HOUSTON, (November 19, 2014)—PCCA, the largest and most-established U.S.-based supplier of chemicals, formulas, equipment and education for compounding pharmacies, is forming PersonalMed™, a preferred provider network (PPN) of Pharmacy Compounding Accreditation Board (PCAB)® Accredited PCCA member pharmacies. PersonalMed represents a strategic approach to pharmacy benefit management similar to health insurers’ preferred provider organizations (PPO), in which hospitals and physicians accept a pre-negotiated fee schedule in order to be included as preferred healthcare providers.
A recent study by Milliman Consulting shows that payors’ overall drug spending can be reduced by up to 13 percent by using a preferred provider network of pharmacies. PersonalMed will represent participating pharmacies in negotiations with third-party payors and Pharmacy Benefits Managers (PBM) by establishing the terms of the group’s relationship with these third parties including the reimbursable formulary, pricing, credentialing requirements, inspections, auditing and other terms. To achieve deeper savings for payors and patients, PersonalMed will offer a fully transparent and predictable pricing model through a pre'negotiated fee schedule.
“PersonalMed will offer quality care to patients throughout the care continuum, using a network of highly credentialed, PCAB-Accredited compounding providerswho are dedicated to excellence in clinical service and are committed to patients’ clinical outcomes,” said Bill Letendre, M.S., R.Ph., M.B.A., vice president of Compounding Pharmacy Management (CPM) Services for PCCA. “PersonalMed will provide payors with a sizeable base of geographically accessible compounding pharmacies.”
PersonalMed network includes an exclusive claims-management and billing platform, that supports payors’ benefit design, clinical audits and other utilization management programs to optimize patients’ medication use and to improve clinical outcomes. The billing platform is fully integrated with the most widely used compounding software in the United States, PK Software. This will allow PersonalMed to leverage collected data to do critical reporting and analysis to conduct outcome studies.
PersonalMed will also support PBM/payors’ adjudication logic to ensure that only a “clean claim” enters the claims platform. PCCA’s full-service model goes beyond supporting commercial lives to include programming to support Medicare Star ratings as well. These include fraud, waste and abuse programs, vaccination, medication-therapy management, drug-utilization reviews and medication-adherence programs.
“We believe that a PPN backed by PCCA will provide the nationwide reach that payors want for their prescribers and patients,” said Delford Doherty, director of Managed Care Services, PCCA. “PersonalMed is being structured in such a way that it will deliver the quality assurances and the wide availability that payors and PBMs demand.”
For more information on PersonalMed, see www.pccarx.com/personalmed.
PCCA helps compounding pharmacies around the world deliver personalized, compounded medications that make a difference in people’s lives. As a compounding pharmacist’s most comprehensive resource, PCCA provides products, services and support to almost 4,000 pharmacist members throughout the United States, Canada, Australia and the United Kingdom. Serving compounding pharmacists since 1981, PCCA is headquartered in Houston, Texas. For more information about the company, visit pccarx.com.