Government and Commercial Pricing & Contracting

Due to the increasingly complex supply chain of life sciences products, it is more important than ever to establish contracts that set clear expectations through a strategic lens that considers the rules and regulations that influence pricing. Contract development is complex due to the number of stakeholders that need to be considered such as the government, pharmaceutical companies, health plans and the public. Life sciences companies must keep the entire ecosystem in mind.

Baker Tilly’s life sciences team can provide solutions to support each of your contract strategy needs:

• Overall contract strategy: Build strength across commercial contract networks with government pricing considerations in mind.
• Gross-to-net calculations: Attain accurate and timely pricing insights, adjustment calculations and scenario analysis capabilities that offer additional visibility into pricing practices, while tying together relevant data across disparate information systems.

Numerous complex government programs can make up a significant share of overall product sales for life science companies. Participation in government programs, however, requires life sciences companies to follow strict guidelines and regulations, which often require regular self-reporting on a multitude of complex calculations in order to remain compliant. To safe guard the future health of their products, it is crucial for life sciences companies to have a clear understanding of what is expected of them and establish proper steps toward compliance for each government program, with tight controls and proactive monitoring for potential compliance and ethics risks.

Baker Tilly’s life sciences advisory and support solutions team stays current with rapidly changing government program regulations. We also help our clients interpret, implement and comply with program requirements. Our wide breadth of service offerings include:

• Medicare and Medicaid price reporting calculation support: Establish foundational capabilities to enable accurate and timely calculation of key Medicare and Medicaid price metrics such as the CMS Average Sales Price (ASP), Average Manufacturer Price (AMP), Drug Rebate Program metrics and more.
• Government pricing system integration: Including program stand up, compliance, audit services and the development of integrated reporting capabilities that support regular information sharing to the CMS Drug Data Reporting for Medicaid (DDR) system and CMS ASP.
• 340B Drug Pricing Program: Support program stand up and ongoing compliance to 340B Drug Pricing Program through development and review of policies and procedures, internal controls, testing of 340B transaction record accuracy and corrective action planning when necessary.
• VA FSS program contracting and pricing: Assistance with Federal Supply Schedule (FSS) proposal and renewal package preparation, contract negotiations, and development and deployment of post-award compliance programs. Customized tools for other federal government agencies (OGA) contract pricing, statutory pricing, non-federal average manufacturer price (non-FAMP) and federal ceiling price (FCP) reporting, Price Reductions Clause (PRC) monitoring and compliance and revenue maximization. Assistance with Trade Agreements Act (TAA), Industrial Funding Fee (IFF) reporting, and contract management and administration.
• Federal funding compliance requirements: Fully understand the administrative, reporting and other obligations included in federal agreements and contracts, including the timeline of when funds are dispersed and the preparation for a government audit.
• Across government contracts we provide audit and disclosure support, customized policy development, and audit and procedural documentation on an as needed or on an ongoing basis (e.g., monthly, quarterly, annually, etc.).

As the volume of specialty and high price pharmaceutical and medical device products grow, life sciences companies will have billions of dollars at stake each year. This, along with the sheer volume of stakeholders in the life sciences supply chain cause challenges in managing the commercial contracting life cycle. In order to succeed, the life sciences industry must make it a priority to develop strategies for accurately tracking transactions to ensure they are receiving accurate reimbursement based on detailed analytics. From the point of initial contract negotiation, terms must be laid out clearly and appropriately followed. Post signature, life sciences company can reduce risk through the adoption of analytics to help ensure the terms of these contracts are being adhered to.

Baker Tilly’s life sciences team offers a start to finish approach for commercial contract compliance and ethics needs, including:

• Chargeback reviews: Provide transactional reviews to determine whether chargebacks are appropriately applied, especially to specific customer types (e.g., non-contract sales) or when a product is returned. Our comprehensive reviews cover the whole life cycle of product distribution including contract management (EDI 845), chargeback management (EDI 844), inventory management (EDI 852), and sales (EDI 867). We also perform additional wholesale distributor reviews including, but not limited to, pricing compliance (e.g., wholesale acquisition cost, contract customer pricing, public health service act, etc.), price protection reconciliations, deductions testing and distribution center audits.
• Rebates: Provide support in modeling rebate scenarios and drafting contracts that contain clear language to reduce ambiguity when calculating the rebates. We also offer full rebate payment reviews including, but not limited to, monitoring for rebate eligibility, claims adjudication, best price audits and administrative fee audits to identify discrepancies between what is being claimed and what has actually been earned.
• BFSF FMV assessments: Assistance with compiling a catalog of services to be tested, determining of the legal prongs of the Bona Fide Service Fee (BFSF) test and fair market valuation (FMV) calculation, and creation of work process tools to facilitate compliance with the Centers for Medicare and Medicaid Services (CMS) BFSF test.
• Across commercial contracts we can provide audit disclosure support, customized policy development, and audit and procedural documentation on an as needed or on an ongoing basis (e.g., monthly, quarterly, annually, etc.).