Manufacturer List Price is $6/tablet for Brand X. Tablet is taken once/day; Your Product is on Tier 3 for Managed Care/PBM. Your Product is on Tier 3 for Medicare Plans.
First DataBank Standard Mark-up to arrive at AWP is 20%
Retailer dispensing fee is $2
Cash Paying customer pays AWP +5%
Co-Pays for Medicare are $3 Tier 1, $15 Tier 2, $40 Tier 3, Coinsurance 20% Tier 4
Medicare Part D Plans gets the following when not in donut hole:
30% rebate for Tier 2;
20% for Tier 3;
10% for Tier 4
- Managed Care and VA/Military are considered equivalent plans (Comparable Plans)
- Medicaid & FSS has no CPI penalty
- One strong State controlled Medicaid gets a 10% supplemental rebate for Tier 2
- PHS Hospital is given highest price that is still nominal
- Managed Care/PBM reimburses brand to the retail pharmacy at AWP -10%
- Co-Pays for Managed Care/PBM are $5 Tier 1, $25 Tier 2, $40 Tier 3, Coinsurance 25% Tier 4
- Managed Care/PBM gets the following rebate from the manufacturer:
15% rebate for Tier 2
5% rebate for Tier 3
0% rebate for Tier 4
The Medicare Co-Pay questions is asking; What is the Co-Pay for the Tier that your product is situated?
The Retail Price=WAC =AMP=NFAMP
"Not Applicable" only applies to the "%Difference vs List Price" part of the table. You need to provide the Co-Pay as an answer.
You are taking the perspective of the manufacturer so the prices entered into the Cascade are what the manufacturer is going to receive similar to Price to the Channel in PharmaSim.
So the Managed Care price is how much is manufacturer receiving for sales going thru Managed Care?
So Medicaid price is how much is manufacturer receiving for sales going thru Medicaid?
So Medicare price is how much is manufacturer receiving for sales going thru Medicare Part D while patient is in Donut Hole?
How much manufacturer is receiving does not apply to co-pays.
Express prices as a price/per tablet.
Complete the Cascade
Current List Price
Medicare Price in Donut Hole Paid to Pharma Manufacturer
Managed Care Price Paid to Pharma Manufacturer
Medicaid Price
FSS Price
Best Medicaid Price(Lowest Price That Any State Medicaid Receives)
Highest PHS Nominal Price
Managed Care Patient Pays What?
Medicare Patient Pays What Co-Pay for Tier?
Current List Price
Medicare Price in Donut Hole
Managed Care Price
Medicaid Price
FSS Price
Best Medicaid Price
PHS Nominal Price
Managed Care Patient Pays What?
Medicare Co-Pay Is What?