Medicare Prescription Drug Price Negotiation Act of 2011

H.R. 1406, Fairness to Pet Owners Act of 2011 H.R. 2248, Medicare Prescription Drug Price Negotiation Act of 2011 S. 1099, Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2011 H.R. 436, Health Care Cost Reduction Act of 2012 S. 1855, Pandemic All-hazards Preparedness Act

Client expense: $440,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Defense, Dept of (DOD), Drug Enforcement Administration (DEA), Federal Reserve System, Food & Drug Administration (FDA), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Internal Revenue Service (IRS), Justice, Dept of (DOJ), SENATE

H.R. 675, Strengthening Medicare Anti-Fraud Measures Act of 2011 (Herger). H.R. 999, Medicare Prescription Drug Savings and Choice Act (Schakowsky) - Medicare Part D changes. H.R. 1063, Strengthening Medicare And Repaying Taxpayers Act (Murphy) - Medicare secondary payer rules. H.R. 1357, Puerto Rico Medicare Part B Equity Act (Pierluisi). H.R. 1580, Medicare Beneficiary Preservation of Choice Act (Gonzalez) - Medicare Advantage enrollment periods. H.R. 2190, Medicare Drug Savings Act (Waxman) - rebates for dual eligibles. H.R. 2248, Medicare Prescription Drug Price Negotiation Act (Welch) - Part D price negotiation. H.R. 2770, Medicare Cost Contract Extension Act (Paulsen) - extension of Medicare cost plans. H.R. 3399, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Roskam/Carney). H.R. 3519 (Towns) - exempting Medicare from sequestration. H.R. 3691, Senior Medicare Fairness Act (Paulsen) - frailty adjuster for certain MA SNPs. H.R. 4254, Medicare Advantage Program Integrity Act (Stark) - MA payment changes. H.R. 5872, Sequestration Transparency Act (Hensarling). H.R. 5979, Medicaid Accountability and Care Act (Cassidy) -- federal financing of state Medicaid programs. H.R. 6232, Medicare Better Health Rewards Program Act (Paulsen) - incentives for wellness and prevention. H.R. 6300, Medicaid Long-Term Care Reform Act (Boustany) - LTC and Medicaid issues. S. 31, Prescription Drug and Health Improvement Act (Franken) - Part D price negotiation. S. 44, Medicare Prescription Drug Price Negotiation Act (Klobuchar) - Part D price negotiation. S. 560, Medicare Prescription Drug Savings and Choice Act (Durbin) - Medicare Part D changes. S. 1206, Medicare Drug Savings Act (Rockefeller) - rebates for dual eligibles. S. 1251, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Coburn/Carper). S. 1479, Medicare Beneficiary Preservation of Choice Act (Casey) - Medicare Advantage enrollment periods. S. 1497, Medicare Cost Contract Extension Act (Klobuchar) - extension of Medicare cost plans. S. 1999, Senior Medicare Fairness Act (Klobuchar) - frailty adjuster for certain MA SNPs. S. 2196, Congressional Health Care for Seniors Act (Paul) - reforms affecting Medicare and Medigap. S. 2243, Medicare Better Health Rewards Program Act (Wyden-Portman) - incentives for wellness and prevention.

HR 891 and S 274 - legislation that would expand the existing medication therapy management program in Medicare Part D; S 31 and S 44 and HR 2248 and HR 3638 - legislation that would require or allow the federal government to negotiate prescription drug prices on behalf of Medicare Part D plan sponsors; HR 999 and S 560 - legislation that would establish a nationwide Part D plan administered by the federal government; HR 1055 - legislation that would allow Part D plan sponsors to offer "off-label" coverage HR 2190 and S 1206 - legislation that would require prescription drug manufacturers to pay Medicaid "best price" rebates for covered prescription drugs purchased by dual eligibles under Medicare Part D; HR 3613 - legislation that would require Medicare Part D plans to establish an exceptions process for patient cost-sharing amounts; HR 4215 - legislation that would establish audit requirements and other transparency requirements for Medicare part D plan sponsors; HR 6392 - legislation that would allow the federal government to negotiate prescription drug prices on behalf of Medicare Part D plan sponsors; Worked on proposed legislative language, work which included consultation with Senate committee staff, that would amend the current prompt payment rules in Medicare Part D in the interest of preventing fraud.

Client expense: $170,000 · Firm income: Not reported

H.R. 1406, Fairness to Pet Owners Act of 2011 H.R. 2248, Medicare Prescription Drug Price Negotiation Act of 2011 S. 1099, Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2011 H.R. 436, Health Care Cost Reduction Act of 2012

Client expense: $440,000 · Firm income: Not reported

Health reform proposals that impact Medicare Part D such as formulary requirements, PBM disclosure provisions, closing of the Part D coverage gap. General reg/leg Part D issues such as direct negotiation (HR 2190, HR 2248, S 1206) & MTM expansion (HR 891/S 274). Statutory implementation of changes to the definition of AMP in Medicaid. Exclusion of specialty distributors' prompt pay discounts from the definition of Average Sales Price (HR 905/S 733). Medicare audit restrictions (HR 4215)

Client expense: $423,292 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Labor, Dept of (DOL), SENATE, White House Office

H.R. 675, Strengthening Medicare Anti-Fraud Measures Act of 2011 (Herger) 16. Specific Lobbying Issues (continued): H.R. 999, Medicare Prescription Drug Savings and Choice Act (Schakowsky) Medicare Part D changes H.R. 1063, Strengthening Medicare And Repaying Taxpayers Act (Murphy) Medicare secondary payer rules H.R. 1357, Puerto Rico Medicare Part B Equity Act (Pierluisi) H.R. 1580, Medicare Beneficiary Preservation of Choice Act (Gonzalez) Medicare Advantage enrollment periods H.R. 2190, Medicare Drug Savings Act (Waxman) rebates for dual eligibles H.R. 2248, Medicare Prescription Drug Price Negotiation Act (Welch) Part D price negotiation H.R. 2770, Medicare Cost Contract Extension Act (Paulsen) extension of Medicare cost plans H.R. 3399, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Roskam/Carney) H.R. 3519 (Towns) exempting Medicare from sequestration H.R. 3691, Senior Medicare Fairness Act (Paulsen) frailty adjuster for certain MA SNPs H.R. 4254, Medicare Advantage Program Integrity Act (Stark) MA payment changes H.R. 5872, Sequestration Transparency Act (Hensarling) H.R. 5979, Medicaid Accountability and Care Act (Cassidy) -- federal financing of state Medicaid programs H.R. 6232, Medicare Better Health Rewards Program Act (Paulsen) incentives for wellness and prevention H.R. 6300, Medicaid Long-Term Care Reform Act (Boustany) LTC and Medicaid issues S. 31, Prescription Drug and Health Improvement Act (Franken) Part D price negotiation S. 44, Medicare Prescription Drug Price Negotiation Act (Klobuchar) Part D price negotiation S. 560, Medicare Prescription Drug Savings and Choice Act (Durbin) Medicare Part D changes S. 1206, Medicare Drug Savings Act (Rockefeller) rebates for dual eligibles S. 1251, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Coburn/Carper) S. 1479, Medicare Beneficiary Preservation of Choice Act (Casey) Medicare Advantage enrollment periods S. 1497, Medicare Cost Contract Extension Act (Klobuchar) extension of Medicare cost plans S. 1999, Senior Medicare Fairness Act (Klobuchar) frailty adjuster for certain MA SNPs S. 2196, Congressional Health Care for Seniors Act (Paul) reforms affecting Medicare and Medigap S. 2243, Medicare Better Health Rewards Program Act (Wyden-Portman) incentives for wellness and prevention Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, data, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); Medicare Medical Loss Ratio issues raised by initial implementation in 2014; implications of sequestration in 2013 for Medicare Advantage and Part D plans; application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; implementation of MA and Part D changes made in the Accountable Care Act (ACA), including application of the MA Star Rating system for payment purposes starting 2012 and changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital Regulatory Issues (continued): days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; issues related to Medigap coverage; issues relating to "meaningful use" requirements for health information technology; and other issues relating to health care reform implementation.

