What is a specialty injectable? There is no clear answer. There is no standard list of specialty injectable drugs. It’s an ongoing dilemma to determine if injectables are pharmacy costs, medical costs, or both. We offer a solution to reduce confusion and increase savings.
The PharmVantage Pharmacy Services Administration (PSA) solution provides a comprehensive and flexible solution to the injectable dilemma. Our integrated medical and pharmacy claims engine allows the adjudication of injectable claims into finite buckets that offer an unprecedented level of granularity to injectable drug use within a utilizing population. With PSA, an open crosswalk between NDCs, HCPCS codes (e.g., “J-codes”) and diagnosis codes appropriately separates injectable claims into distinct medical and pharmaceutical charges, thus enabling more accuracy and clarity around pricing and reimbursement.
Our Injectable Program℠ is an acquisition cost-based (patent pending) injectable distribution program, utilizing Robo-Rebate℠ (our fully-transparent Rebate Management System). The program provides a window into the actual net cost of these expensive pharmaceuticals. There isn’t any incentive to “float the dose” or dispense more product to patients, because our program’s dispensing fees are not tied to volume. Our distribution program is also patterned after the Competitive Acquisition Program (CAP) favored by the federal government.
With this injectable program, true transparency provides clear savings. The program offers true transparency on all discounts, rebates and other fees negotiated with manufacturers and/or suppliers of injectable drugs. These price concessions are incorporated into the administration of the benefit design so that payors as well as patients that require injectable drugs realize their fair share of the savings. This program does its share to help reduce the high cost of injectable drugs.