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PD-RxNet is an advanced, proprietary software-driven
pharmaceutical management system. It is specifically designed to
enhance physicians' capabilities to better assist their patients'
personal health management programs by performing numerous essential
and consequential functions during the point
of direct patient care. Most importantly, it provides a mechanism
in which MCOs can affect drug cost controls effectively, at the
source for all prescriptions the physician.
It is comprised of four primary components, each of which is designed
to operate independently of or collectively with one another. A
MCO can select desired components to be integrated within their
network structure. PD-Rx recognizes the importance of direct oversight
of these key elements of the PD-Rx Net for quality assurance, dependability,
and reputability purposes. As such, the company has direct involvement
over each of these areas, thus ensuring cohesiveness.
Pharmacy Software System:
The primary component of the PD-Rx Net is a stand-alone,
on-site computerized pharmacy software system designed specifically
for physician offices. The software provides for recording patient
personal and diagnosis information, acute care medication dispensing
at patient point-of-care and formulary compliance for multiple formularies.
The pivotal feature of the PD-Rx Net desirable to MCOs, which
distinguishes it from similar software systems in the marketplace,
is the capturing of the patient diagnosis codes in the physician’s
office. This vital piece of information, which has not been easily
obtainable thus far by MCOs, enhances the outcome management assessment
by providing the link between prescriber, patient, medication and,
now, the diagnosis. With this added information, the MCO can quickly
and easily make decisions regarding the proper use of medications
for specific diseases, as well as greatly assist in the determination
of outcome studies.
Electronic Scripting:
The second component of the PD-Rx Net is a communications
network that gives the physician the capability to electronically
transmit prescriptions directly to participating retail and mail
order pharmacies. This eliminates legibility problems and incomplete
patient information. In addition, various checks, which have historically
been performed at the pharmacy, can now be conducted at the point
of care, i.e., member eligibility, pharmaceutical compliance, allergy
screening, and drug interaction screening.
Electronic Claims Processing:
This feature provides the physician with point-of-service,
electronic claims submission and adjudication capabilities. Specifically,
this function of the PD-Rx Net will:
1. Verify patient eligibility.
2. Determine if prescribed medication is covered under the patient's
plan.
3. Determine if there is a maximum allowable cost for multi-source
medications.
4. Determine the maximum amount that may be dispensed.
5. Monitor refills.
6. Check for possible drug to drug interactions.
7. Confirm the co-payment and the net amount to be paid by the
plan
8. submit the claim for payment.
Using this component will result in fewer claims rejections because
of the improved accuracy of information. Also, since claims processing
time is reduced, the payment turn-around time is reduced, thus improving
cash flow for the physician.
Pharmacy Benefit Management Interaction:
Traditionally, ingredient costs and dispensing
fees were easy targets for MCOs to focus upon to tower healthcare
expenses. Today, this area of concern has shifted to the control
of what is dispensed, how it is dispensed, and the impact on overall
medical costs. PD-Rx clearly seeks to impress this new focus by
providing a comprehensive PBM component of the PD-Rx Net in which
MCOs can effect these changes most effectively - with the physician.
The key function of this PD-Rx Netcomponent illustrates to MCOs
how money spent in certain areas adds value to their overall health
benefit program. In this rote, the PD-Rx PBM component is networked
with the physician's office to obtain an array of information used
to manage the prescription drug program and coverage, including:
1. Drug Utilization Evaluation
Patient-specific drug problems are monitored through
concurrent (at dispensing or during drug therapy) or retrospective
(after dispensing or post-drug therapy) review. These reviews
are typically used to identify drug/disease conflicts, drug/drug
interactions, chronic over-utilization/under-utilization (or noncompliance
by the patient), drug/sex and drug/age conflicts, and drug/pregnancy
contraindications. The data contacted can be used to assist development
of cost effective drug therapy and outcomes research.
2. Pharmacy Program Strategy
This is accomplished by presenting to the MCO ways to control
overall pharmacy costs. These strategies include:
- Adjudicating system recommendations.
- Utilization programs
- Clinical review by PD-Rx pharmacist and
physician consultants.
- Development and participation on pharmacy
and therapeutic committees
- Disease management and plan design.
3. Drug Cost Management Strategies
One of the primary responsibilities is the assurance that the
price paid for products and services are competitive. This includes
contracting practices, formulary compliance, rebates, dispensing
settings and incentives to use cost effective, high quality products.
4. Data Storage and Transfer
This is a critical part of the PD-Rx Net pharmacy program. In
addition to on-tine real-time claims adjudication, data is collected
for use in internal office reports to educate and inform the physician
about prescribing habits. It can also transfer collected data
directly for merging into larger databases, which can be used
for many drug utilization reviews and outcomes research activities.
Generic And Name Brand
Pharmaceuticals
One of the most important considerations for an MCO is the
cost savings realized from the elimination of pharmaceutical handling
and dispensing fees. As a convenience and service, PD-Rx offers
a broad product line selection of generic and name brand pharmaceuticals,
which are repackaged into unit-of-use sizes. Not only can PD-Rx
obtain pharmaceuticals at a lower price through volume purchasing,
we can repackage medications into unit-of-use sizes much more accurately,
efficiently, and economically by generating large volume automated
production runs. Ultimately, MCOs reap these savings.
Mail Order Services
With the use of the PD-Rx Net, each MCO can be linked directly to
a mail order pharmacy. Selective contracts and services will be
made available to MCOs through PD-Rx. The PD-Rx Net can also be
integrated to connect a MCO with a currently contracted mail order
program. This provides continued convenience to the patient for
prescription refill of chronic care medications.
Shared Information
The PD-Rx Net creates a mechanism for health care providers and
payers to provide effective personal health management for patients
while positively impacting patient health and satisfaction and lowering
the cost of quality health care delivery to all.
Strategically partner your MCO with an experienced and knowledgeable
pioneer in the pharmaceutical repackaging industry and pharmaceutical
software development arena. Call today for more information on or
a personal demonstration of the PD-Rx Net, as well as any of the
supporting products or services carried by PD-Rx.
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