Discussions regarding Medicare Part D (H.R.2248/S. 44)

Client expense: $180,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.Con.Res. 112, House budget resolution (Ryan) Medicare, Medicaid, ACA issues H.R. 675, Strengthening Medicare Anti-Fraud Measures Act of 2011 (Herger) H.R. 999, Medicare Prescription Drug Savings and Choice Act (Schakowsky) Medicare Part D changes 16. Specific Lobbying Issues (continued): H.R. 1063, Strengthening Medicare And Repaying Taxpayers Act (Murphy) Medicare secondary payer rules H.R. 1357, Puerto Rico Medicare Part B Equity Act (Pierluisi) H.R. 1580, Medicare Beneficiary Preservation of Choice Act (Gonzalez) Medicare Advantage enrollment periods H.R. 2190, Medicare Drug Savings Act (Waxman) rebates for dual eligibles H.R. 2248, Medicare Prescription Drug Price Negotiation Act (Welch) Part D price negotiation H.R. 2770, Medicare Cost Contract Extension Act (Paulsen) extension of Medicare cost plans H.R. 3399, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Roskam/Carney) H.R. 3519 (Towns) exempting Medicare from sequestration H.R. 3691, Senior Medicare Fairness Act (Paulsen) frailty adjuster for certain MA SNPs H.R. 4254, Medicare Advantage Program Integrity Act (Stark) MA payment changes H.R. 5979, Medicaid Accountability and Care Act (Cassidy) -- federal financing of state Medicaid programs S. 31, Prescription Drug and Health Improvement Act (Franken) Part D price negotiation S. 44, Medicare Prescription Drug Price Negotiation Act (Klobuchar) Part D price negotiation S. 560, Medicare Prescription Drug Savings and Choice Act (Durbin) Medicare Part D changes S. 1206, Medicare Drug Savings Act (Rockefeller) rebates for dual eligibles S. 1251, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Coburn/Carper) S. 1479, Medicare Beneficiary Preservation of Choice Act (Casey) Medicare Advantage enrollment periods S. 1497, Medicare Cost Contract Extension Act (Klobuchar) extension of Medicare cost plans S. 1999, Senior Medicare Fairness Act (Klobuchar) frailty adjuster for certain MA SNPs S. 2196, Congressional Health Care for Seniors Act (Paul) reforms affecting Medicare and Medigap S. 2243, Medicare Better Health Rewards Program Act (Wyden-Portman) incentives for wellness and prevention Regulatory Issues: Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including; risk adjustment methodology, data, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, Part D coverage gap discount program, including employer group waiver plan (EGWP) issues, and other operational issues; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; implementation of MA and Part D changes made in the Accountable Care Act (ACA), including application of the MA Star Rating system for payment purposes starting 2012 and changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles, including the Capitated Financial Alignment Demonstration; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including Medicaid expansion, the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; issues related to Medigap coverage; and other issues relating to health care reform implementation.

H.R. 1406, Fairness to Pet Owners Act of 2011 H.R. 2248, Medicare Prescription Drug Price Negotiation Act of 2011 S. 1099, Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2011 H.R. 436, Health Care Cost Reduction Act of 2012

Client expense: $560,000 · Firm income: Not reported

HR 891 and S 274 - legislation that would expand the existing medication therapy management program in Medicare Part D; S 31 and S 44 and HR 2248 and HR 3638 - legislation that would require or allow the federal government to negotiate prescription drug prices on behalf of Medicare Part D plan sponsors; HR 999 and S 560 - legislation that would establish a nationwide Part D plan administered by the federal government; HR 1055 - legislation that would allow Part D plan sponsors to offer "off-label" coverage HR 2190 and S 1206 - legislation that would require prescription drug manufacturers to pay Medicaid "best price" rebates for covered prescription drugs purchased by dual eligibles under Medicare Part D; HR 3613 - legislation that would require Medicare Part D plans to establish an exceptions process for patient cost-sharing amounts; HR 4215 - legislation that would establish audit requirements and other transparency requirements for Medicare part D plan sponsors; Worked on proposed legislative language, work which included consultation with Senate committee staff, that would amend the current prompt payment rules in Medicare Part D in the interest of preventing fraud.

Client expense: $150,000 · Firm income: Not reported

H.Con.Res. 112, House budget resolution (Ryan) - Medicare, Medicaid, ACA issues H.R. 675, Strengthening Medicare Anti-Fraud Measures Act of 2011 (Herger) H.R. 999, Medicare Prescription Drug Savings and Choice Act (Schakowsky) - Medicare Part D changes H.R. 1063, Strengthening Medicare And Repaying Taxpayers Act (Murphy) - Medicare secondary payer rules H.R. 1357, Puerto Rico Medicare Part B Equity Act (Pierluisi) H.R. 1580, Medicare Beneficiary Preservation of Choice Act (Gonzalez) - Medicare Advantage enrollment periods H.R. 2190, Medicare Drug Savings Act (Waxman) - rebates for dual eligibles H.R. 2248, Medicare Prescription Drug Price Negotiation Act (Welch) - Part D price negotiation H.R. 2770, Medicare Cost Contract Extension Act (Paulsen) - extension of Medicare cost plans H.R. 3399, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Roskam/Carney) H.R. 3519 (Towns) - exempting Medicare from sequestration H.R. 3691, Senior Medicare Fairness Act (Paulsen) - frailty adjuster for certain MA SNPs H.R. 4254, Medicare Advantage Program Integrity Act (Stark) - MA payment changes H.R. 5979, Medicaid Accountability and Care Act (Cassidy) -- federal financing of state Medicaid programs S. 31, Prescription Drug and Health Improvement Act (Franken) - Part D price negotiation S. 44, Medicare Prescription Drug Price Negotiation Act (Klobuchar) - Part D price negotiation S. 560, Medicare Prescription Drug Savings and Choice Act (Durbin) - Medicare Part D changes S. 1206, Medicare Drug Savings Act (Rockefeller) - rebates for dual eligibles S. 1251, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Coburn/Carper) S. 1479, Medicare Beneficiary Preservation of Choice Act (Casey) - Medicare Advantage enrollment periods S. 1497, Medicare Cost Contract Extension Act (Klobuchar) - extension of Medicare cost plans S. 1999, Senior Medicare Fairness Act (Klobuchar) - frailty adjuster for certain MA SNPs S. 2196, Congressional Health Care for Seniors Act (Paul) - reforms affecting Medicare and Medigap S. 2243, Medicare Better Health Rewards Program Act (Wyden-Portman) - incentives for wellness and prevention

