The class-action settlement agreement reached by McKesson Corporation and the plaintiffs regarding average wholesale prices will have an impact on the future of prescription drug pricing and reimbursement. However, a $288,000,000 fund has been created to provide reimbursement to third-party payors who were impacted by the alleged collusion to inflate AWP from August 1, 2001 to March 15, 2005.

TPPs are described as self-insured employers, insurance companies and others responsible for payment of drugs based on AWP pricing. However, access to these settlement funds will only be provided to those TPPs that file a claim. TPPs have until July 9, 2009 to file a claim.

The settlement lists more than 400 drugs, which allegedly had their AWP prices inflated by around 5%. The list includes some widely prescribed drugs such as Lipitor, Claritin, Prozac, Nexium, Plavix, Allegra, Wellbutrin, Ambien, Prilosec, Zantac, Valtrex, Zyprexa, Celebrex, Imitrex, Risperdal, Seroquel and Neurontin. During a typical year, the dollars spent on the drugs on the list could represent between 25% and 35% of the total dollars paid on pharmacy claims for a self-insured employer. If those drugs were on average 5% higher than they should have been, the price increase represents 1% to 2% of a self-insured employer’s total spending on pharmacy drugs for each year.

In order to file a claim, TPPs must obtain pharmacy claims data for the period between August 1, 2001 and December 31, 2003. This shorter window of time will serve as a proxy period to estimate the total exposure of an employer. This data must be analyzed to determine how much was paid on the more than 400 drugs involved in the settlement. After this information is gathered, TPPs must file a specific claim form listing the amount they spent on the subject drugs during the proxy period. TPPs must also provide supporting data to Rust Consulting, the settlement administrator.

In order to meet the July 9, 2009 deadline, self-insured employers should:

• Decide whether or not they will perform the analysis and claim submission in-house or through a qualified vendor.

• Find out who served as the employer’s PBM between August 1, 2001 and December 31, 2003.

•  Request the historical data required to submit the claim form to the settlement administrator.

Browning is director of strategic development for Chapman Kelly, a Jeffersonville, Ind.-based auditor. He can be reached at mbrowning@chapmankelly.com.