340B DISCOUNT DRUG PROGRAM OVERVIEW

Similar documents
PHYSICAL THERAPY MARKET OVERVIEW

INTRAOPERATIVE NEUROPHYSIOLOGICAL MONITORING OVERVIEW. October 2014

Workers Compensation Overview

HOME HEALTH OVERVIEW. February 2015

ORTHOPEDIC INDUSTRY OVERVIEW

HEALTHCARE STAFFING MARKET OVERVIEW. November 2015

340B Drug Discount Program Identifying risks and internal audit focus areas

Federal 340B Drug Pricing Program

XXXXXXXFUNDAMENTALS An Essential Guide for Health System Executive Management

340B Drug Pricing Program

The 3 Keys to Success in Your 340B Program. Rob Nahoopii, PharmD, MS, BCPS CEO Turnkey Pharmacy Solutions A 340B Management Company

Keep Your Savings: 340B Audits and Ensuring Compliance

C. Covered 340B drugs, as found in section 1927 (k)(2) of the Social Security Act, include the following outpatient drugs:

The 340B Drug Pricing Program. Ariel Winter and Daniel Zabinski November 6, 2014

Overview of the 340B Drug Pricing Program

MEDICARE PART B DRUGS. Action Needed to Reduce Financial Incentives to Prescribe 340B Drugs at Participating Hospitals

The Pharmacy 340B Program- Compliance & Internal Audit Strategies. for Covered Entities. Matthew D. Vogelien Huron Healthcare

340B Drug Discount Program Improving Compliance to Protect Savings and Be Audit Ready. Suzanne Herzog Founding Director Rx X Consulting

340B Drug Pricing Program: Overview and Recent Developments

340B Drug Discount Program Overview and Emerging Issues

Let s consider two situations

340B Drug Pricing Program January 15, 2015

340B: ARE WE MONITORING COMPLIANCE EFFECTIVELY AND EFFICIENTLY

Urgent Care Industry Overview

Invested in Your Success

GAO DRUG PRICING. Manufacturer Discounts in the 340B Program Offer Benefits, but Federal Oversight Needs Improvement

GROWTH OF THE 340B PROGRAM: PAST TRENDS, FUTURE PROJECTIONS

The PHS 340B Drug Pricing Program

4/3/2015 WHAT IS 340B? DISCLOSURE. No conflicts of interest to disclose

Is your organization 340B equipped? Understanding Contract Pharmacy arrangements

The 340B Program: Today and Beyond

BUY Target: 215p. Strategic impact: cross-selling. Financial impact: good value

340B University Page 1 340B Manager and Coordinator Job Description Template

340B Policy Landscape

Implementing a System-wide 340B Program

The 340B Drug Pricing Program: The Basics

340B Compliance: I sure wish I d known that!

Ensuring Integrity in use of 340B pricing: Responsibility, Compliance, Accountability

340B PROGRAM. Scrutiny & Uncertainty Increase the Need for Compliance

The 340B Program: New Developments and New Opportunities for CAHs and Others. Todd Nova Hall Render

340B Drug Pricing Program: Recent Developments and Compliance Update

Maximizing the 340B Drug Discount Program: A Webinar for Finance Executives in 340B Hospitals Webinar

Legal Alert. Long-Awaited 340B Program Guidance Now Available for Comments: What Stakeholders Need to Know. Authors

CPAs and ADVISORS. experience access // 340B QUALIFICATIONS, BENEFITS AND CURRENT FOCUS

THE 340B DRUG DISCOUNT PROGRAM A Review and Analysis of the 340B Program

Manhattan Office Property Price Index August 4, 2011 DJIA: RMZ: 10-Yr Treasury Note:

THE 340B DRUG DISCOUNT PROGRAM A Review and Analysis of the 340B Program

HRSA Pharmacy Services Support Center: The 340B Access Resource

The Evolving Landscape of Payment Care Delivery and Manufacturer Implications of Coverage Expansion

Trends and Technology A Capital Markets Perspective

7/16/ th Annual 340B Coalition Conference July 19, 2010 Washington, DC. Safety Net Hospitals for Pharmaceutical Access

Concordius Capital Holdings, Inc. Registered Investment Advisor Acquisition Program

Printed copies are for reference only. Please refer to the electronic copy of this policy for the latest version.

10/1/2013. Objectives. 340B Drug Pricing Program; Transitioning from Access to Integrity. 340B Stats, Arkansas. 340B Participating Entities, AR

PHARMACY CARE FQHCs AND 340B PROGRAM

UPDATES ON 340B Where do we go from here?

