Pro Pharma Announces Comprehensive Specialty Analyses™

Increase Efficiencies & Reduce the High Cost of Specialty Medication Utilization
Comprehensive Specialty Analyses™
Comprehensive Specialty Analyses™
CANOGA PARK, Calif. - Nov. 19, 2014 - PRLog -- “PRO PHARMA utilizes a multi-pronged approach to analyze pharmacy and medical encounter claims through problem flagging, feedback on performance, peer to peer comparison, etc. This program is fully customizable to fit the needs of each client -”, says Craig Stern, PharmD, MBA, President of Pro Pharma Pharmaceutical Consultants, Inc. “PRO PHARMA specializes in Pharmacy Benefits and Organizational Strategy for Health Care Systems. As an outgrowth of our Consulting we have developed Data Analytical capabilities that focus on Standardization and Analysis of Integrated Data Sets for both Pharmacy and Medical Claims.”

A 2013 Employer Pharmacy Benefit Plan Survey from a large consulting firm illustrated that 30% of respondents did not know the magnitude of their Specialty Drug Costs.  Today, these costs typically represent 20% or more of an employer’s annual pharmacy benefit plan costs and are expected to reach 30% by 2015.  With more than 900 Specialty Drugs in development and cost currently averaging $2,800 per 30-day supply, employers and other plan sponsors need to develop strategies for managing and controlling utilization of these rapidly rising drug costs.  Furthermore, Specialty Drug costs under the pharmacy benefit plan typically represent 50% of an employer’s total Specialty Costs; the other 50% is generated by Specialty Drug covered through the Medical Plan.

These challenges require employers and other plan sponsors to develop strategies that:

Ø  Manage Specialty Drug utilization to ensure that the right drug is dispensed at the right dose, at the right time for the right condition, and, in the case of infused drugs, at the most cost-effective location; and

Ø  Achieve optimal pricing of Specialty Drugs in this intensely competitive employer “buyer’s market” for pharmacy benefit plan vendors.

PRO PHARMA’S Comprehensive Specialty Analyses™ ( identify pricing differences, usage, trends, and actionable opportunities in the medical data that were not apparent in the past.  In order to achieve these goals it is necessary to view the Medical Data from multiple perspectives, i.e., a 360 degree view that allows for seeing beyond the obvious of top drugs spend and top providers as well as compare and contrast it with the Pharmacy Claims Data.

According to Craig Stern, President of Pro Pharma, “Specialty is the "new" brand.  It must be Measured, Prioritized, Managed and Improved according to the Total Quality Assurance Cycle (TQA).  The ultimate outcome of any Specialty Medical Analyses must include an in-depth understanding of the current situation, channel and provider comparisons, and options that can be prioritized for action.”

“Having all your specialty pharmacy efforts managed through a single source provides you increased control over this previously unwieldy segment of care. It becomes standardized, simplified. Our comprehensive services put you in control”, states Carol Stern, RN, BSN, MBA, CEO.

For more information on Pro Pharma’s Products and Services, please contact us at (888) 701-5438. (

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 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 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.

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”.

Carol Stern, CEO
Pro Pharma Pharmaceutical Consultants, Inc. News
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