Mercer Short Duration Fixed Income Fund Class Y-3 · NASDAQ:MSDYX
Mercer Short Duration Fixed Income Fund Class Y-3 — Mercer — Conference Presentation (October 2021)
38 slides from Mercer Short Duration Fixed Income Fund Class Y-3's conference presentation, Oct 26, 2021
Slide 1: Challenges at the intersection of Medicaid and 340B
Challenges at the intersection of Medicaid and 340B October 26, 2021 welcome to brighter
Slide 2: Our 340B discussion today
Our 340B discussion today 1 A brief history 2 340B considerations for state Medicaid programs 3 Identifying your state’s 340B objective 4 Matching 340B strategy to objective A Principal and pharmacist in Mercer’s Government Human Services Consulting practice, Sara assists state clients in evaluation
Slide 3: Slido Warm-up: four truths and a lie about my experience with 340B
Slido Warm-up: four truths and a lie about my experience with 340B. Identify the lie. ⓘ Start presenting to display the poll results on this slide.
Slide 4: What do you think of when you hear "340B?"
What do you think of when you hear "340B?" ⓘ Start presenting to display the poll results on this slide.
Slide 5: 340B program
a O — 2 os (ras a a ne) weiboid gore
Slide 6: A transformation
A transformation Over Signed into law by Duplicate discounts hospitals George HW Bush prohibited pharmacies Tied to Medicaid rebates Medicare from the beginning Prescription participate in the 340B program Deficit Reduction Act: Children’s hospitals added Drug Act Allowed more rural and small urban
Slide 7: Growing nationally
Growing nationally Between 2010 and 2019 340B Sales $90 $80 340B CEs increased $80 34% $70 $67 $58 from 9,700 to 13,000 CEs Billions of Dollars $60 $50 $46 Contract pharmacies increased $40 1,669% $30 from 1,300 to 23,000 $20 $10 Between 2017 and 2020 $0 2017 2018 2019 2020 340B Sales have grown 76%
Slide 8: 340B growth is not uniform
340B growth is not uniform Growth by Disease Category Growth by Distribution Channel Gastro 60% Neurology Hemostatic 50% Psychiatric 40% Resp-Therapy Anti-Viral 30% Immunology 20% Anti-Arthritic Diabetes 10% Targeted Oncology 0% 0% 10% 20% 30% 40% 50% Retail Hospital Clinic Mail Year Over Year Sales
Slide 9: 340B contract pharmacies
340B contract pharmacies Approximately Pharmacies are Most Covered Entities paid by the also pay Third Party covered entity for Administrators (TPAs) the dispensing Per Prescription service of covered entities contract Flat Monthly Fee with outside pharmacies Flat fee per prescription Percentage of
Slide 10: On a collision course? Four major stakeholders, four different perspectives
On a collision course? Four major stakeholders, four different perspectives 340B covered Pharmaceutical Contract State Medicaid entities manufacturers pharmacies programs • Provide care • Need to participate • Revenue and patient • Limited state • Expand access in 340B to enter volume expansion budg
Slide 11: What Trump-era policy(s) was recently rescinded by the Biden Administration?
What Trump-era policy(s) was recently rescinded by the Biden Administration? ⓘ Start presenting to display the poll results on this slide.
Slide 12: Approaching 30 years: Legal and regulatory challenges
Approaching 30 years Legal and regulatory challenges July 24, 2020, executive order December 2020, 2020 HHS Office requires that community health of General Counsel Advisory HHS’s 2018 OPPS rule included a centers pass all of their 340B drug Opinion: drug manufacturers reduction in Medicare reimburs
Slide 13: Navigating the Medicaid and 340B intersection
Navigating the Medicaid and 340B intersection Assess Objective The first step is to assess the state’s 1 2 The state must determine the primary 340B landscape policy objective related to 340B 340B policy decision steps Implement Select Not one size fits all The state must take steps to implement the
Slide 14: considerations: assessing the landscape
considerations assessing the landscape
Slide 15: 340B State Medicaid considerations: Double discounts and compliance
340B State Medicaid considerations Double discounts and compliance Medicaid cannot claim rebate on a drug that was purchased through the 340B program 340B entities must register with HRSA through the 340B database Pharmacies are not always able to consistently use claim level identifiers at the time
Slide 16: 340B State Medicaid considerations: Program design considerations
340B State Medicaid considerations Program design considerations State can establish payment rates Medicaid can pay no more than the State can establish payment rate for 340B in the MCO contracts 340B ceiling price plus a professional for 340B products dispensing fee State can allow PBM to set rates
Slide 17: Physician Administered Drugs
Physician Administered Drugs 340B entities can purchase PADs through 340B Hospital market consolidation has increased 340B PAD activity State Medicaid considerations Duplicate discount prevention Flexibility in payment methodology Copyright © 2021 Mercer LLC. All rights reserved.