CONTRACT RESEARCH ORGANIZATION INDUSTRY OVERVIEW

IPAA Private Capital Conference. January 2014

Real-time Pre and Post Claim Edits: Improve Reimbursement, Compliance and Safety

October 27, Attention: RIN 0906-AB08. RE: 340B Drug Pricing Program Omnibus Guidance. Dear Captain Pedley:

TEXAS VENDOR DRUG PROGRAM PHARMACY PROVIDER PROCEDURE MANUAL

Joseph J. Tiedemann Senior Director Investments Senior Portfolio Manager OMEGA Group. OMEGA Management Fundamentals

MEDICAID DRUG PRICE COMPARISON: AVERAGE SALES PRICE TO AVERAGE WHOLESALE PRICE

SECOND NOTICE: IMPORTANT INFORMATION REGARDING YOUR GE STOCK IRA ACCOUNT

Through the Snow, Job Market Plows Ahead

Finally... maybe? The Long Awaited 340B Mega Guidance. Georgia Healthcare Financial Management Association. October 2015

Structuring 340B Contract Pharmacy Arrangements: Meeting Legal and Regulatory Requirements

Health Care Reform *

340B Benefits Some, Not Others

E-ALERT Health Care HEALTH CARE REFORM: MEDICAID PRESCRIPTION DRUG REIMBURSEMENT. Executive Summary

340B Mega Guidance: Implications for Essential Hospitals Sarah Mutinsky and Barbara Eyman Washington Counsel, America s Essential Hospitals Eyman

COMMODITY STRUCTURED NOTES Introducing The World s Oldest Asset Class... For Today s Investors

STATES COLLECTION OF REBATES FOR DRUGS PAID THROUGH MEDICAID MANAGED CARE ORGANIZATIONS

Pharmacy Benefit Managers: What we do

340B Compliance Self-Assessment: Self-Audit Process Page 1 A Sample Self-Audit Process for Community Health Centers

DENTAL PRACTICE MANAGEMENT OVERVIEW

Transcription:

340B DISCOUNT DRUG PROGRAM OVERVIEW March 2014 Investment banking services are provided by Harris Williams LLC, a registered broker-dealer and member of FINRA and SIPC, and Harris Williams & Co. Ltd, which is authorised and regulated by the Financial Conduct Authority. Harris Williams & Co. is a trade name under which Harris Williams LLC and Harris Williams & Co. Ltd conduct business.

340B DISCOUNT DRUG PROGRAM OVERVIEW Section 340B of the Public Health Service Act provides access to prescription drugs at significantly discounted prices for eligible facilities ( covered entities ). On average, covered entities receive discounts of approximately 50% of average wholesale price ( AWP ) through the 340B program. Covered entities include disproportionate share hospitals ( DSH ), federally qualified health centers, and other healthcare facilities that serve predominately low-income, special need, and indigent patients. In order to maintain eligibility, covered entities must meet a number of requirements and are subject to annual recertification by the Health Resources and Services Administration ( HRSA ). Strict inventory control to ensure that medications reach vulnerable patient populations Increased billing and reporting requirements Maintenance of separate inventories and patient / claims processing records 340B Drug Pricing As of December 2012 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 100% 66% 64% 51% 42% AWP GPO Medicaid Rebate 340B Avg VA Sources: Pembroke Consulting and GAO analysis of HRSA data. 1

340B PROGRAM GROWTH As a result of health reform-driven changes, drug spend through 340B is expected to reach $16 billion by 2019P from $7 billion currently. Since 2001, the number of covered entities has increased 6.8% annually. The Patient Protection and Affordable Care Act ( PPACA ) opened access to rural hospitals, freestanding oncology centers, sole-community hospitals, and critical access hospitals. Expansion in Medicaid coverage codified by the PPACA has also driven an increase in the number of covered entities 340B Drug Expenditures For the Years Ended and Ending December 31, 2013 to 2019P ($ in billions) 340B Covered Entities For the Years Ended December 31, 2001 to 2011 $18.0 $16.0 $14.0 $12.0 $10.0 $8.0 $7.2 $8.7 $10.1 $11.6 $13.1 $14.5 $16.0 18,000 16,000 14,000 12,000 10,000 8,000 14,076 14,725 11,442 12,162 13,139 11,926 12,404 10,325 8,605 9,193 16,572 $6.0 6,000 $4.0 4,000 $2.0 2,000 $0.0 2013 2014P 2015P 2016P 2017P 2018P 2019P 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Source: Avalere Health analysis of HRSA data. 2

