FMV/Compliance
What does FMV stand for?
Fair Market Value
What entity submits chargebacks to Novartis?
Wholesalers
The Government Reporting Team calculates and reports what?
Federal Drug Prices
What does PBM stand for?
Pharmacy Benefit Manager
What subset of US citizens does Medicaid mainly cover?
Low-income individuals and families
Compliance controls are primarily designed to reduce what?
Risk/Errors
How is a chargeback calculated?
WAC - Contract Price = Chargeback
What team relies on accurate Government Reporting pricing for their rebate amounts?
Medicaid
What part of Medicare does Managed Care work with?
Medicare Part D
Who submits rebate invoices to the Medicaid team?
States
Compliance ensures that we adhere to _____ regulations and requirements?
SOX
What are the big three wholesalers?
Cardinal, Cencora, McKesson
Model N is used by GR to perform what?
Pricing Calculations
What are the big three PBMs?
ESI, Optum, Caremark
Medicaid rebates represent a significant portion of gross-to-net what?
Revenue Deductions
What law makes it illegal to provide payments to induce business or referrals?
Anti-Kickbak Statute
ICCR ensures correct pricing by validating what before payment?
Contract Eligibility
What are AMP and Best Price used to calculate?
The Unite Rebate Amount, URA
Why does Manages Care pay rebates?
Formulary Access and Increased Market Share
How many days does Novartis have to pay Medicaid rebate invoices after they are received?
38 days from the postmark date
Compliance primarily interacts with what external team?
Auditors
Deductions and Bill Onlys
What is the formula to calculate the statutory Medicaid rebate?
23.1% of AMP or AMP-Best Price, plus an inflation component
In rebate processing, what are the two main steps used to validate invoices?
Claim-level Validations and Rebate Eligibility Review
What team negotiates Medicaid supplemental rebate deals?
Market Access