Inside the Medicare Transaction Facilitator: Early Wins and Growing Pains

In this episode of VerifiedRx, Carolyn Liptak is joined by Dr. Jennifer Tussey, Senior Specialty Pharmacy Manager at BJC Health, to discuss early experiences with the Medicare Transaction Facilitator (MTF) and the Medicare Drug Price Negotiation Program. From managing complex data flows and delayed payments to coordinating cross-functional teams and evolving workflows, they share practical insights from the first cycle of implementation. Tune in to learn what’s working, what’s challenging, and how health systems are adapting in real time.

 

Guest speaker:  

Jennifer Tussey, PharmD, CSP, AAHIVP

Senior Specialty Pharmacy Manager

Specialty, Oncology, Mail Order

BJC Health East Region

 

Host:  

Carolyn Liptak, MBA, BS Pharm

Pharmacy Executive Director, Regulatory Compliance

Vizient Center for Pharmacy Practice Excellence

 

Show Notes:

00:05 — Introduction

• Announcer welcomes listeners to VerifiedRx, produced by the Vizient Center for Pharmacy Practice Excellence.

00:14 — Episode Overview

• Host Carolyn Liptak introduces the topic: early experiences with the
  Medicare Drug Price Negotiation Program (MDPNP) and the Medicare Transaction Facilitator (MTF).
• Discussion focuses on:
  • Implementation planning
  • Early operational challenges
  • Payment and data flow issues
  • Lessons learned from initial rollout
• Guest: Dr. Jennifer Tussey, Senior Specialty Pharmacy Manager at BJC Health.

00:14 — Key Program Definitions

• Medicare Drug Price Negotiation Program (MDPNP):
  • Created under the Inflation Reduction Act (2022)
  • Allows CMS to negotiate prices for select high-cost drugs without generic/biosimilar competition
  • Establishes a Maximum Fair Price (MFP)
• Medicare Transaction Facilitator (MTF):
  • Operational system supporting:
    • Data exchange
    • Payment processing
    • Coordination between CMS, manufacturers, and dispensers
  • Ensures Part D beneficiaries receive negotiated pricing

02:00 — Health System Context

• Jennifer oversees specialty, oncology, and mail-order pharmacy operations within BJC Health’s east region.
• Approximately 12 pharmacies impacted by MTF processes.

02:27 — Implementation Strategy

• Initial steps:
  • Participation in CMS webinars
  • Formation of a multidisciplinary team
• Key roles involved:
  • Pharmacy leadership
  • Data analyst
  • Business manager
  • Reconciliation technician
  • Revenue cycle team
• Responsibilities include:
  • Tracking claims and payment status
  • Managing 340B eligibility
  • Reconciling payments across multiple systems (MTF, Beacon, internal systems)

03:54 — Enrollment Experience

• Enrollment process was relatively straightforward:
  • Entity signatures
  • System setup for remittance processing
• Complexity increased post-enrollment due to:
  • Data fragmentation across systems
  • Limited access for revenue cycle teams
• Required strong coordination across departments.

05:09 — Data & Payment Flow Challenges

• Data flow remains slow but improving.
• Current timeline:
  • ~19 days for payment finalization
  • Up to 45 days for resolution if inquiries are required
• Early collection rates:
  • Initially ~10%
  • Improved to ~60%

05:09 — Operational Workflow Adjustments

• Monitoring cadence evolved:
  • From daily tracking → now biweekly review cycles
• Teams review claims approximately 45 days in arrears.

06:02 — Inquiry & Tracking Challenges

• System limitations:
  • Inquiry submissions may not be saved reliably
  • Lack of built-in tracking tools
• Requires manual documentation and tracking to monitor claim status and follow-ups.

06:18 — Managing Payment Inconsistencies

• Payment discrepancies handled through inquiry process.
• Key challenges:
  • Delayed initiation (must wait for processing window)
  • Extended resolution timelines (up to 45 days)
• Requires proactive and continuous follow-up.

06:53 — Financial & Resource Challenges

• Low reimbursement margins under standard refund amounts.
• Even large systems with wholesale discounts experience tight margins.
• Significant FTE investment required to manage the process.
• Smaller systems may face:
  • Greater operational burden
  • Limited staffing capacity

07:33 — Operational Evolution

• Processes are continuously evolving.
• Key success factors:
  • Ongoing process refinement
  • Strong internal documentation
  • Rapid incorporation of lessons learned
• Example:
  • Identifying system issues with inquiry tracking and adjusting workflows accordingly

08:14 — Key Advice: Patience & Persistence

• Success requires:
  • Patience with slow-moving processes
  • Meticulous follow-up
  • Strong tracking systems (e.g., Excel-based workflows)
• High claim volume (500+ scripts at a time) necessitates structured tracking tools.

09:07 — Additional Financial Considerations

• Low net margins combined with high operational workload.
• Challenges amplified for:
  • Smaller pharmacies
  • Systems with fewer resources
• Emphasizes importance of operational efficiency and resource planning.

09:36 — Final Takeaways

• MTF implementation is:
  • Complex
  • Resource-intensive
  • Still evolving
• Key themes:
  • Strong cross-functional collaboration is essential
  • Processes will require ongoing refinement
  • Financial sustainability remains a concern

09:46 — Closing

• Carolyn thanks Jennifer for sharing insights and real-world experience.
• Reminder to subscribe, provide feedback, and stay engaged with VerifiedRx content.

 

Links | Resources: 

Medicare Drug Price Negotiation Program: Click Here

Medicare Transaction Facilitator General Resources: Click Here

Pharmacy and Dispensing Entity Resources: Click Here

 

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