S 1699 - Prescription Drug Cost Reduction Act - provisions related to Medicare Part B and drug rebates HR 999 - Medicare Prescription Drug Savings and Choice Act of 2011- provisions related to Medicare Part D HR 2190 - Medicare Drug Savings Act of 2011- provisions related to Medicare Part D HR 2248 - Medicare Prescription Drug Price Negotiation Act of 2011- provision related to Medicare Part D HR 3765 - Temporary Payroll Tax Cut Continuation Act of 2011- provisions related to Medicare S 31 - Prescription Drug and Health Improvement Act of 2011-provisions related to Medicare Part D S 44 - Medicare Prescription Drug Price Negotiation Act of 2011- provisions related to Medicare Part D HR 452 - Medicare Decisions Accountability Act - provisions related to the Independent Payment Advisory Board (IPAB) H.R. 5 - To improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system - provisions related to the Independent Payment Advisory Board (IPAB) S 560 - Medicare Prescription Drug Savings and Choice Act of 2011- provisions related to Medicare Part D S 668 - Health Care Bureaucrats Elimination Act - provisions related to the Independent Payment Advisory Board (IPAB) S 1206 - Medicare Prescription Drug Savings Act of 2011- provisions related to Medicare Part D S 1251 - Medicare and Medicaid FAST Act - provisions related to Part D issues H.R. 1063 - Strengthening Medicare & Repaying Taxpayers Act of 2011 - provisions relating to reform of Secondary Payer rules S 365 - Budget Control Act of 2011 - provisions related to deficit reduction through Medicare and Medicaid

Client expense: $1,440,000 · Firm income: Not reported

*Part D price negotiation - S 31, Prescription Drug and Health Improvement Act of 2011; S 44, Medicare Prescription Drug Price Negotiation Act of 2011; HR 2248, Medicare Prescription Drug Price Negotiation Act of 2011. *Medicare Part D changes - HR 999, Medicare Prescription Drug Savings and Choice Act of 2011; S 560, Medicare Prescription Drug Savings and Choice Act of 2011. *Medicare secondary payer rules - HR 1063, Strengthening Medicare And Repaying Taxpayers Act of 2011. *Medicare Advantage enrollment periods - HR 1580, Medicare Beneficiary Preservation of Choice Act of 2011; S 1479, Medicare Beneficiary Preservation of Choice Act of 2011. *Rebates for dual eligibles - HR 2190, Medicare Drug Savings Act of 2011; S 1206, Medicare Drug Savings Act of 2011. *Strengthening Medicare anti-fraud measures - HR 675, Strengthening Medicare Anti-Fraud Measures Act of 2011. *Extension of Medicare cost plans - HR 2770, Medicare Cost Contract Extension Act of 2011; S 1497, Medicare Cost Contract Extension Act of 2011. *Medicare and Medicaid fraud and abuse - S 1251, Medicare and Medicaid FAST Act. *Frailty adjuster for certain MA SNPs - HR 3691, Senior Medicare Fairness Act of 2011; S 1999, Senior Medicare Fairness Act. *MA payment changes - HR 4254, Medicare Advantage Program Integrity Act of 2012. *Reforms affecting Medicare and Medigap - S 2196, Congressional Health Care for Seniors Act of 2012. *Incentives for wellness and prevention - S 2243, Medicare Better Health Rewards Program Act of 2012. *Puerto Rico Medicare Part B - HR 1357, Puerto Rico Medicare Part B Equity Act of 2011. *Medicare and Medicaid - HR 3399, Medicare and Medicaid FAST Act. *Exempting Medicare from sequestration - HR 3519, To amend to exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011. *Medicare, Medicaid, ACA issues - HConRes 112, Establishing the budget for the United States Government for fiscal year 2013 and setting forth appropriate budgetary levels for fiscal years 2014 through 2022. *Federal financing of State Medicaid programs - HR 5979, Medicaid Accountability and Care Act of 2012.

Health reform proposals that impact Medicare Part D such as formulary requirements, PBM disclosure provisions, closing of the Part D coverage gap. General reg/leg Part D issues such as direct negotiation (HR 2190, HR 2248, S 1206) & MTM expansion (HR 891/S 274). Statutory implementation of changes to the definition of AMP in Medicaid. Exclusion of specialty distributors' prompt pay discounts from the definition of Average Sales Price (HR 905/S 733). Medicare audit restrictions (HR 4215)

Client expense: $470,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Labor, Dept of (DOL), SENATE, White House Office

Health reform proposals that impact Medicare Part D such as formulary requirements, PBM disclosure provisions, closing of the Part D coverage gap. General reg/leg Part D issues such as direct negotiation (HR 2190, HR 2248, S 1206) & MTM expansion (HR 891/S 274). Statutory implementation of changes to the definition of AMP in Medicaid. Exclusion of specialty distributors' prompt pay discounts from the definition of Average Sales Price (HR 905/S 733). Medicare audit restrictions (HR 4215)

Client expense: $370,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Defense, Dept of (DOD), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Labor, Dept of (DOL), SENATE, U.S. Trade Representative (USTR), White House Office

Discussions regarding Medicare Part D (H.R.2248/S. 44)

Client expense: $150,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Sustainable growth rate and impact on other Medicare programs, Medicare physician payment, budget offsets - HR 3630, Middle Class Tax Relief and Job Creation Act of 2012. Impact of House budget resolution on Medicare provisions - H Con Res 112, Establishing the budget for the United States Government for fiscal year 2013 and setting forth appropriate budgetary levels for fiscal years 2014 through 2022. *Part D price negotiation - S 31, Prescription Drug and Health Improvement Act of 2011; S 44, Medicare Prescription Drug Price Negotiation Act of 2011; HR 2248, Medicare Prescription Drug Price Negotiation Act of 2011. *Medicare Part D changes - HR 999, Medicare Prescription Drug Savings and Choice Act of 2011; S 560, Medicare Prescription Drug Savings and Choice Act of 2011. *Medicare secondary payer rules - HR 1063, Strengthening Medicare And Repaying Taxpayers Act of 2011. *Medicare Advantage enrollment periods - HR 1580, Medicare Beneficiary Preservation of Choice Act of 2011; S 1479, Medicare Beneficiary Preservation of Choice Act of 2011. *Rebates for dual eligibles - HR 2190, Medicare Drug Savings Act of 2011; S 1206, Medicare Drug Savings Act of 2011. *Strengthening Medicare anti-fraud measures - HR 675, Strengthening Medicare Anti-Fraud Measures Act of 2011. *Extension of Medicare cost plans - HR 2770, Medicare Cost Contract Extension Act of 2011; S 1497, Medicare Cost Contract Extension Act of 2011. *Medicare and Medicaid fraud and abuse - S 1251, Medicare and Medicaid FAST Act. *Budget offsets - S 1944, Middle Class Tax Cut Act of 2011; S 1931, Temporary Tax Holiday and Government Reduction Act. *Frailty adjuster for certain MA SNPs - HR 3691, Senior Medicare Fairness Act of 2011; S 1999, Senior Medicare Fairness Act. *Medicare physician payment, extension of QI and TMA programs, budget offsets - HR 3765, Temporary Payroll Tax Cut Continuation Act of 2011. *MA payment changes - HR 4254, Medicare Advantage Program Integrity Act of 2012. *Reforms affecting Medicare and Medigap - S 2196, Congressional Health Care for Seniors Act of 2012. *Incentives for wellness and prevention - S 2243, Medicare Better Health Rewards Program Act of 2012. *Puerto Rico Medicare Part B - HR 1357, Puerto Rico Medicare Part B Equity Act of 2011. *Medicare and Medicaid - HR 3399, Medicare and Medicaid FAST Act. *Exempting Medicare from sequestration - HR 3519, To amend to exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011.

