Top Large Pharma Manufacturer was looking to build a custom platform to provide capabilities to evaluate service fees paid to purchasing entities across commercialchannels to determine if service fees are bona fide and payments are made within fair market value (FMV) ensuring compliance with the Centers for Medicare &Medicaid Services (CMS) outlined criteria, resulting in accurate and compliant Government Pricing calculations.
- The company had a process and models in place to assess Bona Fide Service Fees and Fair Market Value for complex agreements across the following channels:
- Patient Services (Co-Pay Agreements)
- Managed Care Service / Admin Fees
- GPO / Wholesaler Agreements
- The process was highly manual and with data and documents residing in several locations.
- Due to the need for historical documents and data, the new platform would need to support relatively high storage requirements
- Due to the nature of the data and documents, a solution that could ensure data integrity and security was needed
- The stakeholders spanned across multiple teams (Contracting, Governance, Finance, etc.) with differing needs between the groups
- Custom solution on a Marbls hosted Salesforce org, isolated from other company data for Bona Fide Service Fee / Fair Market Value requests for new and amended service agreements to adhere to Government Compliance
- Flexibility in solution supports new FMV models without the need for system changes
- Central repository for historical and ongoing FMV assessments conducted by the business over the previous years
- Streamlined and repeatable process to reduce the time and effort required to conduct assessments and facilitated enhanced linkage of ongoing amendments to exiting agreements
- Formalized approval process and enhanced reporting capabilities to allow teams to easily pull assessment metrics ad-hoc and enhance auditability
- Reviewed existing fair market value models and walked through the current contract assessment process
- Conducted workshop sessions with relevant business teams to determine business and technical requirements, finalize scope, and develop budget estimates and timelines to build out a custom solution on the Salesforce platform
- Conducted sprint cycles to build out the requirements and demo each portion of the assessment process for regular iterative reviews and acceptance by the business teams
- Organized System Integration Test (SIT) and User Acceptance Testing (UAT) of the newly created platform to ensure the system met the documented requirements
- Conducted trainings and knowledge transfer sessions to allow the manufacturer to manage the application as the system admin moving forward