Pro Pharma Announces Presentation of PBMI Webinar

Pro Pharma, in collaboration with PBMI will be presenting: "Headaches No More…Improving Parity in Medical Specialty Reimbursement." Learn what steps a Health Plan can take to make Medical Specialty Rx more efficient, accurate and less costly.
PBMI | Headaches No More...Improving Parity in Medical Specialty Reimbursement
PBMI | Headaches No More...Improving Parity in Medical Specialty Reimbursement
CHATSWORTH, Calif. - May 23, 2018 - PRLog -- Pro Pharma Pharmaceutical Consultants, Inc., (dba Pro Pharma) a Pharmaceutical Consulting Organization which focuses on Data Analytical Expertise an Specialty Reimbursement for our clients, announced a new Webinar to be presented on behalf of the Pharmacy Benefit Management Institute (PBMI)  on Wednesday June 13, 2018 at 1:30PM EDT.

A large public health plan in California identified issues in the payment of Specialty Rx paid under the medical benefit.  An innovative approach was necessary to correct claim adjudication issues.  The first step was to analyze the medical claims for common adjudication problems, e.g., matching to approved diagnoses, correct ICD10 coding, claim validity tests for dose/quantity/duration, pricing compliance with contracts, miscellaneous code denials, etc.  The second step was to inform the IT department of the issues for corrective actions.  The third step was to identify rebatable drugs for potential manufacturer discussions and contracting.  The fourth step is to intervene with prescribers who are responsible for a high volume of adjudication issues.

This presentation will present the approach to the problem, the analyses, the current Health Plan interventions, and the plans for the future next steps.

The goal is to present what one Health Plan has done, and plans to do, to make Specialty Rx more efficient, accurate and less costly, and focus on the following topics:

1)  Identify three (3) Rebatable Drugs in your Specialty Rx paid under the Medical Benefit
2)  Discuss the methodology for oversight and management of Specialty Rx paid under your Medical Benefit
3)  Describe next steps in managing and controlling Specialty Rx to produce efficiencies resulting in lower costs

To Register Visit:

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, 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.   Please check the Pro Pharma Website for other relevant Services and/or Programs that might benefit you and your organization. Pro Pharma directly markets its products in the U.S. and collaborates with partners to reach international markets.

For more information about PRO PHARMA, please visit

         Carol Stern, (888)701-5438

Carol J. Stern
(888) 701-5438
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Tags:Medical Billing, Specialty Medication, Pbmi
Location:Chatsworth - California - United States
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Page Updated Last on: May 23, 2018
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