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Government Pricing & Contract Concierge

 

With the complexity in Government Pricing (GP), we help life sciences manufacturers navigate the complexities and legalities of government health programs, like Medicare, Medicaid, and Veteran Affairs.

 

Services Include:

  • GP Compliance Assessment & Roadmap

  • Custom GP Audit Plans for Compliance / Internal Audit Teams

  • Policy and Procedure Review / Development

  • Recalculation & Financial Impact Analysis

CASE STUDY:

Our Government Pricing Reports Rule

  • CHALLENGE

    A mid-size generics pharmaceutical subsidiary wanted to evaluate and improve their Government Pricing (“GP”) reporting and gain an understanding of their liability exposure.

  • APPROACH

    - Conduct interviews with key personnel responsible for GP reporting.

    - Assess current policies, procedures, and methodology for GP reporting operations, such as Class of Trade Assignment, 340B Validations and Contract evaluation.

    - Collect sales, rebates, chargebacks, and price adjustments data for 2 different product families across a sample period and perform a 1-year recalculation for Average Manufacturer Price (“AMP”) for the sample products and period.

    - Assign Class of Trade Assignments to all customers in the sample.

    - Develop new methodology for the AMP calculation based on the company’s systems and processes.

    - Perform a financial impact analysis based on the new methodologies and recalculations.

  • IMPACT

    HELIO was able to identify systemic problems with crucial components of GP reporting and create an enhancement plan with recommendations to be implemented to systems and data usage. With the financial impact analysis, the company was able to understand its financial and liability exposure and act to mitigate the consequences.