Pro Pharma Pharmaceutical Consultants, Inc. consults in Managed Care and has a long history of working with a wide variety of Health Plans, Municipalities, Self-Insured Companies, and more.
Pro Pharma assists Clients with Benefit and Formulary Design, including all the necessary information such as strength, NDC, GPI, HCPCS, etc. We can then give you the final Formulary, and upon your approval, will provide you with two versions:
- Printable – to be made available to providers
- Spreadsheet – to be uploaded and can be sent to your PBM. This version is complete with GPI, GNC and NDC codes
Fraud, Waste & Abuse at Work
Problem: A Client needed a Specialty Drug Formulary that included new benefits and exclusions.
Methodology: Pro Pharma designed a Formulary that included applicable drugs, categories, and references to coding. The Formulary was Generic-Biased and designed for the new benefit/copay design. After all appropriate approvals Pro Pharma developed an NDC Coded Formulary, including Quantity Limits, Maximum Dollar Amounts, Step Therapy and Prior Authorization (PA) Flags. The subsequent coded Formulary was sent to the PBM after all appropriate approvals from Medical Directors was garnered. Pro Pharma managed questions from the PBM for an expedited implementation. Subsequently, Pro Pharma answered questions from the Pharmacy and Physician Network Providers and the PBM.
Outcome: The Formulary process allowed for expedited implementation and applicable cost savings. Subsequently, Pro Pharma managed the Drug Utilization Review (DUR) process and designed a customized analytical and digital reporting Tool for this Client. The Client was very satisfied as they did not have the internal expertise to handle these issues, nor did they have the experience of how to manage unforeseen complications.
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