CHALLENGES OF THE 340B PROGRAM Covered entities are facing increased scrutiny at a time when discounts from the 340B program are most needed. Due to growth in utilization of the program, HRSA increased its 340B audit activity in late 2012. Manufacturers have begun to require independent audits due to revenue lost through discounts Recent reports by the Government Accountability Office and the Office of the Inspector General highlight abuse and misuse of the 340B program. Diversion providing discounted drugs to ineligible patients Duplicate discounts receiving both 340B pricing and other government program discounts, such as Medicaid Meanwhile, public sector hospital margins remain under significant pressure, driving the need for covered entities to maximize savings from 340B. Public Sector Hospital Margins 1 For the Years Ended December 31, 2007 to 2011 0% 2007 2008 2009 2010 2011 (2%) (4%) (6%) (8%) (7.0%) (6.7%) (5.9%) (7.2%) (10%) (8.5%) Covered entities often lack the expertise and resources to implement and maintain a compliant 340B program, presenting an attractive opportunity for outsourced providers. Source: MedPac. (1) Medicare margins. 3

OPPORTUNITIES WITHIN THE 340B MARKET The complexity of managing a 340B program has driven demand for pharmacy service providers specializing in serving the needs of covered entities. Pharmacy management firms with expertise in 340B are able to help unsophisticated covered entities implement efficient, profitable, and compliant 340B programs. Many eligible facilities are not aware that the 340B program is available to them Services include patient eligibility analysis, procurement assistance, licensing and compliance verification, and inventory control Contract pharmacies enable covered entities lacking in-house pharmacy services or facilities to dispense 340B drugs to patients. Covered entity purchases drugs, but contract pharmacy takes physical delivery and manages dispensing to patients Growth in 340B Contract Pharmacy Arrangements Representative 340B Pharmacy Service Providers For the Years Ended December 31, 2003 to 2013 14,000 12,000 10,000 9,783 12,240 8,000 7,325 6,000 4,000 2,000 0 2,981 364 699 1,075 1,449 1,733 2,063 2,410 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Source: Avalere Health analysis of HRSA data. 4

DISCLOSURES Harris Williams & Co. (www.harriswilliams.com) is a preeminent middle market investment bank focused on the advisory needs of clients worldwide. The firm has deep industry knowledge, global transaction expertise, and an unwavering commitment to excellence. Harris Williams & Co. provides sell-side and acquisition advisory, restructuring advisory, board advisory, private placements, and capital markets advisory services. Investment banking services are provided by Harris Williams LLC, a registered broker-dealer and member of FINRA and SIPC, and Harris Williams & Co. Ltd, which is authorised and regulated by the Financial Conduct Authority. Harris Williams & Co. is a trade name under which Harris Williams LLC and Harris Williams & Co. Ltd conduct business. THIS REPORT MAY CONTAIN REFERENCES TO REGISTERED TRADEMARKS, SERVICE MARKS AND COPYRIGHTS OWNED BY THIRD-PARTY INFORMATION PROVIDERS. NONE OF THE THIRD-PARTY INFORMATION PROVIDERS IS ENDORSING THE OFFERING OF, AND SHALL NOT IN ANY WAY BE DEEMED AN ISSUER OR UNDERWRITER OF, THE SECURITIES, FINANCIAL INSTRUMENTS OR OTHER INVESTMENTS DISCUSSED IN THIS REPORT, AND SHALL NOT HAVE ANY LIABILITY OR RESPONSIBILITY FOR ANY STATEMENTS MADE IN THE REPORT OR FOR ANY FINANCIAL STATEMENTS, FINANCIAL PROJECTIONS OR OTHER FINANCIAL INFORMATION CONTAINED OR ATTACHED AS AN EXHIBIT TO THE REPORT. FOR MORE INFORMATION ABOUT THE MATERIALS PROVIDED BY SUCH THIRD PARTIES, PLEASE CONTACT US AT +1 (804) 648-0072. The information and views contained in this report were prepared by Harris Williams & Co. ( Harris Williams ). It is not a research report, as such term is defined by applicable law and regulations, and is provided for informational purposes only. It is not to be construed as an offer to buy or sell or a solicitation of an offer to buy or sell any financial instruments or to participate in any particular trading strategy. The information contained herein is believed by Harris Williams to be reliable but Harris Williams makes no representation as to the accuracy or completeness of such information. Harris Williams and/or its affiliates may be market makers or specialists in, act as advisers or lenders to, have positions in and effect transactions in securities of companies mentioned herein and also may provide, may have provided, or may seek to provide investment banking services for those companies. In addition, Harris Williams and/or its affiliates or their respective officers, directors and employees may hold long or short positions in the securities, options thereon or other related financial products of companies discussed herein. Opinions, estimates and projections in this report constitute Harris Williams judgment and are subject to change without notice. The financial instruments discussed in this report may not be suitable for all investors, and investors must make their own investment decisions using their own independent advisors as they believe necessary and based upon their specific financial situations and investment objectives. Also, past performance is not necessarily indicative of future results. No part of this material may be copied or duplicated in any form or by any means, or redistributed, without Harris Williams prior written consent. Copyright 2014 Harris Williams & Co., all rights reserved. 5