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Pro Pharma’s Webinar on Specialty Program Design Now Available
“Specialty Medication in Today’s Healthcare Environment” is now available for free download in both video and pdf format.
For more infomation visit http://www.propharmaconsultants.com/
The webinar was specifically designed to educate participants on the design of specialty medication programs. It showed how to measure results, manage both cost and utilization, and provided a glimpse into the future of specialty medication programs.
- Introduction and Definitions
- Medical / Pharmacy Coding
- Management Metrics
- Management Approaches
- Utilization Testing
- Management Outcomes
- Future and Opportunities
The idea for this webinar spawned from ever increasing challenges in both pharmacy and medical claims affecting quality of care, cost and utilization standards.
These challenges require employers and other plan sponsors to develop strategies that:
- 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
- Achieve optimal pricing of specialty drugs in this intensely competitive employer “buyer’s market” for pharmacy benefit plan vendors.
According to Dr. 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.”
The information provided in the webinar was based on Pro Pharma’s twenty (20) plus years of experience in analyzing and managing total medical spend with particular emphasis on specialty medications, in particular, Pro Pharma’s Comprehensive Specialty Analyses Program TM, which has just been updated. For more infomation visit http://propharmaconsultants.com/
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, including but not limited to comparison of pricing, analysis of duplicate payments, audits of specialty claims and analysis of channel discounts.
Following the webinar many interesting questions were asked, demonstrating a high demand for education in the specialty arena. Pro Pharma is committed to the further education of those interested in specialty program design and application and will continue to provide quality information, as well as be a resource for those who seek further assistance in this challenging industry.
For more information on Pro Pharma or its products and services, please contact us at (888) 701-5438 or visit our webpage.
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 Comprehensive Specialty Analyses™, JCode Calculator™, Invoice Screening ™, Pro Pharma Suite of Tools™, Rx MAC List™, Quality Management Program™, Treatment Calendar™, and Biotech Modeling™. The Pro Pharma directly markets its products in the U.S. and collaborates with partners to reach international markets.
About JCode Calculator™
Pro Pharma has developed a Standardized Injectable Fee Schedule to assist with the management of claims payment. 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 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 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”.
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 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.
Pro Pharma uses Clinical Protocols to analyze patient encounter data and diagnoses for required exams, tests, and medications. In this way, physician practices can schedule the applicable services for each patient and then review them for exceptions.
Treatment Calendar™ functions in the following manner as a:
Quality tool for benchmarking
Tool to align provider and payer incentives by focusing on actionable patient specific quality improvements
Risk management tool to identify therapy that doesn't comply with national norms
Tool to graphically identify gaps in compliance
Please visit the Pro Pharma Pharmaceutical Consultants, Inc. website for more complete information at http://www.propharmaconsulants.com
Carol Stern, CEO