CMS
    and pharma industryWhat expectations will be
    set?
  • Strong interest from potential card sponsors
    drug manufacturers
  • Opportunity in marketing of card and establishing
    brand visibility
  • CMS balancing regulatory oversight and incredibly
    fast go-live imperative, while also learning
    about very complex industry
  • Both partners building relationship needed for
    success of Part D
About PowerShow.com