Table of Contents. Elsevier Clinical Solutions Drug Pricing PRICING POLICIES PRICING POLICIES... 1 REPORTED PRICES... 1 CALCULATED PRICE TYPES...
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1 PRICING POLICIES
2 PRICING POLICIES Table of Contents PRICING POLICIES... 1 REPORTED PRICES... 1 CALCULATED PRICE TYPES... 3 Revision: 28 June 2016 Copyright 2016 Elsevier. All rights reserved. Page i
3 Pricing Policies Reported Prices Elsevier offers several price types as they are directly reported from the product marketing firms, government agencies or private entities. These include: Average Wholesale Price (AWP), Wholesale Acquisition Cost (WAC), Direct Price (DP), Federal Supply Schedule (FSS), CMS Federal Upper Limit (CMS-FUL), National Average Drug Acquisition Cost (NADAC), Maximum Allowable Cost (MAC), Average Acquisition Cost (AAC), Affordable Care Act- Federal Upper Limit (ACA-FUL), and Predictive Acquisition Cost (PAC). 1) Average Wholesale Price (AWP): a) AWP is supplied for all packages in which the marketing firm reports a suggested average wholesale price. b) The AWP reported by Elsevier is not intended to represent actual transaction prices and does not include prompt pay or other discounts, rebates or reductions in price. c) Elsevier does not perform any independent investigation or analysis of actual transaction prices for purposes of reporting AWP. AWP will change only as a function of a reported price change by the marketing firm. As Elsevier does not require pricing for a product to be listed, it is acceptable for the AWP field to be zero. 2) Wholesale Acquisition Cost (WAC): a) WAC is defined in the Medicare Prescription Drug, Improvement and Modernization Act of 2003 as follows: The term Wholesale Acquisition Cost means, with respect to a drug or biological, the manufacturer s list price for the drug or biological to wholesalers or direct purchasers in the United States, not including prompt pay or other discounts, rebates or reductions in price, as reported in wholesale price guides or other publications of drug or biological pricing data. b) The WAC price is populated for those manufacturers that report a WAC price. Elsevier publishes the WAC as it is directly reported to Elsevier by the product s marketing firm. 3) Direct Price: a) Direct price is defined as the list price for a drug or biological to non-wholesaler customers, not including prompt pay or other discounts, rebates or reductions in price. b) Direct price is populated for those manufacturers that sell direct and report a Direct Price for their products. Elsevier publishes the Direct Price as it is directly reported to Elsevier by the product s marketing firm. 4) Federal Supply Schedule (FSS): Revision: 28 June 2016 Copyright 2016 Elsevier. All rights reserved. Page 1
4 a) The US Department of Veterans Affairs publishes FSS and FSS Big 4 pricing for pharmaceutical products. b) FSS pricing is the multiple-award, multi-year federal contract which satisfies all federal contract laws and regulations, based on vendors business with commercial customers. c) FSS Big 4 pricing is only available to VA, Department of Defense, Public Health Service (Indian Health Service), and U.S. Coast guard customers. While FSS dual prices are negotiated for Other Government Agencies that comprise the remaining authorized users of the FSS program. Elsevier publishes the FSS and FSS Big 4 prices as posted on the US Department of Veterans Affairs web site. 5) CMS Federal Upper Limit Price (CMS- FUL): Elsevier publishes the CMS Federal Upper Limit prices as they are reported by the Centers for Medicare and Medicaid Services. Note: CMS Federal Upper Limit Price (CMS- FUL) was EndDated as of 31 March ) National Average Drug Acquisition Cost (NADAC): The NADAC, created by the Centers for Medicare & Medicaid Services, is a survey-based price type that is based on a monthly voluntary survey of randomly selected pharmacies nationwide. The NADAC file is updated on a weekly basis and each month a new survey file is posted to reflect findings from the previous month s survey results. Elsevier publishes both the weekly file and monthly file in separate price fields. 7) Maximum Allowable Cost (MAC): The state-defined reimbursement limit for multi-source drugs. Each state sets its own MAC program, which can include more drugs than are covered under FUL. Not all states publish a MAC. Elsevier publishes the MAC as reported by the each state. 8) Average Acquisition Cost (AAC): The average cost at which pharmacies within a particular state purchase a drug. The cost is defined and calculated by the applicable state Medicaid program. Not all states calculate an AAC. Elsevier publishes the AAC as reported by the each state. 9) Affordable Care Act- Federal Upper Limit (ACA-FUL): Elsevier publishes the CMS Federal Upper Limit prices as they are reported by the Centers for Medicare and Medicaid Services. (ACA-FUL) is populated at the Specific Drug Product (SDP) Level. 10) Predictive Acquisition Cost (PAC): Revision: 28 June 2016 Copyright 2016 Elsevier. All rights reserved. Page 2
5 A new drug price type that more accurately tracks true acquisition cost. PAC is published by Glass Box Analytics. Elsevier publishes the PAC as reported by Glass Box Analytics and is the exclusive distributer of the PAC price type. Calculated Price Types In addition to publishing the aforementioned reported price types, Elsevier publishes three (3) calculated price types: Calculated AWP (C-AWP), Calculated AWP 1.20 (C-AWP 1.20), and Calculated CMS Federal Upper Limit Price (C-CMS-FUL). 1) Calculated Average Wholesale Price (C-AWP): a) For companies not suggesting an AWP, a mark-up of 25% is applied to the reported WAC. b) If no WAC is reported, then a 25% mark-up is applied to the reported Direct Price (DP). c) If a marketing firm does not report either a WAC or DP, then there will be no Calculated AWP price applied to the package. 2) Calculated Average Wholesale Price 1.20 (C-AWP 1.20): a) For companies not suggesting an AWP, a mark-up of 20% is applied to the reported WAC. b) If no WAC is reported, then a 20% mark-up is applied to the reported Direct Price (DP). c) If a marketing firm does not report either a WAC or DP, then there will be no Calculated AWP price applied to the package. If companies report a suggested Average Wholesale Price, a Calculated Average Wholesale Price is not applied. Therefore, there will either be a reported AWP, or C-AWP and C-AWP ) Calculated CMS Federal Upper Limit Price (C-CMS-FUL): On the last day of each calendar month at 11:30 PM EST, Elsevier calculates a proposed CMS FUL Price, and applies that price to all package sizes of each product that meet the same criteria used by CMS to create their published FUL, without regard to the use of the most common package size: Using a unique combination of ingredient(s), strength(s), Dosage Form and Route of Administration as the marker for a representative product, Elsevier applies the following criteria to create a Calculated CMS-FUL: 1) There must be three (3) actively marketed products by different firms at the time of calculation. 2) The unit price is calculated for both the reported WAC and/or DP price types, regardless of unit quantity per package. 3) A markup of 150% is applied to the lowest WAC or DP unit price for the unique representative product, and is considered the Calculated CMS FUL (C-CMS-FUL). Revision: 28 June 2016 Copyright 2016 Elsevier. All rights reserved. Page 3
6 4) A price record for the Calculated CMS FUL is assigned to all package sizes of all actively marketed versions of the representative product. The previous Calculated CMS FUL record s EndDate is set to the last day of the month, thereby making it an inactive price. Revision: 28 June 2016 Copyright 2016 Elsevier. All rights reserved. Page 4
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