Pro Pharma announces a cost-effective solution to your challenges in formulary design. For just pennies per member per month (PMPM) you can have total transparency in formulary design, modification, and management. No more looking up obscure or proprietary drug codes, no more reliance on third party agents for whom your organization’s interest may be secondary, no more guessing about patient access, costs, or benefits.
We have highlighted a few of the ways these Programs work for you:
• Simplify formulary design by eliminating the need to refer to obscure or proprietary drug or therapeutic codes. Formulary Solutions translates simple drug definitions into most major code types e.g. GPI, GCN, RxCui, NDC, etc. used by PBMs, Third Party Administrator (TPAs), or state agencies.
• Be as broad or specific as you want – Formulary Solutions allows you to choose components by broad therapeutic categories, or to drill down to specific forms, strengths, or even manufacturers.
• Manage your formulary by reviewing drug spend over time with integrated suggestions for drug and benefit changes that could save your budget.
• Compare drug pricing, manufacturer status, therapeutic alternatives, and more with the click of a button.
• Design step therapy regimes and define Prior Authorization/TAR requirements in one place.
• Review, modify, or add basic benefit limits including quantities, durations, dosages, age bands, per-Rx costs, etc.
• Provide organization-specific formularies to Benefit Administrators in their coding with integrated code translation – Clients can upload formularies (or design it) and have it provide a list of drugs and benefits in codes your PBM or TPA understands.
• Client-Specific customization is available
“Now Pro Pharma's Formulary Solutions and Market Share Programs allow clients to manage their formulary and track the impact of formulary decisions on drug spend. Management is now directly in your hands,” states Dr. Craig Stern, President of Pro Pharma Pharmaceutical Consultants, Inc.
Managing a formulary is time consuming and difficult even if a great deal of the process is managed by a PBM or Health Plan. Formulary updates and changes require knowledge of drugs, coding, what strengths and dosage forms are included in specific codes, identification of prior authorization criteria, quantity limits, step therapy, etc. To add further complications CMS requires NDC and RxCui codes and State Medicaid programs have additional requirements. In addition, even specialty formularies and niche formularies like ADAP for HIV/AIDS have specifications for NDC or other coding requirements.
Specifically, expensive Pharmacist time is required to review, make choices, sort through various codes and make decisions on which drugs/strengths/dosage forms are included, and ultimately to determine which updates are required. Files are produced for transmission to the Health Plan or PBM or for internal use. This requires much research, comparative analysis and time as you can see.
Pro Pharma’s Suite of Management Tools™ offers a comprehensive, transparent and reliable method to continually monitor and provide oversight of your benefits. This can be utilized for pennies PMPM to manage your benefit, manage your vendors and for budgeting purposes annually.
“Therefore, Pro Pharma has practical and useable answers to real problems and issues that can be applied in the workplace. Take charge of your formulary and remove the curtain of uncertainty!” states, Carol Stern, Chief Executive Officer of Pro Pharma Pharmaceutical Consultants, Inc.
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.
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 JCode Calculator™
Pro Pharma has developed a Standardized Injectable Fee Schedule to assist with the management of claims payments. The advantage to this product is that it bases all Injectable reimbursement on AWP, WAC and ASP cost, and can be customized for drug category discounts or multiple discounts based on drug type or specialty. It includes at least one AWP for every HCPS Code and CPT code description; NDC, brand name, generic name, strength, package size, etc. This look-up reference tool provides non-pharmacist billing and claims personnel with the information and knowledge to process and reimburse claims in a timely, efficient and cost effective manner.
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.
About Rx MAC List™ (Pharmacy Maximum Allowable Cost™)
Pro Pharma develops and maintains customized MAC Lists for clients to help manage the effects of rapid and high increase of drug prices.