Zyntrigues, Volume 1, Issue 4 - April 2008
Volume 1, Issue 4, - April 2008 |
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In this Issue
Musingsby Bob Pinkerton, COO Last week I had the opportunity to present to the Academy of Managed Care Pharmacy (AMCP) 20th Annual Meeting and Showcase in San Francisco. The topic of the session was entitled, “Tools for Managing the 2009 Medicare Part D Formulary Submission Process”, and I was joined by Darlene Mednick of Gorman Health Group and Lynn Nishida of The Regence Group. In conversation with some of the attendees after the session, I was struck by the common reaction to the Medicare Part D program in so much as most attendees I spoke with felt the Centers for Medicare and Medicaid Services (CMS) is doing an amazing job in controlling costs and raising the bar for consumer transparency around formulary. From the conversations I also took away that the new discipline and rigorous scrutiny applied by CMS to Part D formulary submission was having an impact on the core pharmacy business processes for other books of business. This included the need for greater formulary accessibility for members and increased analysis of formulary intent. A third area that raised some passion was ensuring P&T intent was accurately reflected in adjudication decisions, and highlighted the need for more streamlined data exchanges between the health plan and adjudicator. Coincidentally, Zynchros launched a new formulary management solution at AMCP called, Zynchros Commercial Plan Pro™. As you may have seen elsewhere, this is a rules-based formulary development and maintenance solution that greatly simplifies the production and management of commercial, Medicaid and other formularies. Built on the Zynchros.com platform, Commercial Plan Pro delivers all of the workflow capabilities of our Part D solution and the same type of robust reporting and analytics that have made Part D Pro the industry standard in Part D submissions. The overall take-away from our discussions in San Francisco was that Formulary data has become more critical to pharmacy benefit programs and that collaboration and information-sharing requirements are likely to get more complex over the coming years. It was generally concluded that automation is absolutely essential to controlling the keys to the pharmacy benefit kingdom. Healthcare Information Technology has a ways to go to catch up to other industry segments but the focus on automation among the attendees was refreshing and encouraging to see. If you were unable to attend and would like to see a copy of the presentations from this session, please e-mail me at bob@zynchros.com. As always, we’d appreciate your views and commentary. Please feel free to e-mail me those, too. Until next month. Bob |
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Formulary is Easy When You Make the Rules!
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| Web Cast: | Zynchros Commercial Plan Pro™ |
| Date: | Tuesday, May 13th |
| Time: | 8:30am - 9:30am Pacific Time; 11:30am-12:30pm Eastern Time |
| Speaker: | David Smith, VP of Product Management, Zynchros |
Would you like more information regarding the web cast or have any questions you'd like to have answered during the web cast? Feel free to contact us, we'd be happy to help you.
Zynchros Reporting Services—When you Want it Done Right, Right Away
We would like to thank those customers who used our PA Reporting Service for this latest CMS submission window. You know, first hand that our professional services team meets deadlines and satisfies requirements.
With the June and October CMS deadlines looming, we invite all of our Part D Pro customers to contact Zynchros professional services today, and arrange for all of your member reports and supplemental files to be created and managed by Zynchros.
Minimize the time you spend sweating the details and maximize your peace of mind! Contact us at service@zynchros.com to wrap up all of your reporting, today.
Managing Commercial Formularies with Rules
by David Smith, VP Project Management
Over the past two-plus years, we’ve focused on making Zynchros.com the best possible environment for managing closed formularies for the Medicare Part D program. CMS centered the program around the Formulary Reference File (FRF): a discrete and relatively short list of “proxy” NDCs, each representing the entire collection of products of a branded or generic drug, dosage form, and strength. We made it easy to select and apply tiers and UM edits to the NDCs from this list, and manage changes to your formulary when CMS added or deleted products from the FRF.
When it comes to managing the open formularies for commercial drug plans, the situation is quite different. Instead of a list of a few thousand “proxy” NDCs as source material, you have the entire drug universe numbering up to more than 50,000 NDCs. Plus, rather than dealing with a couple of dozen changes to the FRF every month, you can have as many or more changes every day across the entire drug universe.
More than a year ago, when we first kicked off a project to create a system for managing commercial formularies, we knew for these reasons alone that we needed something more than an NDC-based system. We discussed the challenges of managing commercial formularies with many of our customers. You told us you needed a way to manage large chunks of the drug universe in a single blow: for example, to assign all generics to Tier 1. You also told us about challenges you have keeping up with changes in the drug universe: on the one hand, you want to be able to simply handle routine changes (such as a new strength of an existing drug being made available), while still being able to react to special events on a case-by-case basis (like a new treatment for an entirely new disease class). You were especially concerned with the problem of not knowing exactly how a particular drug would adjudicate against the formulary, given the initial formulary design, subsequent changes in the drug universe, and any “special cases” that might have been communicated to or implemented by the adjudicator.