H.Con.Res. 112, House budget resolution (Ryan) - Medicare, Medicaid, ACA issues. H.R. 675, Strengthening Medicare Anti-Fraud Measures Act of 2011 (Herger). H.R. 1063, Strengthening Medicare And Repaying Taxpayers Act (Murphy) - Medicare secondary payer rules. H.R. 1580, Medicare Beneficiary Preservation of Choice Act (Gonzalez) - Medicare Advantage enrollment periods. H.R. 2190, Medicare Drug Savings Act (Waxman) - rebates for dual eligibles. H.R. 2248, Medicare Prescription Drug Price Negotiation Act (Welch) - Part D price negotiation. H.R. 2770, Medicare Cost Contract Extension Act (Paulsen) - extension of Medicare cost plans. H.R. 3399, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Roskam/Carney). H.R. 3519 (Towns) - exempting Medicare from sequestration. H.R. 3630, Temporary Payroll Tax Cut Continuation Act (Camp) - Medicare physician payment, extension of QI and TMA programs, budget offsets. H.R. 3691, Senior Medicare Fairness Act (Paulsen) - frailty adjuster for certain MA SNPs. H.R. 3765, Temporary Payroll Tax Cut Continuation Act (Camp) - Medicare physician payment, extension of QI and TMA programs, budget offsets.H.R. 4254, Medicare Advantage Program Integrity Act (Stark) - MA payment changes. S. 31, Prescription Drug and Health Improvement Act (Franken) - Part D price negotiation. S. 44, Medicare Prescription Drug Price Negotiation Act (Klobuchar) - Part D price negotiation. S. 560, Medicare Prescription Drug Savings and Choice Act (Durbin) - Medicare Part D changes. S. 1206, Medicare Drug Savings Act (Rockefeller) - rebates for dual eligibles. S. 1251, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Coburn/Carper). S. 1479, Medicare Beneficiary Preservation of Choice Act (Casey) - Medicare Advantage enrollment periods S. 1497, Medicare Cost Contract Extension Act (Klobuchar) - extension of Medicare cost plans. S. 1931, Temporary Tax Holiday and Government Reduction Act (Heller) -budget offsets. S. 1944, Middle Class Tax Cut Act (Casey) - budget offsets. S. 1999, Senior Medicare Fairness Act (Klobuchar) - frailty adjuster for certain MA SNPs. S. 2196, Congressional Health Care for Seniors Act (Paul) - reforms affecting Medicare and Medigap. S. 2243, Medicare Better Health Rewards Program Act (Wyden-Portman) - incentives for wellness and prevention.

S 1699 - Prescription Drug Cost Reduction Act - provisions related to Medicare Part B and drug rebates HR 999 - Medicare Prescription Drug Savings and Choice Act of 2011- provisions related to Medicare Part D HR 2190 - Medicare Drug Savings Act of 2011- provisions related to Medicare Part D HR 2248 - Medicare Prescription Drug Price Negotiation Act of 2011- provision related to Medicare Part D HR 3765 - Temporary Payroll Tax Cut Continuation Act of 2011- provisions related to Medicare S 31 - Prescription Drug and Health Improvement Act of 2011-provisions related to Medicare Part D S 44 - Medicare Prescription Drug Price Negotiation Act of 2011- provisions related to Medicare Part D HR 452 - Medicare Decisions Accountability Act - provisions related to the Independent Payment Advisory Board (IPAB) H.R. 5 - To improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system - provisions related to the Independent Payment Advisory Board (IPAB) S 560 - Medicare Prescription Drug Savings and Choice Act of 2011- provisions related to Medicare Part D S 668 - Health Care Bureaucrats Elimination Act - provisions related to the Independent Payment Advisory Board (IPAB) S 1206 - Medicare Prescription Drug Savings Act of 2011- provisions related to Medicare Part D S 1251 - Medicare and Medicaid FAST Act - provisions related to Part D issues H.R. 1063 - Strengthening Medicare & Repaying Taxpayers Act of 2011 - provisions relating to reform of Secondary Payer rules S 365 - Budget Control Act of 2011 - provisions related to deficit reduction through Medicare and Medicaid

Client expense: $2,120,000 · Firm income: Not reported

H.R.1406, Fairness to Pet Owners Act of 2011 H.R.2248, Medicare Prescription Drug Price Negotiation Act of 2011 S.1099, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011

Client expense: $560,000 · Firm income: Not reported

HR 891 and S 274 - legislation that would expand the existing medication therapy management program in Medicare Part D S 31 and S 44 and HR 2248 and HR 3638 - legislation that would require or allow the federal government to negotiate prescription drug prices on behalf of Medicare Part D plan sponsors HR 999 and S 560 - legislation that would establish a nationwide Part D plan administered by the federal government HR 1055 - legislation that would allow Part D plan sponsors to offer "off-label" coverage of medications HR 2190 and S 1206 - legislation that would require prescription drug manufacturers to pay Medicaid "best price" rebates for covered prescription drugs purchased by dual eligibles under Medicare Part D HR 3613 - legislation that would require Medicare Part D plans to establish an exceptions process for patient cost-sharing amounts. HR 4215 - legislation that would establish audit requirements and other transparency requirements for Medicare Part D plan sponsors. Worked on proposed legislative language, work which included consultation with Senate committee staff, that would amend the current prompt payment rules in Medicare Part D in the interest of preventing fraud.

