Government Pricing

Pharmaceutical companies are currently “on hold” where government pricing is concerned.

Amidst changes related to the Affordable Care Act, Pharmas still await clarification on the Average Manufacturer Price ruling by the Centers for Medicare and Medicaid Services. Corporate Integrity Agreements (CIAs) are under increased scrutiny and Sarbanes-Oxley also looms over reporting. Despite the overall industry uncertainty, your organization can continue to move forward in an effort to stay ahead of the curve. Now is the time to boost productivity and optimize processes.

What is Government Pricing?

Elaborate pricing structures made in contracts between pharmaceutical companies and government programs or commercial parties include incentives, chargebacks and rebates. The total value of these components make up the product price with variances across contracts. Government regulations require reporting of product pricing based on these contracts to ensure compliance with Corporate Integrity Agreements. Because there are many separate government programs, there are multiple reporting points and exponentially-increased opportunities for error and discrepancies. Where Government Pricing is concerned, there is a constant threat of audit ─ and of not maintaining profitability.

Government pricing reporting requirements include:

  • Medicare Average Sales Price (ASP)
  • Medicaid Average Manufacturer Price (AMP)
  • Medicaid Best Price (BP)
  • Public Health Service Pricing (PHS)
  • Federal Supply Schedule (FSS)
  • Non-Federal Average Manufacturer Price (Non-FAMP)
  • Federal Ceiling Price (FCP)

Who Can Benefit from Government Pricing Solutions?

Our Government Pricing solutions will help you manage the complex pricing calculations required for compliance with government programs and ensure profitability. 

Synchronizing your data isn’t enough. In order to deliver maximum value, we also address improvement of standard operating procedures and making best use of limited resources. With new working paradigms for technology and management, our solutions support ongoing productivity, boost efficiency and compliance and improve staff performance. This approach allows you to take strategic advantage of opportunities in the public healthcare arena to give your organization a competitive edge and maintain your profit margin.

We are often engaged by Life Sciences professionals who are responsible for commercial contracting or managed market access and who may be:

  • Accountable for managing contract operations and supporting compliance with federal and state requirements
  • Experiencing financial losses due to the ACA and 340B Drug Pricing Program
  • Facing required technology systems upgrades to EHRs and record keeping to meet new federal regulations
  • Trying to grow product market share through Medicaid expansion
  • Struggling to retain positions on federal formularies

How We Optimize Your Government Pricing

Our team of industry experts will help you make a strong business case for the benefits of Government Pricing solutions, including improved operational efficiency, compliance, productivity and profitability.

Our Team Can Help You:

  • Upgrade legacy systems to more efficient, compliance-friendly solutions
  • Address and correct security issues that can cripple implementations of new EHR and pharmaceutical record keeping systems
  • Design objective, consistent and measurable “best practice” standards to help boost productivity
  • Draw on government pricing professionals’ expertise to identify results-oriented pathways to profitability
  • Identify problems and optimize supply chains to offset other expenses and gain some financial relief
  • Leverage proper market positioning to get access to exclusive therapy markets and secure a place on Medicaid and Veterans Affairs formulary listings
  • Identify actionable intelligence for internal workflows and external market conditions
  • Evaluate true costs and risks-versus-rewards scenarios for government pricing contracts
  • Engage in predictive analysis to determine likely potential outcomes of healthcare reform and facilitate more proactive response
We bring together deep domain expertise in Life Sciences, Project Management, Technology and Change Management to provide your company with the following benefits:
  • Increased uniformity of performance and better productivity through consistent standards for policies, technologies and procedures
  • More profitability through streamlined internal workflows
  • Reduced costs by eliminating waste in the manufacturing contracting environment
  • Improved compliance with financial reporting and complex accrual demands by establishing government revenue recognition standards and best practices
  • Greater resiliency to meet changing legislative landscape and commercial challenges
  • Recaptured revenue leakage and improved market share
Need Help Finding the Right Solution?

Request a free consultation with one of Paragon's leading industry advisors to discuss the best solution for your organization's unique challenges and goals.

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