Pro Pharma Pharmaceutical Consultants, Inc., a pharmaceutical consultant organization which focuses on data analytical expertise, announced today that it has introduced NEW and IMPROVED Enhancements to the JCode Calculator™ Second Quarter 2012 Update via their secured web access for claims and billing professionals.
One of the unique features of Pro Pharma JCode Calculator™ is that the unit pricing is based on the HCPCS unit description, versus a 1 mL unit price that is commonly available from national databases. For the CPT codes, it utilizes a standard dose as the unit and is priced accordingly.
“The JCode Calculator™ database now includes over 6,500 active NDCs, with over 11.5% price changes in 2012 alone. The database contains not only injectable medications, but HIV/AIDS and oncology oral medications as well as an exhaustive list of enteral feeding products”, said Craig Stern, PharmD, MBA, President of Pro Pharma Pharmaceutical Consultants, Inc.
Dr. Craig Stern continued by saying: “New medications are being added as the pricing becomes available. Now claims and billing professionals are able to identify all JCodes for any drug within seconds. Every entry on the JCode Calculator™ has a field that allows Billing and Claims Professionals to click and see all JCodes that pertain to that drug. This is only one of numerous filters that are user friendly, and customization is available per client request.”
Data fields include, but are not limited to:
• HCPCS Code (including A, J, Q and S Codes)
• Average Wholesale Price (AWP**) by package and HCPCS defined pricing unit
• National Drug Code number (NDC)
• Average Sales Price (ASP)
• Brand Name
• Generic Name
• Package Size
• Current Procedural Code (CPC, formerly CPT) for drugs
** Other cost bases, besides AWP are also available.
Pro Pharma provides secured Web access for Clients to the Pro Pharma secured website for quarterly updates and daily access and includes the following Key Features and Benefits:
• Pricing by Drug-Specific HCPSCS-CPT Codes
• NDC Codes
• Brand and Generic Names
• AWP, WAC, & ASP + 6% Pricing
• Strength and Package Size
• Pricing Per Package & Per Unit
• Therapeutic Category
• Typical Dosage for Vaccines
• Purchase by Day/Week/Month/Quarter
• Customizable Discount Calculator
• Drug Alert Notifications
• Maximum Quantity Approvable Flags
• Check if ICD-9 Approved for Drug
• Check Historical Prices by Date or Date Range
• Brand/Generic Indicator
• Part B & D Indicator Flags
• Easy Web-based Searching
• Improved look up and History Functions
• MMA Part B vs. Part D coverage
• Differentiations between Brand & Generic Drugs
• ICD-9 codes for Approved Diagnoses Identification
• Expanded NDC lookups
• Expected Package Quantity
“The JCode Calculator™ is available on a daily, weekly, monthly and quarterly basis and can be purchased on the Pro Pharma Website. We are continuing to improve our product line by adding new futures and your input in invaluable to our mutual success. Unique USA state pricing can be added for ongoing clients as requested,” said Carol Stern, CEO of Pro Pharma. “Call or email to schedule your online Demo and free evaluation.”
About Pro Pharma Pharmaceutical Consultants, Inc.
PRO PHARMA is a multi-service, woman owned, privately held consulting firm offering a vast portfolio of services to public and private entities including self-insured employers, Taft Hartley Trusts and unions, public employers, for-profit hospitals and integrated health networks, health care insurance companies, worker's compensation insurers, small-to-medium sized HMO's, and physician groups.
As a primary service to plan sponsors for achieving below trend results, PRO PHARMA provides an integrated program of administrative process improvements, clinical quality oversight, and provider/member education.
Pro Pharma’s Consulting services are grounded in the use of data and the communication of that information to define benefit trends, drivers and other analytical indicators. PRO PHARMA markets Biotech Modeling™, Invoice Screening ™, JCode Calculator™, Quality Management Program™, Rx MAC List™, Treatment Calendar™, and Pro Pharma Suite of Tools™. The Company directly markets its products in the U.S. and collaborates with partners to reach international markets.
About Quality Management Program™ (QMP)
Pro Pharma’s Quality Management Program™ (QMP) is a multi-faceted approach that targets the pharmacy benefit cost and quality from multiple directions; namely, physician prescribing decisions, member demands, pharmacy oversight and patient education, HR rep education, and messaging to actives/retirees. The program is focused on providing patients and physicians specific tools designed to make more informed purchasing decisions that expand member co-pay dollars. The bottom line is: payers (self-insured, employers, Trusts, etc.) lower their pharmacy trend.
About Invoice Screening™
About 10% of drug spend is being paid from PBM Invoices, and should have been rejected by clients prior to payment. Pro Pharma’s Invoice Screening™ analyzes invoices against: formulary compliance, compliance with MAC pricing, eligibility, claims pricing, invalid claims, and excluded benefits, pre-payment as an Accounts Payable function. This ensures that clients only pay for valid claims, which saves time and dollars in the long run.
About Biotech Modeling™
Pro Pharma utilizes both the Medical and Pharmacy paid claims to analyze previous claims experience and to develop a model to project future trends. These issues center on the need for drug specific claims information, processing rules to ensure accurate quantities and maximum payment amounts, and rules for processing miscellaneous claims. The model can be updated with enhancements expeditiously given new Medical and Pharmacy claims experience.
Pro Pharma can identify immediate savings opportunities through re-modeling of claims processing procedures, and longer-term savings through technology assessment and utilization management. Additional research and analyses can be performed to determine the biotechnology drug driven costs in procedures, diagnostics, and provider time. It is expected that these adjunctive costs will represent an ever-larger portion of the ambulatory experience downstream
About Treatment Calendar™
Pro Pharma’s Treatment Calendar™ is a proprietary program comprised of Artificial Intelligence rule sets, which allow for quality and cost comparisons by peer-to peer, peer-to-best in class, peer to national norms, and peer to local norms.
Pro Pharma uses Clinical Protocols to analyze patient encounter data and diagnoses for required exams, tests, and medications. In this way, physician practices can schedule the applicable services for each patient and then review them for exceptions.
Treatment Calendar™ functions in the following manner as a:
• Quality tool for benchmarking
• Tool to align provider and payer incentives by focusing on actionable patient specific quality improvements
• Risk management tool to identify therapy that doesn't comply with national norms
• Tool to graphically identify gaps in compliance
About Rx MAC List™ (Pharmacy Maximum Allowable Cost™)
The Cost of Drugs is Skyrocketing. Pro Pharma develops and maintains customized MAC Lists for clients to help manage the effects of rapid and high increase of drug prices.
About Pro Pharma Suite of Tools™
Pro Pharma’s Suite of Tools identifies the cost and clinical issues for both Pharmacy and Medical, and formulates management plans and objectives to develop action plans to address “prescriptions for change.