Pro Pharma Pharmaceutical Consultants, Inc., a pharmaceutical consultant organization which focuses on data analytical expertise, announced today that it has Updated and Enriched the JCode Calculator™ Third Quarter 2012 Update via their secured web access for claims and billing professionals for improved efficiencies.
Pro Pharma’s JCode Calculator™ provides an invaluable resource to ensure standardization of reimbursement procedures to providers which results in overall savings to the organization due to consistent billing and reimbursement practices. Specifically, there are a few categories which are highly sensitive to the potential of overcharges.
“The top three common categories of specialty injectables had small average wholesale price (AWP) increases between 3Q12 and 2Q12. Specialty Oncology medications averaged a 0.8% increase in AWP for 54 of 595 NDCs with a price change; however, a small subset experienced a 324% increase. Specialty Hematology experienced a 0.5% increase (maximum 3.4%) in AWP quarter-over-quarter for 7 of 46 NDCs with a price change. Specialty Rheumatoid Arthritis medications averaged no change for 3Q12 and 2Q12”, states Dr. Craig S. Stern, President of Pro Pharma Pharmaceutical Consultants, Inc. “The above results are reflected in the Third Quarter 2012 Update to the Pro Pharma JCode Calculator™. This Quarterly Update covers all JCodes and their respective NDCs and includes all available AWP, WAC, DP (Direct Price), and ASP, to name a few,” concludes Dr. Stern.
“The JCode Calculator™ is available on a daily, weekly, monthly and quarterly basis and can be purchased on the Pro Pharma Website. Pro Pharma continues to improve our product line by adding new features and client input is invaluable to our mutual success. Unique State Pricing can be added for ongoing clients as requested,” said Carol Stern, CEO of Pro Pharma. “Call or email to schedule your online Demo and free evaluation.”
Please visit Pro Pharma website for more complete information.
About Pro Pharma Pharmaceutical Consultants, Inc.
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 ™, 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.