Pro Pharma Pharmaceutical Consultants, Inc., announces GER Validation Analyses™ available to Health Plans Nationwide; which includes Weighted Average Wholesale Price (WAWP) review and evaluation or Generic Effective Rate (GER) calculations verify that contract guarantees are being met with regard to the overall pricing of brand and generic claims.
Dr. Craig Stern says: “The majority of PBM contracts contain GER benchmarks which are normally calculated and reported quarterly. Vendor assumptions can influence the results of a GER calculation by arbitrarily including or excluding categories of drugs, on those agreements where Vendors are contracted to receive a share of the dollar impact of the performance above contracted Benchmarks. Pro Pharma has developed GER Validation Analyses™, which makes this type of evaluation and reconciliation very straightforward and we routinely ensure outstanding ROIs when our services are engaged.”
Various methodologies are employed to calculate the GER and impact of over/under performance, experience with all methods is essential in interpreting the results of any analysis; whether completed by the Vendor, internally, or by an outside analyst. Pro Pharma’s knowledge and ability to thoroughly understand contract language as it relates to these guarantees is a major influence in preventing future occurrences.
Pro Pharma Weighted AWP Analyses™ (WAWP) or Generic Effective Rate (GER) calculations verify that contract and performance/financial guarantee are being met with regard to the overall pricing of brand and generic claims. In many cases clients do not have the capacity to verify assertions of the Vendors. This allows Health Plans to manage their Vendors.
Vendors can require a share of the dollar impact of performance above contracted benchmarks. You may be paying your Vendor to “Underperform”. Health Plans are contractually guaranteed to receive the total dollar cost impact of “underperformance” of the Vendor network. The Vendor may owe you more than you may be receiving in rebates.
Typical results of GER Validation Analyses™ will generate a savings of 1.5% to 2.5% to Health Plans on total drug spend in the period under review/analysis.
Pro Pharma offers a “Trial Analysis” using a sample of your past data to illustrate areas of concern and possible savings. This “Trial Analysis” will more than guarantee your money back.
For more information contact Pro Pharma Pharmaceutical Consultants, Inc.
About Pro Pharma Pharmaceutical Consultants, Inc.
Pro Pharma (propharmaconsultants.com) 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 ™, 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 drug 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.
Pro Pharma can identify immediate savings opportunities through re-modeling of claims processing procedures, and longer-term savings through technology assessment and utilization management. Additional research and analyses can be performed to determine the biotechnology drug driven costs in procedures, diagnostics, and provider time. It is expected that these adjunctive costs will represent an ever-larger portion of the ambulatory experience downstream
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
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.