Over the past year, multiple proposals addressing drug pricing have emerged at both the state and national levels.  While the end goal is lower costs for payors, provider and patients through greater pricing transparency and more efficient distribution models, these complex changes could have far-reaching implications for hospital pharmacy administration and operations.  This session will dive into the pricing proposals in play and will include discussion of the CMS Pricing Transparency Rule, CMS International Pricing Index model, 340B Program Ceiling Price Rule, and the California Executive Order to reduce state drug costs, among others.

Learning Objectives:

1. Discuss the potential impact new pricing proposals and rules may have on Medicare and Medicaid reimbursement for hospitals.
2. Compare and contrast the components of the various proposals and rules.
3. Discuss the importance of hospital-specific analytics when preparing for these proposals and rules.

A host of changes in regulations and standards have added costs and complications to managing a hospital pharmacy.  Reimbursement cuts from Medicare, Medicaid and private payers have resulted in an increased fiscal scrutiny across departments, but the pharmacy poses specific challenges to the bottom line.  The pharmacy is key to reducing medical errors and improving outcomes — central components of reimbursement. This session will explore how revised formularies, evidence-based treatments, management realignment, and pharmacy automation can have a significant impact on cost and patient outcomes.

Learning Objectives:

1. Identify the components driving increased pressure on hospital pharmacy departments.
2. Describe methods of innovation that can improve outcomes and reduce costs.
3. Outline Medicare compliance requirements and their impact on pharmacy.

Healthcare pharmacies are feeling the effects of new payment models and their impact on patients and the bottom line.  Faced with compressed reimbursement and significant expense reductions, exploring opportunities for maximizing reimbursement practices is critical.  Topics covered will include Medicare Advantage (Part C) changes to Part B + Part D drugs, managed care contracting, site neutral payment, and insurer requirements for Part B + Part D drugs.  Learn how transparency rules can offer the opportunity to uncover problems that can result in improved processes.

Learning Objectives:

1. Discuss factors that can result in lower pharmacy reimbursement.
2. Identify best practices for optimizing your hospital’s data for improved reimbursement results.
3. Analyze transparency processes that can reduce risk and increase compliance.