Monday, August 25, 2025 | 8:30 a.m. – 3:30 p.m. CT | $599
Looking to expand your Medicaid knowledge? Join the experts from Artia Solutions for an in-depth workshop that covers trends in Medicaid and state operations, Medicaid Managed Care, PBMs, and Medicaid rebates, offsets, and net costs.
Monday, August 25, 2025 | 8:30 a.m. – 3:30 p.m. CT | $599
NEW! Connect with The Pricing Group for a workshop designed for professionals new to government pricing, as well as senior leaders looking for a basic understanding of the requirements of the federal healthcare programs for manufacturers.
Monday, August 25, 2025 | 8:30 a.m. – 3:30 p.m. CT | $599
NEW! Join Nimitt Consulting for a dynamic workshop on cell and gene therapies that will demystify CMS’ policies and regulations on coverage, coding, and payment, and shine a spotlight on the key drivers of optimal reimbursement for providers.
SEGMENT ONE: 8:30am – 9:45am
Medicaid Overview and Pharmacy Management
Speakers: Matt Dull and Chad Bissell
Federal law provides a level of flexibility for each state to administer their Medicaid programs. This segment provides an overview of the federal provisions that guide states, as well as how states implement those flexibilities when managing their pharmacy benefits.
SEGMENT TWO: 10:00am – 11:30am
PBM Overview and State Operations
Speakers: Chris Andrews and Chad Bissell
Many states employ a pharmacy benefit manager (PBM) to administer functions such as fiscal agent, claims processor, and supplemental rebate negotiator. This segment will identify the PBMs that focus on Medicaid services, explain how they approach their contracted responsibilities for states, and identify important manufacturer actions in each process.
LUNCH 11:30am – 12:30pm
SEGMENT THREE: 12:30pm – 1:30pm
Medicaid Managed Care
Speaker: Nick Penzetta
Most Medicaid recipients receive their healthcare services through contracted Medicaid Managed Care plans. This segment will compare the differences between the Medicaid Fee-for-Service and Medicaid Managed Care plan healthcare delivery models. It will also focus on how pharmaceuticals are managed within the Managed Medicaid model.
SEGMENT FOUR: 1:45pm – 3:30pm
Medicaid Rebates, Offsets, and Net Costs
Speaker: Kinsey Caldwell
State Medicaid coverage decisions are based on two primary components – clinical efficacy and financial impact. As states evaluate the cost of drugs differently than how a manufacturer evaluates their net revenue of that drug, this segment will review the components a manufacturer needs to be cognizant of when working and negotiating with Medicaid Fee-For-Service programs as it relates to a drug’s financial impact. Topics to be discussed include Medicaid Federal Rebate obligation, Supplemental Rebate opportunities, Unit Rebate Offset Amounts, and Net Costs.
SEGMENT ONE: 8:30am – 9:45am
The Medicare coverage conundrum: how coverage policies (or the lack thereof!) impact beneficiary access
Speakers: The Nimitt Team
This segment will begin with the aspects of Medicare that are foundational to understand – statutory definitions, beneficiary eligibility, Parts of Medicare, and hospital requirements – and then shift into discussion of the current coverage policies and processes for cell and gene therapies. The session will review the CAR-T and Stem Cell Transplant National Coverage Determinations (NCDs) as examples of national policies.
SEGMENT TWO: 10:00am – 11:30am
Cracking the code on payment: coding, charging and billing for cell and gene therapies
Speakers: The Nimitt Team
Medicare reimburses providers based on a relatively simple premise – the charges and codes providers submit on a claim. But that simple structure has layers of complexity and requirements behind it that can result in dramatic variance in payment per case. This session will use case studies with cell and gene therapies to demonstrate the “why” and “how” of the most important numbers on a claim. Key topics include: CPT and ICD-10 procedure codes, HCPCS product codes, hospital chargemasters, NUBC & HIPAA billing and claims requirements.
LUNCH 11:30am – 12:30pm
SEGMENT THREE: 12:30pm – 1:30pm
DRG, NTAP and other riddles: Medicare Inpatient Prospective Payment System (IPPS)
Speakers: The Nimitt Team
Providers are reimbursed through IPPS for any inpatient hospital care of beneficiaries. This segment will focus on the main tenants of the IPPS, including Diagnosis Related Groups (DRGs), New Technology Add-on Payment (NTAP), hospital-specific adjustors and outlier payments. The session will leverage real-world scenarios and core IPPS calculations to illustrate exactly how payments may be computed.
SEGMENT FOUR: 1:45pm – 3:30pm
Unlocking payment in the hospital outpatient and physician office settings: Medicare Physician Fee Schedule (MPFS) and Outpatient Prospective Payment System (OPPS)
Speakers: The Nimitt Team
This session will include specific topics of interest from both OPPS and MPFS for cell and gene therapies. The OPPS section will include payment for drugs, Pass-Through payment status, status indicators and ambulatory payment classifications (APCs), while the MPFS section will focus on how physicians and their teams are paid for clinical services and product administration in different places of service.
WRAP-UP: 3:00pm – 3:30pm
Putting the puzzle together: Navigating Medicare to improve access
Speakers: The Nimitt Team
We will conclude the day by bringing together key concepts from the prior sessions and answering any remaining questions from participants.
SEGMENT ONE: 8:30am – 9:45am
Government Pricing Foundations, Key Concepts, and Medicaid
Speakers: Katie Lapins and Lisa Clayton
We start the day by setting the foundation for all the GP programs, including what drives the GP calculations, the history and requirements for manufacturers to participate in the Medicaid Drug Rebate Program, and examples of the Medicaid-related calculations (AMP, BP, URA).
SEGMENT TWO: 10:00am – 11:30am
PHS/340B Program | Medicare Part B
Speakers: Katie Lapins and Lisa Clayton
The 340B Program is one of the fastest growing Government Programs. Learn how the PHS Price is calculated and why manufacturers need to be concerned about Revenue Leakage with this program. Next, we’ll move onto Medicare where you’ll gain insight into what is covered by the different parts, the requirements for manufacturers, and the Inflation Reduction Act, before diving deeper into Medicare Part B and ASP.
LUNCH 11:30am – 12:30pm
SEGMENT THREE: 12:30pm – 1:30pm
VA/FSS & TRICARE
Speaker: Katie Lapins and Lisa Clayton
After lunch, we will dig into the requirements of the Federal Supply Schedule and TRICARE, how the price is calculated, and best practices for communicating with the Department of Veterans Affairs.
SEGMENT FOUR: 1:45pm – 3:30pm
Medicare Part D | GP Compliance & Current Events
Speaker: Katie Lapins and Lisa Clayton
We will wrap up our day with an overview of Medicare Part D, including the calculation of inflation rebates. We round out the day with a discussion of current “hot topics,” what is meant by “compliance,” what options are available when a mistake is identified, and answer your other questions at this time.