Client expense: $190,000 · Firm income: Not reported

HR 3590, S. 1790, HR 4872 (as enacted into PL 111-148 and PL 111-152) - issues related to Medicare and Medicaid reform, including issues related to Medicare Part D Coverage Gap Program HR 3590, S. 1790, HR 4872 (as enacted into PL 111-148 and PL 111-152) - issues related to Medicare and Medicaid reform, including issues related to Medicaid price reporting, rebate calculation, and expansion of eligible utilizationS. 1251 - issues related to Medicare fraud and abuse laws HR 2190, S. 1206 - issues related to Medicare Part D rebates HR 3590, S. 1790, HR 4872 (as enacted into PL 111-148 and PL 111-152) - issues related to health care reform legislation and implementation, including the newly-created Independent Payment Advisory Board HR 3590, S. 1790, HR 4872 (as enacted into PL 111-148 and PL 111-152), HR 2248 - issues related to health care reform legislation and implementation, including proposed changes to the Medicare Program regarding pharmaceutical rebates and price negotiation

Client expense: $680,000 · Firm income: Not reported

Impact of deficit reduction issues and actions of the Joint Committee on Deficit Reduction on Medicare and Medicare Part D - Proposed legislation re these issues. Sustainable growth rate and impact on other Medicare programs; *Medicare physician payment, extension of QI and TMA programs; *budget offsets - HR 3630, Temporary Payroll Tax Cut Continuation Act of 2011; HR 3765, Temporary Payroll Tax Cut Continuation Act of 2011. Potential changes to Medicare Advantage - Proposed legislation re this issue. *Part D price negotiation - S 31, Prescription Drug and Health Improvement Act of 2011; S 44, Medicare Prescription Drug Price Negotiation Act of 2011; HR 2248, Medicare Prescription Drug Price Negotiation Act of 2011; HR 3399, Medicare and Medicaid FAST Act; HR 3519, To amend to exempt the Medicare program from fallback sequestration under the Budget Control Act of 2011; HR 3630, Temporary Payroll Tax Cut Continuation Act of 2011; HR 3691, Senior Medicare Fairness Act of 2011; HR 3765, Temporary Payroll Tax Cut Continuation Act of 2011. *Medicare Part D changes - HR 999, Medicare Prescription Drug Savings and Choice Act of 2011; S 560, Medicare Prescription Drug Savings and Choice Act of 2011. *Medicare secondary payer rules - HR 1063, Strengthening Medicare And Repaying Taxpayers Act of 2011. *Medicare Advantage enrollment periods - HR 1580, Medicare Beneficiary Preservation of Choice Act of 2011; S 1479, Medicare Beneficiary Preservation of Choice Act of 2011; HR 1357, Puerto Rico Medicare Part B Equity Act of 2011. *Rebates for dual eligibles - HR 2190, Medicare Drug Savings Act of 2011; S 1206, Medicare Drug Savings Act of 2011. *Strengthening Medicare anti-fraud measures - HR 675, Strengthening Medicare Anti-Fraud Measures Act of 2011. *Extension of Medicare cost plans - HR 2770, Medicare Cost Contract Extension Act of 2011; S 1497, Medicare Cost Contract Extension Act of 2011. *Medicare and Medicaid fraud and abuse - S 1251, Medicare and Medicaid FAST Act. *Budget offsets - S 1944, Middle Class Tax Cut Act of 2011; S 1931, Temporary Tax Holiday and Government Reduction Act. *Frailty adjuster for certain MA SNPs - S 1999, Senior Medicare Fairness Act.

H.R. 452, Medicare Decisions Accountability Act of 2011: Provisions related to Independent Payment Advisory Board (IPAB) H.R. 675 Strengthening Medicare Anti-Fraud Measures Act of 2010: Provisions related to exclusion issues H.R. 999, Medicare Prescription Drug Savings and Choice Act of 2011: Provisions related to Part D issues H.R. 2190 Medicare Drug Savings Act of 2011: Provisions related to Part D issues H.R. 2248 Medicare Prescription Drug Price Negotiation Act of 2011: Provisions related to Part D non-interference issues H.R. 3765, Temporary Payroll Tax Cut Continuation Act of 2011: Provisions related to Medicare S. 31, Prescription Drug and Health Improvement Act of 2011: Provisions related to Part D non-interference provisions S. 44, Medicare Prescription Drug Price Negotiation Act of 2011: Provisions related to Part D issues S. 365, Budget Control Act of 2011: Deficit reduction issues related to Medicare/Medicaid S. 560, Medicare Prescription Drug Savings and Choice Act of 2011: Provisions related to Part D issues S. 668, Health Care Bureaucrats Elimination Act: Provisions related to Independent Payment Advisory Board (IPAB) S. 1206, Medicare Prescription Drug Savings Act of 2011: Provisions related to Part D issues S. 1251, Medicare and Medicaid FAST Act: Provisions related to Part D issues. S. 1699, Prescription Drug Cost Reduction Act: Provisions related to Medicare Part B and drug rebates Advocacy on Medicare/Medicaid issues being considered by the Joint Select Committee on Deficit Reduction

Client expense: $4,820,000 · Firm income: Not reported

H.R. 675, Strengthening Medicare Anti-Fraud Measures Act of 2011 (Herger), H.R. 999, Medicare Prescription Drug Savings and Choice Act (Schakowsky) Medicare Part D changes, H.R. 1063, Strengthening Medicare And Repaying Taxpayers Act (Murphy) - Medicare secondary payer rules, H.R. 1357, Puerto Rico Medicare Part B Equity Act (Pierluisi), H.R. 1580, Medicare Beneficiary Preservation of Choice Act (Gonzalez) Medicare Advantage enrollment periods, H.R. 2190, Medicare Drug Savings Act, 16. Specific Lobbying Issues (con't): (Waxman) rebates for dual eligibles, H.R. 2248, Medicare Prescription Drug Price Negotiation Act (Welch) Part D price negotiation, H.R. 2770, Medicare Cost Contract Extension Act (Paulsen) extension of Medicare cost plans, H.R. 3399, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Roskam/Carney), H.R. 3519 (Towns) exempting Medicare from sequestration, H.R. 3630, Temporary Payroll Tax Cut Continuation Act (Camp) Medicare physician payment, extension of QI and TMA programs, budget offsets, H.R. 3691, Senior Medicare Fairness Act (Paulsen) frailty adjuster for certain MA SNPs, H.R. 3765, Temporary Payroll Tax Cut Continuation Act (Camp) Medicare physician payment, extension of QI and TMA programs, budget offsets, S. 31, Prescription Drug and Health Improvement Act (Franken) Part D price negotiation, S. 44, Medicare Prescription Drug Price Negotiation Act (Klobuchar) Part D price negotiation, S. 560, Medicare Prescription Drug Savings and Choice Act (Durbin) Medicare Part D changes, S. 1206, Medicare Drug Savings Act (Rockefeller) rebates for dual eligibles, S. 1251, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Coburn/Carper), S. 1479, Medicare Beneficiary Preservation of Choice Act (Casey) Medicare Advantage enrollment periods, S. 1497, Medicare Cost Contract Extension Act (Klobuchar) extension of Medicare cost plans, S. 1931, Temporary Tax Holiday and Government Reduction Act (Heller) budget offsets, S. 1944, Middle Class Tax Cut Act (Casey) budget offsets, S. 1999, Senior Medicare Fairness Act (Klobuchar) frailty adjuster for certain MA SNPs MMM (Regulatory Issues): Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including; risk adjustment methodology, data, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, and other operational issues; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; implementation of MA and Part D changes made in the Accountable Care Act (ACA), including application of the MA Star Rating system for payment purposes starting 2012 and changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; issues related to data warehouses including the Office of Personnel Management and Office of the Inspector General proposals related to the Federal Employee Health Benefits Program and all-payer comparative effectiveness research and health information technology standards and policies.

