Pro Pharma Announces Analytical Assistance for Financial and Clinical Management

The Analytical Transition Team of Pro Pharma Pharmaceutical Consultants, Inc. provides Data Analytics on an as needed basis or as part of an integrated approach to support Healthcare Professionals with decision-making for Managed Care Operations.
Oct. 29, 2013 - PRLog -- Pro Pharma Pharmaceutical Consultants, Inc., who are Pharmacy Benefit Experts on Managed Care and Data Analytics with Pharmacy Data, Medical Encounter, Lab and Workers’ Compensation Data, announce support to Clients who could benefit from analytical expertise for decision-making utilizing an integrated approach with the Suite of Management Tools™ or one-time assistance.

The Pro Pharma Analytical Transition Team will be supporting Clients who need:

- Assistance building their own Analytics internally
- A bridge for Analytics until their internal systems are in operation
- Back Office Support (Ghosting) for those Clients who require more comprehensive “just in time” support

“In addition, our Clients have asked for specific one-time Analyses that can be addressed quickly and with a minimum of resources at an affordable cost.” states Dr. Craig S. Stern, President of Pro Pharma Pharmaceutical Consultants, Inc.

Pro Pharma Analysts and Dr. Craig Stern have developed Analytical Tools to support Plan and Group Operations.  They were an outgrowth of individual Analytical projects that Pro Pharma has subsequently integrated into a “Suite of Management Tools™" that can be used by Analysts or Non-Analysts alike.  Since many clients requested these one-time Analyses, we expect that others also need this support.

Visit for details.

All Analyses are based on Client-specific Pharmacy and/or Medical Claims data and can be in any format that you have available.  Available Analyses, include, but are not limited to the following:


- Market Share Cost Accounting of Pharmacy Spend
- Custom MAC™ benchmark pricing using a checklist for choosing custom parameters
- Pharmacy Network Provider Discount Analyses
- Analyses of Top Pharmacy Providers for Claims paid below cost leading to potential abuse

Formularies Requiring

- a GPI-to-GCN, or GCN-to-GPI bridge file
- a NDC-to-RxCUI bridge file

Mapping of Enrollment and/or Networks

- Geo-access Maps
- Network accessibility Maps
- Population Maps
- Disease Maps of the population

Age/Gender Banding of the population AND

- By Top Drugs used in each band
- By Patient Severity

Fraud Waste Abuse (FWA) Analyses (predicated on profiling and trending of Claims experience over time)

- By Provider
- By Pharmacy
- By Patient

If you have an immediate need, we would appreciate the opportunity to demonstrate the power of these tools and the time-saving ability to answer your management issues and questions.” said Carol Stern, CEO of Pro Pharma.

If you are interested, please contact Pro Pharma 888-701-5438 to schedule a Web Demo via telephone Conference Call.

About Pro Pharma Pharmaceutical Consultants, Inc.

PRO PHARMAis 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 drugs 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 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.

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”.

Please visit Pro Pharma Pharmaceutical Consultants, Inc. website for more complete information.

Carol Stern
Pro Pharma Pharmaceutical Consultants, Inc. PRs
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