PMQPS doesn’t strive to dispense as many drugs as possible; we actively work with physicians and the patients themselves to make sure all prescriptions are appropriate.
PMQPS has streamlined the specialty drug process so that all deliveries are just-in-time, tracked for pedigree, and included with all prior authorization details and documents.
All prior authorizations are managed through a streamlined and integrate process that allow for rapid clinical, dispensing, and billing turnaround time.
Provide Quarterly Executive Summaries with details on total spend, utilization trends, and any interventions in real time (no lag for IBNR).
Specialty Network Management
The current state of administering healthcare in the United States is very complex. The financial responsibilities and corresponding risks are difficult to understand and manage by clinicians and payers. This is exemplified by the segregation of medications into oral medications (Medicare Part D), injectable medications (Medicare Part B), and other medications that may be either Part B or D depending on a payer’s specific benefit design.
These are areas where PharMedQuest Pharmacy Services (PMQ) excels. Our expertise, experience, use of technology, and proven track record allows us to provide optimal solutions for clinicians, provider groups (medical groups, IPAs, MSOs) and payers (self-insurers or health plans) to deliver cost-effective, quality care and services to patients.
An example of PMQ’s value is our real-time Medical-to-Rx data integration and informatics. This technology is critical in today’s environment. Managed Care contract risk negotiations between payers and providers for the 2015 year occur around mid-2014. However, due to the lack of reliable real-time data, the negotiating parties often use much lagged 2013 data for 2015 decisions.
To further compound the lack of reliable informatics, Part B and D data often reside in different silos and the integration of these specialty claims and expenditures are often not available to negotiating organizations.
Clearly, this is not an optimal situation in any negotiation. PMQ’s solutions prepare our Clients to properly use real-time integrated informatics to forecast and negotiate appropriate rates with a higher degree of accuracy and insight. To read more about our Specialty Network Management solution, see related Media to the left.