Recording and written materials of AIS's audioconference on August 6, 2009

Medicare Part D Reform: Strategies to Prepare for Potentially Enormous Changes in 2010

Medicare Part D is a major focus of pending health care reform legislation, with proposals to eliminate or revamp the coverage gap or “doughnut hole,” institute "means testing” for the Part D benefit, and establish a public prescription drug program to compete with private Part D plans. Major changes could take place in TrOOP calculations and PDE reconciliations. While the chances of enactment are uncertain, what is certain today is the urgent need for Part D plan sponsors to work with their PBMs and other first-tier entities to prepare for potentially big changes in 2010.

Sponsored by Atlantic Information Services, Inc., publisher of Health Plan Week, Medicare Part D News and Medicare Advantage News

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Part D sponsors face great uncertainty regarding the effect on their business of a wide range of potential health care reforms.  There are numerous steps they can take today to make sure relationships with PBMs and other first-tier entities are in order for 2010. The stakes are huge, and the time to act is now.

There has been much talk, for instance, of revamping or possibly removing the coverage gap from Part D. This potential change could dramatically alter true out-of-pocket (TrOOP) calculations and Prescription Drug Event (PDE) transaction reconciliations. Revisions in TrOOP calculations could also have an effect on how plans accurately calculate direct/indirect remuneration (DIR), which CMS has already changed, effective Jan. 1, 2010, in an effort to slow beneficiaries’ movement to the coverage gap.

Hear Susan Hayes of Pharmacy Outcome Specialists and Steve Arbaugh of ATTAC Consulting Group provide details of what sponsors should do now to prepare for the potential impact of various health care reform proposals on Part D.  

Topics discussed include:

Speakers

SUSAN HAYES is a principal and founder of Pharmacy Outcome Specialists, a health care consulting firm, where she is responsible for the strategic direction of the firm and specific sales, proposal, product pricing, and development.  She is a lead project manager for the firm's audit and outsourcing clients, which include Rockford Health Plans, major Blue Cross and Blue Shield organizations and Northwest Airlines. Previously, Ms. Hayes was vice president of marketing for Systemed Pharmacy, Inc and vice president, marketing of Walgreens Healthcare Plus.  In both positions, she was responsible for the strategic development of the target market and product mix for PBMs, growing retail and mail-service revenues and enhancing overall client retention.  For five years prior to Walgreen Co., Ms. Hayes was the national practice leader for William M. Mercer, Inc., specializing in prescription drug auditing and bid procurement. Clients included Arthur Andersen & Co., Exxon USA., Ameritech, Sara Lee Corporation, the Marmon Group and Uniroyal.

STEVE ARBAUGH is a principal with ATTAC Consulting Group, LLC (ACG), where he is responsible for guiding client strategy and developing a broad range of managed care programs and operations, as well as leadership on development, implementation and operation of Medicare Advantage and Medicare Part D benefit programs; fraud, waste and abuse control programs; and compliance monitoring systems. Over his career, he has served in senior executive roles and operations posts, including holding the positions of CEO and chief operating officer with a number of health plans and insurers. He has previously worked with companies such as United Healthcare, Methodist Health Plan (Texas), First Care (Texas) and Care Choices Health Plans (Michigan). Prior to joining ATTAC Consulting Group, Mr. Arbaugh was executive vice president with a national consulting firm specializing in Medicare Advantage and Part D programs. Before that, he was a long-term member of the consulting team at The Pace Group.

Moderator: Barbra Golub, JD, managing editor of Medicare Part D News.

 

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