Pro Pharma Announces Tools for Increasing Quality and Decreasing Pharmacy Drug Spend

Pro Pharma’s Quality Management Program™ has demonstrated definitively that reducing Variance and thereby Improving Quality does lower Pharmacy Trend and Spend
NORTHRIDGE, Calif. - July 23, 2014 - PRLog -- Pro Pharma deployed the PP-Quality Management Program™ (QMP) for the Coalition of Coal / Energy Companies, with a focus on pharmacy trend and spend in the highest utilization areas of the United States, and has been successfully implemented for five (5) straight years.  The program was limited to the management of quality variance to remove the impact of any changes to benefits, copays, formularies, PBM programs, etc.  The program’s latest pharmacy trend was 1% as compared to a national average of 8-10%. The pharmacy trend was consistently less than 2% over the five year period as compared to the benchmark year where the trend was 8%.  During the study period PBMs consistently predicted trends of 16%+ for each year and in excess of 8% in the terminal year.  When new entrants were included in the employer Coalition their trends averaged 11%+ prior to implementation of the PP-QMP™.(

Dr. Craig Stern, President of Pro Pharma, notes, “The PP-QMP™ program performance was also informally compared to Medicaid and the public employee plan performance (PEIA) in applicable States.  Medicaid experienced a 7% trend in the terminal year of the program, while PEIA experienced a 12% trend.  Medicaid did not have significant changes in benefits (copays or formulary), and PEIA changes (increased cost sharing and a QM program) were adjusted by actuaries for the terminal year trend numbers.  The PP-QMP™, Medicaid, and PEIA programs use the same provider networks in general.”

Improvement in Quality of Care and Utilization:

“What is also of note,” states Carol Stern, CEO of Pro Pharma, “is that the quality of care also improved. A Deming principle was once again validated, as a group of more than 3100 physicians were targeted for intervention and made significant impact in increasing quality and decreasing associated costs”.  These target physicians represented about 77% of total drug spend. The study physicians were matched by location and specialty to a control group of physicians.  Results – a 4% increase in per-capita pharmacy drug spend and a 0.3% increase in prescription utilization vs. non-target physicians with an 18% increase in spend and a 10% increase in prescription utilization.

Ms. Stern also comments that, “utilization management focused on coordination of care and decreasing redundant polypharmacy.  The target physicians were scored on five (5) metrics including quality, cost and utilization parameters.  The quality parameters included compliance and persistence metrics for the patient population treated by each physician and were also compared peer-to-peer and peer-to-group.   The physicians with the highest metrics were rewarded and this caused much discussion in meetings!”

Improvement in Management of All Health Care:

All health care data was incorporated into data reported to target physicians in order to minimize the shifting of spend from pharmacy to medical cost centers.  The target of these interventions was to reduce unnecessary Emergency Medical and acute care hospital admissions, inappropriate one day hospital stays, and therapy without requisite diagnostic workup.  The impact of these interventions was reported per-practitioner and was incorporated into their overall scoring. Trending of all health metrics was a fundamental and ongoing component of the program.

It is always appreciated when a program’s outcomes illustrate success.  It is even more appreciated when Accolades are provided by national organizations.  The Pro Pharma Quality Management Program™ won the prestigious Pharmacy Benefit Management Institute (PBMI) Excellence Award in 2009 in conjunction with the Coal/Energy Coalition Companies for their participation. A short webcast is available on the PBMI website as well as the Pro Pharma website.

Please visit Pro Pharma website at for more complete information.

For a Free Web Demo please contact Carol Stern, CEO of Pro Pharma at or call 888-701-5438.

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 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 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

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