H.R.1406, Fairness to Pet Owners Act of 2011 H.R.2248, Medicare Prescription Drug Price Negotiation Act of 2011 S.1099, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011

Client expense: $380,000 · Firm income: Not reported

Health reform proposals that impact Medicare Part D such as formulary requirements, PBM disclosure provisions, closing of the Part D coverage gap. General reg/leg Part D issues such as direct negotiation (HR 2190, HR 2248, S 1206) & MTM expansion (HR 891/S 274). Statutory implementation of changes to the definition of AMP in Medicaid. Exclusion of specialty distributors' prompt pay discounts from the definition of Average Sales Price (HR 905/S 733). Policy considerations of the Jt. Comm on Deficit Reduct

Client expense: $370,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Defense, Dept of (DOD), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Labor, Dept of (DOL), SENATE, U.S. Trade Representative (USTR), White House Office

Health reform proposals that impact Medicare Part D such as formulary requirements, PBM disclosure provisions, closing of the Part D coverage gap. General reg/leg Part D issues such as direct negotiation (HR 2190, HR 2248, S 1206) & MTM expansion (HR 891/S 274). Statutory implementation of changes to the definition of AMP in Medicaid. Exclusion of specialty distributors' prompt pay discounts from the definition of Average Sales Price (HR 905/S 733). Policy considerations of the Jt. Comm on Deficit Reduct

Client expense: $370,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Defense, Dept of (DOD), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Labor, Dept of (DOL), SENATE, U.S. Trade Representative (USTR), White House Office

H.R. 999, Medicare Prescription Drug Savings and Choice Act (Schakowsky) Medicare Part D changes (cont.) H.R. 1063, Strengthening Medicare And Repaying Taxpayers Act (Murphy) Medicare secondary payer rules; H.R. 1580, Medicare Beneficiary Preservation of Choice Act (Gonzalez) Medicare Advantage enrollment periods; H.R. 2248, Medicare Prescription Drug Price Negotiation Act (Welch) Part D price negotiation; S. 31, Prescription Drug and Health Improvement Act (Franken) Part D price negotiation; S. 44, Medicare Prescription Drug Price Negotiation Act (Klobuchar) Part D price negotiation; S. 560, Medicare Prescription Drug Savings and Choice Act (Durbin) Medicare Part D changes; H.R. 675 Strengthening Medicare Anti-Fraud Measures Act of 2011 (Herger); S. 1251 Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Medicare and Medicaid FAST Act) (Coburn/Carper). MMM (Regulatory Issues): Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, data, and audit issues, bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits), application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff, measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training, and Medicare/Medicaid integration and contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education program; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues, MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; implementation of MA and Part D changes made in the Accountable Care Act (ACA), including application of the MA STAR system for payment purposes starting 2012 and changes to the Part D coverage gap; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; issues related to data warehouses including the Office of Personnel Management and Office of the Inspector General proposals related to the Federal Employee Health Benefits Program and all-payer comparative effectiveness research and health information technology standards and policies. Durham (con't): the Assistant Secretary for Planning and Evaluation, Washington, DC, 2001-2005: Acting Deputy Assistant Secretary for Health Policy (8/034/04 and 1/054/05); Deputy to the Deputy Assistant Secretary for Health Policy (7/02 4/05); Senior Advisor for Health Policy (12/01-7/02). SOCIAL SECURITY ADMINISTRATION (SSA), Washington, DC, 1998-2001: Acting Associate Commissioner for Retirement Policy (9/00-12/01); Deputy Associate Commissioner for Retirement Policy (7/98-12/01); OFFICE OF MANAGEMENT AND BUDGET, Washington, DC, 1987-1989: Policy Analyst, Health and Income Maintenance Division. Thornton (con't): OF MANAGEMENT AND BUDGET, WASHINGTON DC, JANUARY 2002 TO MAY 2006; PRESIDENTIAL MANAGEMENT FELLOW, SOCIAL SECURITY ADMINISTRATION, BALTIMORE, MD, JANUARY 2000 TO JANUARY 2002.

H.R. 999, Medicare Prescription Drug Savings and Choice Act (Schakowsky) Medicare Part D changes H.R. 1063, Strengthening Medicare And Repaying Taxpayers Act (Murphy) Medicare secondary payer rules H.R. 1580, Medicare Beneficiary Preservation of Choice Act (Gonzalez) Medicare Advantage enrollment periods H.R. 2190, Medicare Drug Savings Act (Waxman) rebates for dual eligibles H.R. 2248, Medicare Prescription Drug Price Negotiation Act (Welch) Part D price negotiation S. 31, Prescription Drug and Health Improvement Act (Franken) Part D price negotiation S. 44, Medicare Prescription Drug Price Negotiation Act (Klobuchar) Part D price negotiation S. 560, Medicare Prescription Drug Savings and Choice Act (Durbin) Medicare Part D changes H.R. 675, Strengthening Medicare Anti-Fraud Measures Act of 2011 (Herger) H.R. 2770, Medicare Cost Contract Extension Act (Paulsen) extension of Medicare cost plans S. 1206, Medicare Drug Savings Act (Rockefeller) rebates for dual eligibles S. 1251, Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Coburn/Carper) S. 1479, Medicare Beneficiary Preservation of Choice Act (Casey) Medicare Advantage enrollment periods S. 1497, Medicare Cost Contract Extension Act (Klobuchar) extension of Medicare cost plans HR 1357, Puerto Rico Medicare Part B Equity Act of 2011 (Pierluisi) MMM (Regulatory Issues): Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including; risk adjustment methodology, data, and audit issues; bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits); application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff; measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training; contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, and other operational issues; MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; implementation of MA and Part D changes made in the Accountable Care Act (ACA), including application of the MA Star Rating system for payment purposes starting 2012 and changes to the Part D coverage gap; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education Program; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; Medicare/Medicaid integration for dual eligibles; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; issues related to data warehouses including the Office of Personnel Management and Office of the Inspector General proposals related to the Federal Employee Health Benefits Program and all-payer comparative effectiveness research and health information technology standards and policies.

Monitor debt limit, deficit reduction issues, and actions of the Joint Committee on Deficit Reduction on Medicare and Medicare Part D - S 365, Budget Control Act of 2011; S 627, Budget Control Act of 2011; proposed legislation on these issues. *Part D price negotiation - S 31, Prescription Drug and Health Improvement Act of 2011; S 44, Medicare Prescription Drug Price Negotiation Act of 2011; HR 2248, Medicare Prescription Drug Price Negotiation Act of 2011. *Medicare Part D changes - HR 999, Medicare Prescription Drug Savings and Choice Act of 2011; S 560, Medicare Prescription Drug Savings and Choice Act of 2011. *Medicare secondary payer rules - HR 1063, Strengthening Medicare And Repaying Taxpayers Act of 2011. *Medicare Advantage enrollment periods - HR 1580, Medicare Beneficiary Preservation of Choice Act of 2011; S 1479, Medicare Beneficiary Preservation of Choice Act of 2011. *Rebates for dual eligibles - HR 2190, Medicare Drug Savings Act of 2011; S 1206, Medicare Drug Savings Act of 2011. *Strengthening Medicare anti-fraud measures - HR 675, Strengthening Medicare Anti-Fraud Measures Act of 2011. *Extension of Medicare cost plans - HR 2770, Medicare Cost Contract Extension Act of 2011; S 1497, Medicare Cost Contract Extension Act of 2011. *Medicare and Medicaid fraud and abuse - S 1251, Medicare and Medicaid FAST Act .

