EDEN PRAIRIE, MINN.-- Jan. 13, 2010-- In the world of medical
pharmacy, drug prices essentially are a free-for-all, with an
explosion of new biotech drugs about to come to market. For example, a
reasonable price for the injectible drug infliximab would be $59.22
per unit, but NovoLogix has found it being paid at anywhere from $0.78
per unit to $671.00 per unit due to imprecise and inconsistent coding.
Medical pharmacy includes pharmaceuticals covered by the medical
benefit – not the pharmacy benefit – and administered in a physician’s
office, an infusion suite, or a patient’s home. For example, for
oncology alone there are more than 600 new drugs that fit this
description in the pipeline.
Rising at the rate of 10 to 15 percent annually, the cost of drugs and
services that qualify under the medical benefit is expected to
eventually outpace drugs paid under the traditional pharmacy benefit.
Most states, insurers and large employers do not have sophisticated
programs in place to track pharmaceutical products and procedures
covered under the medical benefit, unlike the electronic systems used
by pharmacy benefit managers (PBMs).
“Back in the mid-‘70s, the approach to processing pharmacy claims was
giving a sheet of paper to the pharmacist and asking him to write down
the name of the patient, the name of the drug, and the dollar amount,”
said David J. McLean, Ph.D., CEO of NovoLogix. “When we look at some
of the things being done with drugs paid for under the medical benefit
today, some aren’t much further along.”
NovoLogix uses technological innovations to improve the way services
and drugs are priced, paid for, and delivered to patients across the
U.S. The company has issued a white paper, “Innovations in Healthcare
Technology: Managing Medical Pharmacy,” that explores the issue, as
well as hosting multiple conferences for medical pharmacy leaders from
around the country. The white paper is available at
www.novologix.net/about.htm.
Key concepts discussed include:
-A limiting factor for medical pharmacy stakeholders,
including patients, health plans and healthcare providers is the
inability to gather accurate, timely information and integrate this
information into decision making.
-Challenges facing the industry stem from the systems in
place that typically utilize Healthcare Common Procedure Coding System
(HCPCS) J-codes, rather than the more precise National Drug Codes
(NDC), resulting in reimbursements that can vary by thousands of
dollars for the same dose of the same drug.
-The claims process is often performed manually, lengthy lag
times can occur, and the data that result are often incomplete or
inaccessible.
-Future goals for managing medical pharmacy spend include
improving clinical outcomes, implementing utilization management
programs, and creating data consistency across the pharmacy and
medical benefits.
With many health plans moving toward performance-based contracts with
pharmaceutical companies (manufacturers), the importance of NDCs is
growing.
Using its MedRx suite of services, NovoLogix equips organizations to
continuously deliver improved clinical, financial, and humanistic
outcomes related to medical pharmacy for patients, providers and
payers. NovoLogix’s innovative information system and services
platform creates customizable, PBM-like capabilities that effectively
and efficiently manage drugs covered under the medical benefit.
NovoLogix also delivers significant cost savings. An organization can
save between $6 million and $10 million per year, based on a medical
pharmacy spend of $100 million per 1 million members.
About NovoLogix:
NovoLogix, Inc. is a medical pharmacy benefit management company
delivering a breakthrough Software-as-a-service (SaaS) medical
pharmacy information system called MedRx. NovoLogix manages the
pharmaceuticals covered under an insurer’s medical benefit. Drugs
covered under the medical benefit are usually dispensed in either a
physician’s office or a patient’s home and include injectables and
infusables. They are quite often biotech drugs, commonly used to treat
diseases such as cancer, rheumatoid arthritis and multiple sclerosis.
MedRx’s SaaS technology and management model has consistently reduced
these relatively unmanaged pharmaceutical costs. These savings can be
realized within the rapidly increasing $9.87 per member, per month
(PMPM) medical benefit pharmacy spend. NovoLogix is dedicated to
increasing the level and quality of data available to manage these
disease states.