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Identify Specialty Rx HCPCS, NDCs, Pricing, Dx, Usage, FDA Alerts and Genomic Tests

Bridge JCodes to drugs and receive the benefits – price, approved diagnoses, dosage limits, approved companion genomic testing, and much more!

JCode Calculator™ is an all-inclusive web-based resource that can be integrated into current medical claims payment systems.

JCode Calculator™ bases all injectable reimbursement on the Healthcare Common Procedure Coding System (HCPCS) defined units. Utilizing a spectrum of pricing metrics discounts that can be customized based on drug type, category or specialty.

    Features & Benefits
  • Pricing by Drug-Specific HCPCS-CPT codes
  • Includes J, Q, A, B, C, & S Codes
  • NDC codes
  • Brand and Generic names
  • AWP, WAC, & ASP + 6% pricing
  • Strength And package Size
  • Pricing per package Size
  • Therapeutic Category
  • ICD-10 Diagnosis Flags
  • Maximum Dose
  • Customizable Discount Calculator
  • Drug Alert notifications
  • Maximum Quantity
  • Rebatable medications
  • Genomic Testing

    Client Favorites
  • Brand/Generic indicator
  • Part B & D indicator flags
  • Check If ICD-10 approved for drug
  • Check For FDA approved dosing
  • Easy web-Based searching
  • Purchase By day/Week/month/quarter


JCode Calculator at Work

Problem: A client requested help with converting Average Wholesale Price (AWP) discounts to ASP, WAC, NADAC, AMP and other bases of cost. The client was a provider who was receiving contracts from Health Plans but did not know how to convert and verify the terms of the agreements for payment for specialty medication pricing. For example, the Plan wanted to pay at ASP +20%, but the provider wanted to know what that meant in AWP-Discount as had been previously paid.

Methodology: We developed the conceptual framework and provided the solution. An algorithm developed the conversion calculations and produced the results in tables that the provider could use for each specialty medication that was contracted. The provider was supplied fixed conversions from AWP-to-ASP and other bases of cost. The tables also included variable discounts so that the provider could calculate alternatives as the Plan offered alternatives.

Outcome: The provider achieved its goal of ensuring that contracted discounts resulted in the required profit margins. The provider also had a negotiation tool that allowed them to calculate costs vs. profits on various contracted discounts.

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To Learn More:
Phone:(888) 701-5438
info@propharmaconsultants.com