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Specialty Rx Cost Savings through Utilization Management
Pharmacy Benefit Analyses Provide Thorough Explanations and Recommendations of Findings to; PBM/Specialty Medication Contract Review and Negotiations to provide effective projections for the future
Specialty pharmacy presents a critical need for contracts that provide cost and utilization management. Utilization management (UM) is the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of the applicable health benefits plan, sometimes called “utilization review.”
While PBM and Health Plan contracting may lead to savings at point-of-sale or through rebates, member cost share for Specialty Medications, is so large that contracts require an expanded vision for all stakeholders and benefit designs.
Further, claims processing is an integral part of the contract to ensure that cost of care is not expanded by inaccurate coding.
Yet even with optimal contract language for cost control, utilization management is the second critical component that offers assurance for optimal specialty medication usage for the correct diagnosis, dose, frequency and duration of therapy.
Pro Pharma has extensive experience is claims coding, processing, utilization management and design of contracts to reflect best practices for specialty pharmacy.
Please visit Pro Pharma Consultants website or call 888-701-5438 for complete information.
About Pro Pharma
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.
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™, Quality Management Program™, and Treatment Calendar™. The Company directly markets its products in the U.S. and collaborates with partners to reach international markets.
For more information about Pro Pharma, please visit www.propharmaconsultants.com.
Pro Pharma Pharmaceutical Consultants, Inc.