In response, we’ve spent the past year developing an entirely new module for the Zynchros.com platform, called Commercial Plan Pro. Our goals were:
- Make it quick and easy to create a new formulary by describing, as a series of rules applied to all drugs, not just a static list of NDCs
- Make it easy to update the formulary when the drug universe changes, while still being able to review and override changes
- Always maintain the intent of your formulary both as human-readable list of rules and exceptions, and as a canonical list of NDCs with their Tier and UM edits as would be reflected in the adjudication system
We’re very excited about this new module, and we hope you will be too. If you’d like to learn more about Commercial Plan Pro, I’ll be demonstrating this module at the upcoming NCPDP show in Scottsdale and delivering a webcast highlighting the new functionality on Tuesday, May 13th. You can find more details and registration information on the webcast information page. I hope to (virtually) see you there!
Please feel free to contact me at david.smith@zynchros.com with your questions and comments.
David
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David M Smith
VP Product Management
david.smith@zynchros.com
Tel: (206) 792 4108
Formulary Best Practices Whitepaper Now Available
Download Now
The drug formulary has served as the cornerstone for the administration of prescription drug benefits provided by managed care plans for more than thirty years. In today’s environment of rapid-fire changes to the drug universe, constantly evolving regulations and increasing demand for lower costs from consumers; pharmacy benefit administrators face new challenges in creating, maintaining and communicating pharmacy benefits to their many stakeholders. In this brief discourse, we review the evolution of the modern formulary, the strategic imperatives driving modern formulary management, and the best practices for creating, maintaining and communicating the modern drug formulary.
Tips and Tricks: HPMS Export Filename Demystified
By Scott Pillsbury, Director, Customer Service and IT
With the CMS submittal closing this past week, I’m sure everyone had an opportunity to export their formulary in the HPMS format once or twice. Each time you exported, you were prompted to save, FTP, or Email a file containing your formulary data. During this process, did you happen to take a look at the filename assigned to your export? At first glance, it may look like just a bunch of random letters and numbers, but there’s actually a method to the madness.
As you might imagine, it’s critical that each time you export your formulary it is given a unique name. But at the same time, it’s just as important for you to be able to identify it once it’s saved to your local system.
Here is a sample HPMS export filename: ID123456-HPMS2009-04232008-16242585062.txt
You may notice that the dashes (-) separate the key components of the filename. The first component (ID123456 in the example above) is the “HPMS Formulary ID”. This is an optional parameter for “Part D 2009” formularies that you may supply in the formulary properties page. This field is used to store the unique identification number supplied during your upload to CMS. Once you’ve saved this parameter as a formulary property within Zynchros.com, you won’t have to update it again. If you’ve left this field blank, or you’re exporting a non-2009 formulary, this section will be populated with the “name” you’ve given your formulary.
The second section (HPMS2009 in the example above) describes the “Formulary Type”. In this case, we know that the formulary exported is a 2009 Part D formulary. If you are exporting a “2008 Part D” formulary, this section will say “HPMS2008”.
The third section (04232008 in the example above) is the date that the file was exported. The number created is in a MMDDYYYY format, where MM= month, DD = day, and YYYY = year. In this case, the file was exported on April 23, 2008.
The fourth section (16242585062 in the example above) is an actual time stamp of when Zynchros.com compiled and created the file. The number created is in a HHMMSSNNNNN format, where HH = military hour, MM = minute, SS = second, and NNNNN = fraction of a second to the 5th decimal. So, in our example, we can tell that this file was exported at 16:24:25.85062 in the afternoon. Since our primary servers are located on the west coast, all times are in the Pacific time zone.
The last section of the filename is (.txt in the example above) identifies the file as a “text” file. This is a critical requirement when uploading to CMS. It also helps to associate the file to common viewers, such as Microsoft Notepad.
By including unique identifiers such as Formulary Name and/or HPMS Formulary ID, Formulary Type, and a date/time stamp to 1/100,000 of a second we are ensuring a unique export filename each and every time.
If you have any requests for future installments of “Zynchros Tips and Tricks” please send them to scott.pillsbury@zynchros.com. I look forward to hearing from you.
The Zynchros Website—All New for You
We just gave our website a complete makeover, adding new content and providing more information about our services and company. We hope you will take some time to tour the new site and send your colleagues to check us out. We have new downloads, new collateral and new information all waiting for you. Please let us know what you think by using the form on the Contact Us page. Thanks in advance for your feedback to help us make our site an essential resource for you and your teams.