Medicaid & Medicare Strategy

Experienced & responsive decision support

Medicare and Medicaid: Experienced and Responsive Decision Support

The Advantage Point Solutions team has extensive knowledge and experience in both Medicare and Medicaid managed markets, having developed and implemented clinical, formulary, coverage and rebate strategies for over two decades of pharmacy benefit management. A Medicare strategy that is comprehensive and responsive is critical in the current environment. We are the only pharmaceutical and biotech consulting company that has the skills and experience to manage the entire offering for both manufacturers and payers to ensure compliance and execution of an effective Medicaid or Medicare strategy.

• Comprehensive experience with all aspects of CMS requirements
  • Formulary and protected class policies
  • Coverage inclusion requirements and process
  • Part B and D coverage differences
  • Formulary submission calendar
• Plan benefit design experience
  • Effect of future coverage gap discounts
  • Product restriction tools
  • P&T logistics, decision making, timeline management
• Medicaid state regulations and impact on access
  • Effect of growing Medicaid eligible population
  • Beneficiary, provider and plan pull-through programs