Pro Pharma Pharmaceutical Consultants, Inc., a pharmaceutical consultant organization which focuses on data analytical expertise, announced today that it has introduced NEW and IMPROVED Enhancements to the JCode Calculator™ (Ver. 2) First Quarter 2011 Update (issued 04-28-11) via their secured web access for claims and billing professionals.
Pro Pharma has developed this Standardized Injectable Fee Schedule to assist with management of claims payment of self injectables, vaccines, immunizations and cancer therapeutic agents.
Key Areas of Client Interest Are:
• Difference Between Brand & Generic Drugs;
• Differentiation Between MMA Part B vs. part D Drugs;
• Identification of diagnosis for a drug.
“This update includes more than 80% price changes in our entire JCode Calculator™ database which consists of greater than 1600 entries. Additionally, this reflects all of the many AWP decreases mandated by the FDB-MediSpan recent court decision, and few price increases but they were minimal this quarter”, said Craig Stern, PharmD, MBA, President of Pro Pharma. “Now claims and billing professionals are able to Identify all JCodes for any drug within seconds. Every entry on the Jcode Calculator™ has a field that allows Billing and Claims Professionals to click and see all JCodes that pertain to that drug. This is only one of numerous filters that are user friendly, and customization is available per client request.”
Information Includes, but is not limited to:
• HCPCS Code (including A, J, Q and S Codes);
• Current Procedural Code (CPC, formerly CPT) for drugs;
• Average Wholesale Price (AWP**) by package and pricing unit;
• National Drug Code number (NDC);
• Average Sales Price (ASP);
• Brand Name;
• Generic Name;
• Package Size;
• WAC (Wholesale Acquisition Cost).
** Other cost bases, besides AWP are also available.
About PRO PHARMA
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™, Quality Management Program™, and Treatment Calendar™. The Company directly markets its products in the U.S. and collaborates with partners to reach international markets.
About Quality Management Program™ (QMP)
The QMP is a multi-faceted approach that attacks 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 directed to giving patients and physicians the tools to make better 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.
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 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.