Pro Pharma has developed this Standardized Injectable Fee Schedule to assist with management of claims payment of Self Injectables, Vaccines, Immunizations, Cancer Therapeutic Agents, and now updated and enhanced to include blood glucose monitors and test strips.
“The addition of these new codes for blood glucose monitors and strips is in much demand by claims and billing professionals who utilize our JCode Calculator™ daily via our Secured Web Access," said Craig Stern, PharmD, MBA, President of Pro Pharma. "It is because of an overwhelming number of requests from our regular users that this enhancement was made possible. Therefore, I would like to thank our medical and reimbursement teams for their efforts, which led to this expansive update in this product line, which is specifically designed to help claims and billing professionals.”
Easy to use Functionality Includes, but is not limited to:
• Improved look up and History Functions
• MMA Part B vs. Part D coverage
• Differentiations between Brand & Generic Drugs
• ICD-9 codes for Approved Diagnoses Identification
• Expanded NDC lookups
• Expected Package Quantity
• Drug Alerts where appropriate
• Other cost bases, besides AWP are also available.
Pro Pharma provides secured Web access for Clients to the Pro Pharma secured website for quarterly updates and daily access and includes the following Key Features and Benefits:
• Pricing by Drug-Specific HCPSCS-CPT Codes
• NDC Codes
• Brand and Generic Names
• AWP, WAC, & ASP + 6% Pricing
• Strength and Package Size
• Pricing Per Package & Per Unit
• Therapeutic Category
• ICD-9 Diagnosis Flags
• Typical Dosage for Vaccines
• Purchase by Day/Week/Month/Quarter
• Customizable Discount Calculator
• Drug Alert Notifications
• Maximum Quantity Approvable Flags
• Check if ICD-9 Approved for Drug
• Check Historical Prices by Date or Date Range
• Brand/Generic Indicator
• Part B & D Indicator Flags
• Easy Web-based Searching.
“The JCode Calculator™ is available on a daily, weekly, monthly and quarterly basis and can be purchased on the Pro Pharma Website. We are continuing to improve our product line by adding new futures and your input in invaluable to our mutual success.” said Carol Stern, CEO of Pro Pharma. “Call or email to schedule your online Demo today and get your one week free elevation.”
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™, Rx MAC List™. The Company directly markets its products in the U.S. and collaborates with partners to reach international markets.
About Blood Glucose Monitors
Blood glucose monitoring is a way of testing the concentration of glucose in the blood (glycemia). Particularly important in the care of diabetes mellitus, a blood glucose test is performed by piercing the skin (typically, on the finger or arm) to draw blood, then applying the blood to a chemically active disposable 'test-strip'. Different manufacturers use different technology, but most systems measure an electrical characteristic, and use this to determine the glucose level in the blood.
Healthcare professionals advise patients with diabetes on the appropriate monitoring regime for their condition. Most people with Type 2 diabetes test at least once per day. Diabetics who use insulin (all Type 1 diabetes and many Type 2s) usually test their blood sugar more often (3 to 10 times per day), both to assess the effectiveness of their prior insulin dose and to help determine their next insulin dose.
Improved technology for measuring blood glucose is rapidly changing the standards of care for all diabetic people. Some modern monitors can download readings to a computer which can then be submitted to the physician electronically. Most insurance in the United State including Medicare and Medicaid cover diabetes testing supplies.
A blood glucose monitor is an electronic device for measuring the blood glucose level. A relatively small drop of blood is placed on a disposable test strip which interfaces with a digital meter. Within several seconds, the level of blood glucose will be shown on the digital display. Blood glucose test strips must match the monitor in order to function properly. Most blood glucose test kits come with the monitor and enough supplies for 10 to 30 days. Thereafter, blood glucose test strips matching the monitor will need to be resupplied periodically. Some monitors also require calibration and accuracy testing. Supplies for that purpose are usually included with the monitor. The physician will instruct the patient on how often to test and what to do with the results.
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 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".