GP Forum: H.R. 3200

By: Craig Kubicek, CIS Compliance Associate
craigkubicek@cis-partners.com

On August 19, 2009 a Government Pricing monthly forum was held. The forum was led by CIS members Lauren Pellicciotti (Compliance Manager), and Chris Cobourn (Vice President of Regulatory Compliance). The topic of discussion was H.R. 3200 America's Affordable Health Choices Act of 2009. The bill was introduced by Representative John D. Dingell on July 14th 2009 and can be found online: http://www.gpo.gov/fdsys/pkg/BILLS-111hr3200IH/content-detail.html

H.R. 3200 is an extensive and comprehensive thousand page document that covers the riveting details of the current administration’s proposed solutions to America’s Health Care. As many of us know, the administration is at full-steam, pushing ahead to create a universal Health Care system that is mandatory for all American citizens. However, what many do not know or understand is the government pricing perspective of the H.R. 3200 bill. As the CIS Government Pricing forum was underway, its attendees spoke on the possible implications of the new Government Pricing changes and what might be affected and what to be expected.

In the hour the forum was held a variety of topics were touched. The conference spoke about:

• The amount of money to be involved and how much of it would add to the deficit and how much would be considered revenue
• Pharmacy Reimbursement Limits:

o Use of AMP in Upper Limit Payments (130% of the weighted average)
o Definition in AMP (‘Other Payments’)
o Manufacturer Reporting Requirements (No later than 30 days – Added Clause)
o Disclosure of Price Information In Public (Clause Update)
o Pharmacy Reimbursements Through December 31, 2010
o Additional Rebate For New Formulations of Existing Drugs (‘S’ and ‘I’ drugs)
o Increase Minimum Rebate Percentage for Single Source Drugs (22.1%)
o Increase Minimum Rebate Percentage for Generic Drugs???

A lot of preparation will be needed in order to employ the government’s newly proposed health care overhaul. CIS and its dedicated members have already begun the needed steps of preparing. The Government Pricing forum is just another step in the right direction. Many issues are raised and constructively discussed to ensure that its members are up to date on key government pricing subjects. H.R. 3200 could be a big change for the methodologies in the Government Pricing community. The Government Pricing members are not asking themselves whether or not the new changes will work, but how can they better prepare themselves and make the transition easier.

Next on the list of subjects to discuss

• OMB Budget for FY 2010
• The reauthorization of SCHIP
• The extension of Medicaid rebates to Medicaid Managed Care
• Legal Immigrant Children’s Health Improvement Act of 2009
• 340B Program Improvement and Integrity Act of 2009