Monday, August 25, 2025 | 8:30am – 3:30am 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 | 8:30am – 3:30pm 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 | 8:30am – 3:30pm 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: Medicaid Overview and Pharmacy Management (8:30am– 9:45am)
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: PBM Overview and State Operations (10:00am – 11:30am)
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: Medicaid Managed Care (12:30pm – 1:30pm)
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: Medicaid Rebates, Offsets, and Net Costs (1:45pm – 3:30pm)
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: Government Pricing Foundations, Key Concepts, and Medicaid (8:30am – 9:45am)
Speakers: Katie Lapins and Lisa Clayton
We’ll 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).
Segment Two: Medicaid Unit Rebate Amount (10:00am – 11:30am)
Speakers: Katie Lapins and Lisa Clayton
The AMP and BP calculations drive the Medicaid Unit Rebate Amount (URA) as well as the 340B Program. Learn how to calculate both of these numbers, important to a company’s gross-to-net and accruals, and the opportunities for revenue leakage with the PHS/340B program.
Lunch (11:30am – 12:30pm)
Segment Three: Medicare (12:30pm – 1:30pm)
Speakers: Katie Lapins and Lisa Clayton
After lunch, 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. We’ll take a deeper dive into Medicare Parts B and D, the ASP calculation, and the Inflation Rebates applicable to both programs.
Segment Four: VA/FSS & TRICARE | GP Compliance & Current Events (1:45pm – 3:30pm)
Speakers: Katie Lapins and Lisa Clayton
We will wrap up our day with the requirements of the Federal Supply Schedule and TRICARE, how the FSS price is calculated, and best practices for communicating with the Department of Veterans Affairs. 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.
Segment One: The Medicare Coverage Conundrum: How Coverage Policies (Or the Lack Thereof!) Impact Beneficiary Access (8:30am – 9:45am)
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: Cracking the Code on Payment: Coding, Charging, and Billing for Cell and Gene Therapies (10:00am – 11:30am)
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: DRG, NTAP and Other Riddles: Medicare Inpatient Prospective Payment System (IPPS) (12:30pm – 1:30pm)
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: Unlocking Payment in the Hospital Outpatient and Physician Office Settings: Medicare Physician Fee Schedule (MPFS) and Outpatient Prospective Payment System (OPPS) (1:45pm – 3:30pm)
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: Putting the Puzzle Together: Navigating Medicare to Improve Access (3:00pm – 3:30pm)
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.