THE OHIO DEPARTMENT OF MEDICAID

Transcription

1 HEALTH WEALTH CAREER THE OHIO DEPARTMENT OF MEDICAID PHARMACY STAKEHOLDER ENGAGEMENT MEETING August, 31, 2016 Presenters Mo Wright, RAMA Scott Banken, Mercer Shawna Kittridge, Mercer Ralph Magrish, Mercer

2 AGENDA WHAT WE LL COVER TODAY Covered Outpatient Drugs Final Rule Professional Dispensing Fee Survey Timeline Suggestions and Q&A 2016 MERCER LLC 2

3 COVERED OUTPATIENT DRUGS FINAL RULE 2016 MERCER LLC 3

4 WHY WHO HOW The ODM is conducting a Professional Dispensing Fee survey required under statute every 2 years All Medicaid participating outpatient pharmacies Mercer will Administer survey Conduct statistical analysis Produce report for the ODM 2016 MERCER LLC 4

5 CHECKLIST WHAT YOU LL NEED Preparing for the survey resources needed Financial statements or tax returns From last completed fiscal year (12 months) Demographic information Pharmacy contact information and pharmacy type Prescription counts Floor plans Showing square footage or measurements of the pharmacy (prescription) area and the nonpharmacy (retail) area Certification Signature required (electronic or printed and scanned) For same time period as financial statements or tax returns 2016 MERCER LLC 5

6 HOW TO RESPOND Where is the survey? Online Standard Excel format, multiple tabs, easiest to understand Usernames and passwords mailed Sept. 6 One-tab Excel format, flat file format for large chains Review period through September 2, feedback due by September MERCER LLC 6

7 TYPES OF COSTS Types of Costs Direct pharmacy costs Indirect costs (Overhead) Facility costs Other administrative costs Direct non-pharmacy costs Unallowable costs based on Code of Federal Regulations (2CFR ) Lobbying Advertising Bad debt Income tax 2016 MERCER LLC 7

8 TOTAL CALCULATION Direct pharmacy expenses Allowable Allocated overhead Total allowable pharmacy costs Number of scripts Payroll for pharmacy staff Nonpersonnel costs Facility costs as a percentage of square footage Other expenses allocated as a percentage of sales In total Medicaid only 2016 MERCER LLC 8

9 ENTERING DATA Profile Information For identification and explanation of certain costs For comparison groups and to identify statistically significant causes in varying rates Does the provider dispense 340B Drug Pricing Program (340B) drugs? Was the pharmacy open the entire year? Is one or more of the pharmacists who fill prescriptions at this location also an owner of the store or chain? How many hours per week is the pharmacy department open? (maximum of 168 hours) Pharmacy type 2016 MERCER LLC 9

10 ENTERING DATA Prescription Statistics How many were filled by this pharmacy for the following categories during the reporting period? How many were delivered? Medicaid FFS Medicare FFS (if available) How many Medicaid prescriptions were delivered to members? All other prescriptions (not included above) Delivery radius in miles 2016 MERCER LLC 10

11 ENTERING DATA 340B and Specialty Blood Factor Specialty Sales and Script counts Home Infusion/ Sterile Compound Other specialty (explain in the Comments section) Type of 340B provider Covered entity or contract Does provider purchase drugs through the prime vendor program? 340B Does provider use a 340B administrator? Enter the total number of 340B prescriptions filled during the reporting period Enter the total number of 340B prescriptions billed to Medicaid 2016 MERCER LLC 11

12 ENTERING DATA Sales and Cost of Goods Sold Sales (Pharmacy) Cost of Goods Sold (COGS) Prescription sales other than Over-the-Counter (OTC) dispensed by a pharmacist OTC sales dispensed by pharmacy department Sales of drugs purchased through the 340B program Sales (Non-Pharmacy) OTC sales dispensed by staff not in pharmacy department Portion of federal grants attributable to pharmacy, if any Other sales such as retail sales and services Pharmaceuticals Note: This will not be included in the dispensing fee calculation Non-pharmacy COGS 2016 MERCER LLC 12

13 ENTERING DATA Pharmacy Department Expenses Direct pharmacy costs Owner wages Pharmacy payroll (pharmacist costs and comparison; other pharmacy staff costs) Other pharmacy expenses 2016 MERCER LLC 13

14 ENTERING DATA Non-Pharmacy Department Expenses and Unallowed Costs Direct non-pharmacy payroll expenses CMS-defined unallowed costs (lobbying, advertising, income tax, bad debt) Overhead facility costs (allocated by square footage) Overhead non-facility costs (allocated by percentage of sales) 2016 MERCER LLC 14

15 ENTERING DATA Upload a tax return instead After completing the profile, script counts, specialty, 340B, and payroll questions, you may elect to upload your most recent tax return or full-year financial statement 2016 MERCER LLC 15

16 SUBMITTING THE SURVEY Certify the results Complete the survey Online OR Online OR Enter your name and title Printing, signing and scanning or taking a picture of the signed certification Click Submit Send completed spreadsheet to RxPDFS@mercer.com All completed surveys are subject to data validation and reviewed for reasonableness and completeness 2016 MERCER LLC 16

17 PROFESSIONAL DISPENSING FEE AND ACTUAL ACQUISITION COST SURVEYS WHEN HOW Instructional /mail: September 6 & 7 Technical assistance session: September 13, 10AM noon The survey collection period: September 7 September 28 Online at to RxPDFS@mercer.com Data review and follow-up questions: Upon receipt October MERCER LLC 17

18 PROFESSIONAL DISPENSING FEE AND ACTUAL ACQUISITION COST SURVEYS SURVEY WEBSITE Mercer s website for the ODM survey activities Details and instructions for the surveys Website details Link for direct access to Mercer s dispensing fee survey tool Downloadable templates for survey submission Questions and survey support RxPDFS@mercer.com 1 (877) MERCER LLC 18

19 QUESTIONS 2016 MERCER LLC 19

20 2016 MERCER LLC 20