Client expense: Not reported · Firm income: $100,000

H.R. 452, Medicare Decisions Accountability Act of 2011: Provisions related to Independent Payment Advisory Board (IPAB) H.R. 675 Strengthening Medicare Anti-Fraud Measures Act of 2010: Provisions related to exclusion issues H.R. 999, Medicare Prescription Drug Savings and Choice Act of 2011: Provisions related to Part D issues H.R. 2190 Medicare Drug Savings Act of 2011: Provisions related to Part D issues H.R. 2248 Medicare Prescription Drug Price Negotiation Act of 2011: Provisions related to Part D non-interference issues S. 31, Prescription Drug and Health Improvement Act of 2011: Provisions related to Part D non-interference provisions S. 44, Medicare Prescription Drug Price Negotiation Act of 2011: Provisions related to Part D issues S. 365, Budget Control Act of 2011: Deficit reduction issues related to Medicare/Medicaid S. 454, Strengthening Program Integrity and Accountability in Health Care Act of 2011: Provisions related to exclusion issues S. 560, Medicare Prescription Drug Savings and Choice Act of 2011: Provisions related to Part D issues S. 668, Health Care Bureaucrats Elimination Act: Provisions related to Independent Payment Advisory Board (IPAB) S. 1206, Medicare Prescription Drug Savings Act of 2011: Provisions related to Part D issues S. 1251, Medicare and Medicaid FAST Act: Provisions related to Part D issues

Client expense: $4,740,000 · Firm income: Not reported

H.R.1406, Fairness to Pet Owners Act of 2011 H.R.2248, Medicare Prescription Drug Price Negotiation Act of 2011 S.1099, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011

Client expense: $440,000 · Firm income: Not reported

HR 999 Medicare Prescription Drug Savings and Choice Act of 2011- provisions related to Medicare Part D HR 2190 Medicare Drug Savings Act of 2011- provisions related to Medicare Part D HR 2248 Medicare Prescription Drug Price Negotiation Act of 2011 - provision related to Medicare Part D S 31 Prescription Drug and Health Improvement Act of 2011 - provisions related to Medicare Part D S 44 Medicare Prescription Drug Price Negotiation Act of 2011- provisions related to Medicare Part D HR 452 Medicare Decisions Accountability Act - provisions related to the Independent Payment Advisory Board (IPAB) S 365 Budget Control Act of 2011- deficit reduction issues related to Medicare and Medicaid S 560 Medicare Prescription Drug Savings and Choice Act of 2011- provisions related to Medicare Part D S 668 Health Care Bureaucrats Elimination Act - provisions related to the Independent Payment Advisory Board (IPAB) S 1206 Medicare Prescription Drug Savings Act of 2011- provisions related to Medicare Part D

Client expense: $1,765,000 · Firm income: Not reported

Health reform proposals that impact Medicare Part D such as formulary requirements, PBM disclosure provisions, closing of the Part D coverage gap. General reg/leg Part D issues such as direct negotiation (HR 2190, HR 2248, S 1206) & MTM expansion (HR 891/S 274). Statutory implementation of changes to the definition of AMP in Medicaid. Exclusion of specialty distributors' prompt pay discounts from the definition of Average Sales Price (HR 905/S 733). Policy considerations of the Jt. Comm on Deficit Reduc.

Client expense: $380,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Defense, Dept of (DOD), Executive Office of the President (EOP), Federal Trade Commission (FTC), Food & Drug Administration (FDA), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Labor, Dept of (DOL), SENATE, U.S. Trade Representative (USTR), White House Office

HR 3590, S. 1790, HR 4872 (as enacted into PL 111-148 and PL 111-152) - issues related to Medicare and Medicaid reform, including issues related to Medicare Part D Coverage Gap Program HR 3590, S. 1790, HR 4872 (as enacted into PL 111-148 and PL 111-152) - issues related to Medicare and Medicaid reform, including issues related to Medicaid price reporting, rebate calculation, and expansion of eligible utilization S. 1251 - issues related to Medicare fraud and abuse laws HR 2190, S. 1206 - issues related to Medicare Part D rebates HR 3590, S. 1790, HR 4872 (as enacted into PL 111-148 and PL 111-152) - issues related to health care reform legislation and implementation, including the newly-created Independent Payment Advisory Board HR 3590, S. 1790, HR 4872 (as enacted into PL 111-148 and PL 111-152), HR 2248 - issues related to health care reform legislation and implementation, including proposed changes to the Medicare Program regarding pharmaceutical rebates and price negotiation

Client expense: $680,000 · Firm income: Not reported

HR 3590, S. 1790, HR 4872 (as enacted into PL 111-148 and PL 111-152) - issues related to Medicare and Medicaid reform, including issues related to Medicare Part D Coverage Gap Program HR 3590, S. 1790, HR 4872 (as enacted into PL 111-148 and PL 111-152) - issues related to Medicare and Medicaid reform, including issues related to Medicaid price reporting, rebate calculation, and expansion of eligible utilization S. 1251 - issues related to Medicare fraud and abuse laws HR 2190, S. 1206 - issues related to Medicare Part D rebates HR 3590, S. 1790, HR 4872 (as enacted into PL 111-148 and PL 111-152) - issues related to health care reform legislation and implementation, including the newly-created Independent Payment Advisory Board HR 3590, S. 1790, HR 4872 (as enacted into PL 111-148 and PL 111-152), HR 2248 - issues related to health care reform legislation and implementation, including proposed changes to the Medicare Program regarding pharmaceutical rebates and price negotiation

Client expense: $680,000 · Firm income: Not reported

Impact of budget and deficit reduction proposals on Medicare and Medicare Part D - Proposed legislation on these issues. *Part D price negotiation - S 31, Prescription Drug and Health Improvement Act of 2011; S 44, Medicare Prescription Drug Price Negotiation Act of 2011; HR 2248, Medicare Prescription Drug Price Negotiation Act of 2011. *Medicare Part D changes - HR 999, Medicare Prescription Drug Savings and Choice Act of 2011; S 560, Medicare Prescription Drug Savings and Choice Act of 2011. *Medicare secondary payer rules - HR 1063, Strengthening Medicare And Repaying Taxpayers Act of 2011. *Medicare Advantage enrollment periods - HR 1580, Medicare Beneficiary Preservation of Choice Act of 2011. *Medicaid & CHIP maintenance of effort requirements - HR 1683, State Flexibility Act; S 868, State Flexibility Act. *Medicaid block grants - HR 2013, Medicaid Improvement and State Empowerment Act; S 1031, Medicaid Improvement and State Empowerment Act. *Medicare claims & payment data - S 756, Medicare Data Access for Transparency and Accountability Act.

