News By Tag
News By Place
Pro Pharma Announces Over One Billion Dollars in Healthcare Savings
Pro Pharma Pharmaceutical Consultants, Inc., Pharmacy Benefit Experts on Managed Care and Data Analytics announced savings of over $1B in healthcare costs savings for Pro Pharma clients who utilize the Pro Pharma Suite of Management Tools™.
According to Dr. Craig Stern, President of Pro Pharma Pharmaceutical Consultants, Inc. (Pro Pharma), "it is a common business aphorism that "You need to measure ... to improve". This also applies to health care. Over the last ten (10) years health care has focused on attacking the so-called "low hanging fruit". This refers to areas where cost can be squeezed out, for example, keeping patients out of the Emergency Room, analyzing outlier providers and removing them from networks or steering patients to lower cost alternatives, tiered copays, generic substitution, etc. The result has often been a lower trend in spending. Technology has also improved such that encounter claims can be analyzed closer to payment rather than to wait for retrospective audits."
Pro Pharma has demonstrated that the above strategies have been maximized over the past twenty-six (26) years, in saving its clients well over $1B dollars. We have done this by utilizing the following methods and techniques:
• Analyses that identify opportunities with rapid cost savings corrections
• Invoice Screens™ to correct business logic that provides immediate savings
• Directed management for clients through Invoice Screens™ to identify opportunities to improve downstream cost control
• Analyses of MAC Pricing™ fees to improve savings to purchasers
• Streamline and Improve benefit rules to capture more brand/generic savings for Plans and Member copays
• Identify high-risk providers and work with them through peer-to-peer comparative measurements to decrease the variability in their prescribing
• Identify fraud, waste and abuse (FWA) potential and use the data to change behaviors of target providers
Dr. Stern goes on to say that "the end result of using measurement to target change can only be effective when it is combined with a management approach to effect the change that is desired. Data analytics is necessary, and crucial, but it is not the entire answer."
Further, according to Dr. Stern, "when all of the options are on the table, they can be prioritized. Prioritization leads to "Prescriptions for Change". "Prescriptions for Change" require action".
While no situation, program, or purchaser is exactly the same, the need for measurement, analysis and actionable results is a constant. Pro Pharma has the expertise and the experience. The results are evident and demonstrable.
"Pro Pharma has the expertise, knowledge and tools to work with your organization to achieve measurable savings and improve quality to your members with our state-of-the-
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 drusg 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;
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”.