Slide 18: Understanding your 340B entity population
Understanding your 340B entity population What 340B entities are present What do you know about how the in your state? providers are using the discounts? • Federally Qualified Health Centers (FQHCs) • Disproportionate Share Hospitals (DSHs) • Critical Access Hospitals (CAHs) • Family Planning Provid
Slide 19: What other entities might have interest in 340B?
What other entities might have interest in 340B? Ryan White/AIDS Corrections Drug Assistance Department Program State Employee University Hospital Insurance Program Systems Copyright © 2021 Mercer LLC. All rights reserved.
Slide 20: State reps only: Who is reaching out to you about 340B?
State reps only: Who is reaching out to you about 340B? ⓘ Start presenting to display the poll results on this slide.
Slide 21: The reference of 340B to a "political football"
The reference of 340B to a “political football” Who is politically powerful in your state? Patient DSH FQHCs advocacy hospitals groups Pharmaceutical Managed manufacturers Other care plans Copyright © 2021 Mercer LLC. All rights reserved.
Slide 22: Rank these entities from the most to least politically powerful
Rank these entities from the most to least politically powerful in your state ⓘ Start presenting to display the poll results on this slide.
Slide 23: 340B objective: your preferred route
340B objective your preferred route
Slide 24: Identifying your Medicaid 340B objective
Identifying your Medicaid 340B objective To find the policy that is the best fit for your state, first identify your priority objective Compliance Budget Safety net Patient access Political • Reduce/eliminate • Reduce the gross provider revenue • Ensure members compromise audit findings Medicaid pha
Slide 25: What are your top 340B objectives?
What are your top 340B objectives? ⓘ Start presenting to display the poll results on this slide.
Slide 26: strategy to objective: navigating the intersection
strategy to objective navigating the intersection
Slide 27: Objective: Compliance. Strategy: Reduce opportunity for double discounts
340B Objective | Compliance Strategy | Reduce opportunity for double discounts “Nuclear option” Require contract Require pharmacies to Require all 340B entities Require all providers to pharmacies to carve identify 340B claims at to submit quarterly use non-340B drug for Medicaid out of 340B the poi
Slide 28: FFS 340B carve-in or carve-out by state
FFS 340B carve-in or carve-out by state Retail pharmacy and PAD claims Covered Entity (CE) Decision For Both Carve-In for Both Carve-Out for Both District of Columbia CE Decision for Retail; No Policy for PADs Carve-Out for Retail; CE Decision for PADs • Delaware and North Dakota — CEs must obtain a
Slide 29: FFS contract pharmacies policy
FFS contract pharmacies policy Contract Pharmacies Allowed Contract Pharmacies Not Allowed District of Columbia • California — only hemophilia treatment centers have state- approved contract pharmacy arrangements • New Hampshire — only allowed for family planning medications prescribed at family pla
Slide 30: Objective: Improve the state budget. Strategy: Encourage 340B use in target areas
340B Objective | Improve the state budget Strategy | Encourage 340B use in target areas • State Employee Program Identify 340B opportunities for • Corrections other state programs • Non-Medicaid health program such as a Basic Health Plan (BHP) • Unit Rebate Offset Amount is returned 100% to federal
Slide 31: Objective: Maintain safety net revenue and patient access
340B Objective | Maintain safety net revenue and patient access Strategy | Seek out new payment models Program design Maintain Move away Safety Maintain from per-Rx payment Move from a Net Safety FFS to a PAHP Provider Net Explore bundled payment or MCO environment Revenue or APM options to gain fle
Slide 32: Objective: Achieve political compromise. Strategy: Think outside the 340B box
340B Objective | Achieve political compromise Strategy | Think outside the 340B box Identify alternative Consider add-on Develop a quality Allow for shared provider revenue payments for select incentive program savings on PADs streams providers for 340B providers Possible to apply a policy Is it pos
Slide 33: What is next in your state's 340B journey?
What is next in your state’s 340B journey? Copyright © 2021 Mercer LLC. All rights reserved.
Slide 34: It's almost lunch time. What 340B topic would you like to chat about?
It's almost lunch time. If we're sitting next to each other, what 340B topic would you like to chat about? ⓘ Start presenting to display the poll results on this slide.
Slide 35: Q&A and Resources
Submit your questions through the chat section Q&A and Resources Stay in the know Download the deck and find more information on 340B www.mercer-government.mercer.com/our-insights.html First in the country A Principal and pharmacist in Mercer’s Watch the video Government Human Services Consulting ww
Slide 36: Audience Q&A Session
Audience Q&A Session ⓘ Start presenting to display the audience questions on this slide.
Slide 37: Slide 37
Slide 38: A business of Marsh McLennan
A business of Marsh McLennan