What Health Plans Should Know About Value Based Care, PBM Contracts and Rebate Aggregators
May 12 @ 12:00 pm - 1:00 pm
11:00 AM CT – 12:00 PM CT (60 minutes)
Vendor Spotlight Host: Frier Levitt, LLC.
During this interactive webinar, Frier Levitt’s Co-Founding Partners, Daniel B. Frier, Esq. and Jonathan E. Levitt, Esq. will discuss the importance of value-based care in the medical and pharmacy benefit space, as well as loopholes in the contracts between PBMs and Plan Sponsors that impact cost-containment strategies. Health Plans will learn about value-based care in the medical and pharmacy benefit space, where providers are rewarded financially for helping their patients stay healthy – instead of being financially rewarded by increasing fee-for-service payments they prescribe when their patients get sick. Information asymmetry leads to a growing national trend in which Plan Sponsors in the Medicare, Medicaid and Commercial space get fleeced by PBMs, particularly as it relates to drug rebates. Panelists will discuss key contract provisions that Health Plans should negotiate into Pharmacy Benefit Arrangement contracts. Cautionary tales will be told about the dangers of “rebate aggregators”.
- Learn the difference in payment models (balancing financial risk) versus traditional fee-for-service payments (paid separately for each service) to Bundle/Episode-of-care which cover all the care a patient receives during treatment.
- Learn the legal considerations of the Anti-Kickback Statute and the Health Insurance Portability and Accountability Act (HIPAA).
- Learn about the types of Provider Organizations and management of data
- Learn the critical contract terms between a PBM and Health Plan, including manufacturer rebates, audit rights, and market check.
- Learn what every Health Plan needs to know about Rebate Aggregators.
- Learn what Health Plans need to know about negotiating with PBMs.