About JCode Calculator™ and Pro Pharma

medicine

The Story About JCode Calculator™

Introduction

Over the past 25 years, the JCode Calculator™ has been used by public and private Health Plans, physician groups, individual physicians, and pharmacists. Our motivation is to provide the most complete information about Specialty Medications provided under both the Pharmacy and Medical Benefits. This includes self-injectable specialty medications covered under Pharmacy Benefits and injectable medications administered in a clinical setting covered under the Medical Benefit. This includes all Medicare Part B medications including oral cancer medications, enteral feeding, HIV/AIDS medications, etc.

Application

The JCode Calculator™ includes product information, pricing, package label diagnoses and dosages, utilization information, companion genomic testing, FDA alerts, and other valuable information. For those users requiring more diagnostic information there are also Compendia/Guidelines from national organizations for diagnostic criteria and treatment guidelines.

Specifically, J Codes are from the HCPCS code reference. Drugs, NDCs and dosages are taken from national public resources as well as package inserts. Pricing information is taken from CMS, national resources for validation, cloud searches, pharmacy wholesaler pricing, etc. Companion Genomic testing information is taken from literature sources. Alerts are taken from FDA and CDC releases. Compendia/Guidelines are taken from national organizations representing specific diseases, NCCN guidelines, NCI guidelines, etc. The JCode Calculator™ is updated continually with the most current information.

Originally, JCode Calculator was in the form of an Excel Spreadsheet, and has now morphed into the current format that is cloud-based and contains multiple factors for evaluating and approving Specialty Medications.

About Our Company

Analytics at your Fingertips

Pro Pharma Pharmaceutical Consultants, Inc. (Pro Pharma) was established in 1985 as a Consulting and Analytics company.  Our goal was, and still is, to assist in the design of Pharmacy Benefits, analyze utilization, and provide action plans for improvement based on client-specific data and information.

Our analytics are comprehensive in nature and encompass both Financial and Clinical findings and recommendations illustrated in a clear and concise manner.  Based on years of experience, a Library of Custom-Client Analyses are available, and the option exists for all stakeholders to perform their own analytics for management and clinical oversight.

What Our Customers Say

Large Health Plan

“The JCode Calculator™ is very comprehensive for our purposes.  If there ever is a drug that we can’t find, or we have a question or need assistance, they not only meet our expectation but exceed it with the information that they provide.”

Medium Health Plan

“If we ever find a drug that is not shown on the Pro Pharma Website, we receive a same day response from your staff which is AWESOME! We have Users who have access to the Website, including Claims, Financial Auditors, Utilization Management and Provider Contracts, so this responsiveness is vital for our workflow. We find the JCode Calculator™ to be continually updated with current and correct coding, AND if there are ever any questions, I or my staff have, we receive an answer back the same day!”

 

Self-Insured Trust

“Once a claim is forwarded to Pro Pharma for Dr. Stern to review, we know that we will receive back a thorough and unbiased professional review with recommendations that will hold up to Physician scrutiny.  If there are further questions, once the physician has requested a re-review and supplied further information and data to Pro Pharma, it is almost a certainty that no further reviews are necessary, and the case is put to rest!”