Client expense: Not reported · Firm income: $100,000

H.R. 999, Medicare Prescription Drug Savings and Choice Act (Schakowsky) Medicare Part D changes (cont.) H.R. 1063, Strengthening Medicare And Repaying Taxpayers Act (Murphy) Medicare secondary payer rules; H.R. 1580, Medicare Beneficiary Preservation of Choice Act (Gonzalez) Medicare Advantage enrollment periods; H.R. 2248, Medicare Prescription Drug Price Negotiation Act (Welch) Part D price negotiation; S. 31, Prescription Drug and Health Improvement Act (Franken) Part D price negotiation; S. 44, Medicare Prescription Drug Price Negotiation Act (Klobuchar) Part D price negotiation; S. 560, Medicare Prescription Drug Savings and Choice Act (Durbin) Medicare Part D changes; H.R. 675 Strengthening Medicare Anti-Fraud Measures Act of 2011 (Herger); S. 1251 Medicare and Medicaid Fighting Fraud and Abuse to Save Taxpayers' Dollars Act (Medicare and Medicaid FAST Act) (Coburn/Carper). MMM (Regulatory Issues): Ongoing implementation issues for the Medicare Advantage (MA) and Medicare Part D prescription drug programs, including risk adjustment methodology, data, and audit issues, bidding and payment issues (including MA rate assumptions, MA coding intensity, MA Secondary Payer issues, Part D reinsurance, Part D low income subsidies, and audits), application process, audits to evaluate compliance with MA and Part D program rules, benefit design rules, SSA and CMS premium withhold processing issues, enrollment rules, marketing materials review and approval, marketing activities, including conduct and compensation of brokers and agents and plan sponsor marketing staff, measurement and oversight of plan performance including Special Needs Plans (SNPs); quality measures, grievance and appeals processes, fraud and abuse compliance including training, and Medicare/Medicaid integration and contracting issues for Dual Eligible Special Needs Plans (SNPs); Federal preemption of State authority under MA and Part D programs, Part D prescription drug event data reporting, Part D formulary rules, Part D pharmacy access standards, and other operational issues; Medicare creditable drug coverage reporting requirements; implementation issues for the Medicare Retiree Drug Subsidy program; functionality of the Medicare Personal Plan Finder and Drug Plan Finder; National Medicare Education program; ongoing implementation issues for the Medicare cost plan program including enrollment, marketing materials review and approval and other operational issues, MA and Part D systems issues affecting enrollment and disenrollment processing and payment and other operational issues; Medicare demonstration program on performance-based payments for physician groups; physician quality reporting initiative; issues relating to Medicare coverage policy and national coverage decisions; Medicare clinical trials; implementation of MA and Part D changes made in the Accountable Care Act (ACA), including application of the MA STAR system for payment purposes starting 2012 and changes to the Part D coverage gap; Medicaid managed care regulations and policies, including the Medicaid managed care actuarial soundness standard, quality oversight, Medicaid and CHIP Payment and Access Commission (MACPAC), grievance and appeals processes, fraud and abuse compliance, beneficiary information requirements, treatment of Medicaid health plan member hospital days in the upper payment limit calculation; policies affecting State Medicaid funding, including block grants, the calculation of the federal medical assistance (federal matching) percentage (FMAP), and intergovernmental transfers (IGTs); coordination of benefits with state Medicaid programs; Medicaid prescription drug cost issues affecting Medicaid health plans; health plan-related Childrens Health Insurance Program (CHIP) issues, including eligibility and outreach issues; implementation of Medicaid changes made in Deficit Reduction Act of 2005, including Medicaid managed care organization provider tax issues; standards for electronic prescribing; implementation of Medicaid changes of interest to Medicaid health plans made in the ACA including the managed care organization (MCO) prescription drug rebate provisions, minimum payments to primary care providers (PCPs), interactions between the Medicaid program and health insurance exchanges, and Medicaid and CHIP maintenance of effort (MOE) requirements; issues related to data warehouses including the Office of Personnel Management and Office of the Inspector General proposals related to the Federal Employee Health Benefits Program and all-payer comparative effectiveness research and health information technology standards and policies. Durham (con't): the Assistant Secretary for Planning and Evaluation, Washington, DC, 2001-2005: Acting Deputy Assistant Secretary for Health Policy (8/034/04 and 1/054/05); Deputy to the Deputy Assistant Secretary for Health Policy (7/02 4/05); Senior Advisor for Health Policy (12/01-7/02). SOCIAL SECURITY ADMINISTRATION (SSA), Washington, DC, 1998-2001: Acting Associate Commissioner for Retirement Policy (9/00-12/01); Deputy Associate Commissioner for Retirement Policy (7/98-12/01); OFFICE OF MANAGEMENT AND BUDGET, Washington, DC, 1987-1989: Policy Analyst, Health and Income Maintenance Division. Thornton (con't): OF MANAGEMENT AND BUDGET, WASHINGTON DC, JANUARY 2002 TO MAY 2006; PRESIDENTIAL MANAGEMENT FELLOW, SOCIAL SECURITY ADMINISTRATION, BALTIMORE, MD, JANUARY 2000 TO JANUARY 2002.

H.R. 452, Medicare Decisions Accountability Act of 2011: Provisions related to Independent Payment Advisory Board (IPAB) H.R. 675, Strengthening Medicare Anti-Fraud Measures Act of 2010: Provisions related to exclusion issues H.R. 999, Medicare Prescription Drug Savings and Choice Act of 2011: Provisions related to Part D issues H.R. 2190 Medicare Drug Savings Act of 2011: Provisions related to Part D issues H.R. 2248, Medicare Prescription Drug Price Negotiation Act of 2011: Provisions related to Part D non-interference issues S. 31, Prescription Drug and Health Improvement Act of 2011: Provisions related to Part D non-interference provisions S. 44, Medicare Prescription Drug Price Negotiation Act of 2011: Provisions related to Part D issues S. 454, Strengthening Program Integrity and Accountability in Health Care Act of 2011: Provisions related to exclusion issues S. 560, Medicare Prescription Drug Savings and Choice Act of 2011: Provisions related to Part D issues S. 668, Health Care Bureaucrats Elimination Act: Provisions related to Independent Payment Advisory Board (IPAB) S. 1206, Medicare Prescription Drug Savings Act of 2011: Provisions related to Part D issues

Client expense: $4,690,000 · Firm income: Not reported

H.R.989, To amend title XIX of the Social Security Act to require, at the option of a state, drug manufacturers to pay rebates to state prescription drug discount programs as a condition of participation in a rebate agreement for outpatient prescription drugs under the Medicaid programH.R.5, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011 H.R.1406, Fairness to Pet Owners Act of 2011 H.R.999, Medicare Prescription Drug Savings and Choice Act of 2011 H.R.2248, Medicare Prescription Drug Price Negotiation Act of 2011 S.1099, Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011

Client expense: $580,000 · Firm income: Not reported

Health reform proposals that impact Medicare Part D such as formulary requirements, PBM disclosure provisions, closing of the Part D coverage gap. General regulatory changes and legislative issues that impact the Part D program such as direct negotiation (HR 2190, HR 2248, S 1206) & MTM expansion (HR 891/S 274). Statutory implementation of changes to the definition of AMP in Medicaid. Exclusion of specialty distributors' prompt pay discounts from the definition of Average Sales Price (HR 905/S 733).

Client expense: $450,000 · Firm income: Not reported

Government targets: Centers For Medicare and Medicaid Services (CMS), Congressional Budget Office (CBO), Defense, Dept of (DOD), Executive Office of the President (EOP), Federal Trade Commission (FTC), Government Accountability Office (GAO), HOUSE OF REPRESENTATIVES, Health & Human Services, Dept of (HHS), Health Resources & Services Administration (HRSA), Internal Revenue Service (IRS), Labor, Dept of (DOL), SENATE, White House Office