Focus on the Drug Payment Methods Landscape. Academy of Managed Care Pharmacy April 17, 2009. Overview. AMCP updating its payment references Environmental scan of payment today Payment methods Payment sources Impact of AMP Other payment methods and developments. I. AMCP Updates.
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Academy of Managed Care Pharmacy
April 17, 2009
Total = $227.5
Source: National Health Spending in 2007…. Health Affairs Volume 28, Number 1; 2009.
1.Applying Management Techniques to Drugs in the Medical Benefit. Express Scripts presentation to PCMA. March 24, 2009
2. Medical Pharmaceutical Management: a payor perspective. Aetna Pharmacy Management. 2009
Retail Rx DrugsMedical Benefit Drugs
Medicare AWP, WAC, Negotiated ASP with few AWP, WAC exceptions
Medicaid AWP, WAC ASP, AWP, WAC
Private Ins AWP, WAC, Negotiated AWP, ASP
Medicare Part D; Medicaid; most private insurance
45% of private insurance; Medicare and Medicaid exceptions“Back of the Envelope” AWP Impact
Source: Tag & Associates, Inc. estimates from data on file.
George Pennebaker, the Father of AWP
Created in 1969 for Medi-Cal to simplify pharmacy claims processing
Replaced payment based on actual acquisition cost with a new standard reference price -- AWP