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Pro Pharma Pharmaceutical Consultants, Inc. announced that they will be attending AMCP’s 2009 Educational Conference and Dr. Craig Stern PharmD, MBA, President of Pro Pharma and Danny R. Moriarity, Director Business Systems Continuous Improvements: Hire to Retire Peabody Energy, Corp. will present a Case Study entitled: “A Quality Initiative to Improve Physician Prescribing Practices”
The following topics will be presented:
• Key cornerstones in developing a successful multi-faceted prescriber intervention program focused on quality management.
• Detailed and specific physician and/or patient focused reports representing compelling information which influences prescriber practice patterns.
• Critical success factors for an effective Quality Management Program™.
In February 2009 PBMI (Pharmacy Benefit Management Institute) awarded the 2009 Pharmacy Benefit Innovation Award to the collaboration of the Coal/Energy Coalition and Pro Pharma for a physician intervention program that improves the quality of pharmaceutical care, while also lowering drug trend. The awards were announced at PBMI's 14th Annual Drug Benefit Conference earlier this year.
The physician intervention program, implemented by Pro Pharma for the Coal/Energy Coalition, targets prescribers in seven states that are among the highest utilizers of prescription drugs. Compelling clinical information with patient-specific opportunities to improve pharmaceutical care is a key to engaging physicians. Three-year results show improved quality leads to lower costs. In 2007, the Coalition drug trend was -3 percent compared to 8.3 percent nationally and 16 percent for the coal/energy industry.
Craig Stern, Pharm. D., stated “our Quality Management program now has over four years of history with the coal producers.” He went on to note that “for the first three years pharmacy benefit costs (including retirees) increased at a rate that was well below 2% per annum; and that while the forth year is not fully analyzed, it appears that we will show a trend for the most recent year that will be well below national averages and in the low single digits once again.” Dr. Stern also noted, “What makes our results so striking is that we are operating our program in the highest cost and highest frequency regions within the United States and upon the employed and retired population that has the highest prescription rates.”
It will be worth your while to attend this innovative presentation and share your experiences and bring questions to AMCP’s Annual Educational Conference. This will enable you to share knowledge and expertise with a wide audience of Managed Care professionals to enrich your abilities to improve quality, while controlling costs.
Case Study Session Description:
Continuing increases in pharmacy benefit cost occur even while generic use increases as a percent of total medications dispensed. Movement of office injectables from the medical benefit to the pharmacy benefit has highlighted the run-away inflation for such medications. For six member companies of the Coal/Energy Coalition, traditional interventions were not curbing escalation in costs. Exasperated with a trend that significantly exceeded the national average every year, the Coalition companies came together in 2003 to try an innovative approach to improving quality of care and managing benefit costs.
Pro Pharma implemented a program which engages physicians in improving the clinical quality of pharmaceutical care for their patients, while lowering costs. The objective is to decrease the quality gap between actual prescribing experience and national standards of care for applicable diagnosis and move the mean toward lower trends.
Four-year results show improved quality leads to lower costs. In 2008 the Coalition drug trend was 1% compared to 10.7% nationally with 16% estimated for the coal/energy industry.
About PBMI
The Pharmacy Benefit Management Institute provides research, continuing education, and Web resources that help health care benefit executive’s work effectively with their pharmacy benefit managers to improve the design and management of drug benefit programs.
About AMCP
The Academy of Managed Care Pharmacy is a national professional organization for individual pharmacists, health care practitioners (non-pharmacist) and associates who practice in managed care settings. The Academy has over 5,700 members providing comprehensive coverage to the more than 200 million Americans served by managed care.
AMCP’s mission is to empower its members to serve society by using sound medication management principles and strategies to improve health care for all.
About PRO PHARMA
PRO PHARMA (propharmaconsultants.com) is a multi-service, woman owned (WBE certified in Los Angeles, California and Pennsylvania), 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 and products 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 JCode Calculator™, Invoice Screening™, Quality Management Program™, Biotech Modeling™, and Treatment Calendar™. PRO PHARMA directly markets its products in the United States and collaborates with partners to reach international markets.
About Pro Pharma‘s Quality Management Program™ (QMP)
The QMP is a multi-faceted approach that focuses on the pharmacy benefit quality and cost from multiple directions; namely, physician prescribing decisions, member demands, pharmacy oversight and patient education, Human Resource personnel education, and messaging to member actives/retirees. The program is directed to providing patients and physicians with the necessary information and tools to make better purchasing decisions, which also 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, and puts the dollars back in the client’s pocketbook.
About JCode Calculator™
Pro Pharma has developed a Standardized Injectable Fee Schedule to assist with the management of claims payments. This product bases all Injectable reimbursement on AWP 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. Most importantly…it serves as a useful resource tool for claims payment and billing personnel.
About Treatment Calendar™
Pro Pharma has developed a management tool for physicians to effectively monitor patient compliance with national standards of care, including prophylactic vaccinations, and laboratory tests in conjunction with drug dispensing. This tool enables the physician to proactively bring patients in for examinations, and/or prescribe the necessary examinations, procedures, prophylactic measures, and laboratory tests to effectively manage patient disease states.
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carol.stern[.]propharmaconsultants.com 
