Quality Management Program

The Quality Management Program™ has been instrumental in controlling drug spend and trend by:

• Maintaining Drug Cost Trend to Low Single Digit Inflation
• Managing Utilization (numbers of scripts per patient/year)
• Minimizing Variance of Actual to Budget

Thereby improving quality-prescribing decisions for your members, without having to change your benefits.

Bottom Line: Physicians will prescribe cost effectively when they are included in planning and implementation. Payers can expect to see performance improvement savings of 8-11%

Pro Pharma utilizes a multi-pronged approach to manage pharmacy costs through provider education, problem flagging, feedback on performance and patient education/involvement. The goal is to educate prescribers in clinical therapeutic decision-making and cost effective prescribing, which is consistent with managed care contracts. These programs can integrate effectively with Client/Health Plan and PBM drug-switching programs if currently in use or planned for by Client.

The Quality Managment Program Utilizes:

• Patient Specific Queries
• Digital & Clinical Edits For Monitoring Medication Effectiveness And Risks
• Treatment calendar
• Artificial Intelligence Rule Sets Applied To Integrated Data To Identify And Trend Complex Clinical Problems
• Trend Managment
• Oversight Of Financial Trend And Clinical Usage

Pro Pharma's Quality Management Program™ results have proven in markets nationwide to increase quality outcomes and decrease costs associated with managing the pharmacy and medical benefits, respectively. Our methodology is to integrate clinical therapeutics with prudent business principles to achieve cost contraction as a result of improved quality management. Savings accrue from physician-accepted general education about evidence-based practice and information about the cost-effectiveness of competing medications.