SERVICES

Government Pricing & Rebate Processing Services

Program Services

Prescription Analytics provides full-service support for all activities required for federal and state pharmaceutical programs. This begins with helping secure federal and state contracts supportive of a client’s commercialization strategy and then includes but is not limited to:

Medicaid Drug Rebate Program (MDRP)

Government Pricing calculations
- Calculate and submit to CMS Average Manufacturer Price (AMP), Best Price, Nominal Price, Customary Prompt Pay Discount and Unit Rebate Amount (URA)
- Complete additional required government submissions (e.g. Texas formulary, HAD (old HDMA))
- NDC-level AMP variance reporting
Quarterly rebate invoice capture, reconciliation, payment, dispute management and reporting (across 300+ Medicaid programs)
- Invoice capture
  - Manage client portal access across all PBM/state portals
  - Collect Medicaid invoices across all 300+ state government programs (includes digital and mail/printed invoice formats)
  - Enter invoice data into our proprietary rebate management system – removing duplicate and redundant statements for dispute resolution
  - Track against client history and conduct quarterly program audits to secure invoices from state program statements that were never received
- Invoice reconciliation
  - Proactively manage quarterly invoices to ensure adherence to strict deadline requirements
  - Reconcile state invoices against client history in our proprietary rebate management system
  - Execute disciplined audits on the following values to confirm invoice accuracy prior to payment processing: URA validation, utilization validation and reasonability testing, customized validation for unique products and packaging types, rounding/penny balance validation, interest/adjustment validation, validate zero-dollar invoices against prior payments or credits to avoid unnecessary processing
  - Review of reconciled invoices from state programs or processors with a history of errors, full audit of ADAP and supplemental programs and claims level detail (CLD validation where appropriate)
- Invoice payments
  - Maintain a unique checking account with anti-fraud positive pay protection
  - Print and mail checks and required backup documentation on behalf of clients for all state programs
  - Financial audits for payment validation
- Disputes and resolution/credit management
  - Resolve discrepancies with state entities to ensure accurate payment application and balances
  - Provide supporting backup documentation as required
  - Leverage our scope, scale, and relationships with states and PBMs to drive improvements with processing entities
- Historical record build and validation
  - Review all client MDRP invoices and payments against state/PBM records
  - Manage discrepancy resolution with states/PBMs to ensure accurate payments are processed and valid credits are applied
  - Build historical records for clients and state/PBMs for more accurate and efficient processing of Prior Quarter Adjustment Statements (PQAS)
- AMP restatement related to special projects
  - Process PQASs as needed due to AMP restatements
  - Manage all facets of credit recovery from state programs
- Reporting capabilities
  - Full history payment reports
  - NDC and program level detail showing clients what was processed for each batch/quarter
  - Credit tracking by labeler and state program
  - Regulatory changes impacting future accruals
  - Trends in top-Medicaid rebate states
  - Client-defined reports as required
Timely submission of all new product registrations with CMS (Centers for Medicaid and Medicare Services) and any required state-specific programs

PHS / 340B

Complete PHS quarterly pricing calculations
Complete required submissions to PHS portal
Comprehensive management of PHS/340 entity notifications and payments
Communication of pricing to required stakeholders

VA / FSS

Complete and submit Federal Supply Schedule (FSS) Solicitation for new labelers
Complete and submit FSS Non-FAMP/IFF calculations
Complete Annual FSS Public Law Federal Ceiling Price calculations and submissions
Monitor and update Tracking Customer if required
Prepare all modification forms for submission to VA
National Award Contract CRF/IFF (Cost Recovery Fee/Industrial Funding Fee) calculations
SAM registration support

Tricare

Receive and reconcile quarterly Tricare Rebate invoice
Complete claim validation process
Processing of rebate payment through client Rebate Checking Account
Provide quarterly report to client and electronically archive related data

Medicare Part D Discount and Rebate Program

Establish plan participation; complete and submit required contracting applications
Secure access to CMS TPA Web Portal
Download quarterly discount data and complete reconciliation
Validate, reconcile and manage annual inflation penalty rebate
Prepare client ACH payment summary report for approval
Upload batch payment reports to the portal and release funds
Follow up on and track ACH transaction completions
Archive all related data

Medicare Part B – Physician Administered and Injectable Products

Select and organize required business data
Calculate ASP, submit to client for approval and submit via ASP reporting portal
Validate, reconcile and management of quarterly inflation penalty rebate

Affordable Care Act Brand Tax

Complete required confirmations and submissions
Complete annual reconciliation and payment reporting

Turnkey Support

Prescription Analytics provides turnkey support for Government Pricing and Rebate Processing Services in the following areas:

Pricing Calculations and Submissions to regulatory authorities for all federal and state pharmaceutical programs (includes AMP, Best Price, Nominal Price, URA and more)
Rebate Invoice and Discount Program reconciliations, payments and submissions
Regulatory Updates and Impact Analysis communication regarding pharmaceutical government contracting, pricing and discount programs
Dispute Resolution with all government entities
Secure Archival Records of all historic datasets
Executive-level Reporting on Medicaid Rebates (ROSI/PQAS, units dollars, top states), Medicaid Credits, AMP and URA trends, and regulatory trends and impact summaries