Zynchros

In this Issue

• Musings, by Bob Pinkerton
• Zynchros e-Prescribing Certified Export Program, by Doug Stoddard
• Preview of Changes for Medicare Part D 2009, by David Smith
• Zynchros Welcomes New Customers
• Enhanced Member Formulary Service
• Tips and Tricks: Formulary Identities , by Scott Pillsbury

Musings

by Bob Pinkerton, COO

PHARMACY QUALITY MANAGEMENT

I was chatting with an old friend the other day, a veteran, high-tech start-up executive, and he asked me an interesting question. “I get what your company does today”, he stated. “But what is your vision and how do you communicate that in 30 seconds to your current and prospective customers?” I thought about that for a few seconds and told him we see ourselves as a driving force in quality for pharmacy benefits. “How so?” he followed up. At that moment I realized he was making the point that we have remained very focused on our Medicare Part D solution and, perhaps, have not done a great job of sharing the “big picture” with our entire community.

From its inception, Zynchros has had a laser-like focus on formulary management and regulatory reporting requirements for Medicare Part D. Our success, to date, has flowed from this specialization and we continue to grow that business.
But, in talking to our customers, it is very clear that the general shift of our industry - from a paper-based, “bricks & mortar” paradigm (analog health care) to a technology-driven online paradigm (digital health care) - has surfaced a number of issues that extend beyond our current offerings:

• How can we help our customers accelerate the promised ROI from e-Prescribing?

• What can we do to help customers who are facing the end of a generation of technology solutions that would be considered “back office” applications and bring them to a more modern infrastructure and delivery system?

• How can we truly help with, not just controlling pharmacy costs, but actually reducing the total drug spend?

• Can we really help our customers transition to an online world, especially as it relates to member experience, satisfaction and retention?

• How can we help to bring all of the pharmacy-related constituents together - doctors, patients, health plans, PBMs, retail pharmacy, etc. – into an online community where shared information is common knowledge and better prescribing decisions improve safety and efficacy, while reducing overall spending?

From the beginning, our vision was to develop a pharmacy technology platform that is based on a collaborative approach to pharmacy-based medicine. The first solution on that platform (Zynchros.com) was our Medicare Part D application, solving the very real pains the new program brought to payers. Now, we are positioned to deliver other applications that leverage the platform and integrate with each other.

The overall goal is to provide payers with a comprehensive, 360° view of all aspects of pharmacy benefits. From business intent to pharmacoeconomic strategy, from actuarial support to enabling new marketing approaches, from regulatory requirements to contracting and rebating – from P & T to the point-of-care™. We see a day when payers will be able to view a near real-time “dashboard” that shows how formulary decisions are being adjudicated, the financial impact of a formulary change or introduction of a new pharma rebate, and every aspect of your pharmacy spending – in the same way we can monitor stock price fluctuations today.

There are, to paraphrase Robert Frost, “… miles to go before we sleep …” in making this a reality. But, it’s good to have dreams and ambitions.

If you have other suggestions as to how we might integrate with your key systems or enable new aspects of your business, I’d personally love to hear from you. Sometimes just stating a dream out loud brings it closer to reality.

Bob

Zynchros e-Prescribing Certified Export Program

by Doug Stoddard, Director, Business Development

The need for high quality, up-to-date formulary information at the point of care is vital to facilitate clinical decision making and formulary compliant prescribing. Findings in the CMS E-Rx Report to Congress, released in April of 2007, highlighted that inaccurate formulary information was a significant factor in the adoption of electronic prescribing. Formulary information is not just a list of drugs; it is a fundamental element in the transformation of the healthcare value chain. [read more]

Enabling Quality Formulary Consumption at the Point of Care

One of the serious challenges most health plans face is determining exactly how to ensure their e-Prescribing initiatives reflect and enforce their formulary intent accurately across all of their stakeholders within the e-Prescribing loop. 

To assist health plans in ramping up their e-Prescribing initiatives quickly and easily, Zynchros has created the e-Prescribing Certified Export Program, which provides a friction free entry point to e-Prescribing by facilitating the dissemination of accurate formulary information.  The Certified e-Prescribing Export Program will:

• Reduce start-up costs e-Prescribing initiatives

• Improve the quality of your formulary information at the point-of-prescribing

• Eliminate confusion and incomplete data from third-party data vendors

The Zynchros e-Prescribing Certified Export will be branded and embedded within the Zynchros.com platform for ease of use and seamless integration Zynchros.com users will export their current, accurate and compliant formulary file directly to their e-Prescribing partners.

Zynchros is currently enrolling e-Prescribing vendors into the Certified Export Program and will make their export available within Zynchros.com.  If you are currently investigating an e-Prescribing vendor or you are interested in learning more please contact your sales representative via email at sales@zynchros.com or call 866.ZYNCHROS (866.996.2476).

Preview of Changes for Medicare Part D 2009

by David Smith, VP, Product Management

CMS has proposed a number of potential changes for formularies in the Medicare Part D 2009 program, compared to 2008. We've analyzed the draft Call Letter and the Paperwork Reduction Act filings from CMS, and identified the following significant changes:

• A new “Step Therapy Type” field in the HPMS formulary file, to declare when step therapy applies only to new starts

• A new “Prior Authorization Type” field, declaring when PA applies only to new starts or to Part B adjudication only

• New supplementary formulary files for:

• OTC drugs

• Home Infusion drugs, and

• Excluded drugs

• Prior Authorization file now required as a flat, tab-delimited file

The final call letter is due to be published on March 15th, and assuming there are no major discrepancies from the draft version; we are planning to release an update to Zynchros.com on March 21st with new functionality to help you prepare for the Part D 2009 formulary submission window opening on March 31st. We previewed the upcoming changes in a webcast on March 11th – thanks to everyone who attended and provided us with valuable comments and feedback. Links to the recording, presentation and Q&A are being sent to everyone who registered for the session under separate cover.

Coming Soon to Zynchros.com:

New Tools for Creating Formularies for the Commercial and Medicaid Markets
Our R&D team here at Zynchros is in the process of finalizing new functionality that will revolutionize your process for creating and maintaining formularies for commercial and Medicaid prescription drug plans. If you (or someone you know) currently manages formularies for plan types other than Part D, and would like to preview our new features, we'd be happy to give you a tour of the new beta-test version and get your feedback on our design. If you are interested in taking a look, please email me at David.Smith@zynchros.com.
--
David M Smith
VP Product Management
david.smith@zynchros.com
Tel: (206) 792 4108

Zynchros Welcomes New Customers

Fallon Community Health Plan

Founded in 1977, Fallon Community Health Plan provides health care services designed to meet the unique and changing needs of all we serve. FCHP is the only health plan in Massachusetts that is both an insurer and provider of care. Fallon (FCHP) serves the healthcare needs of approximately 200,000 members. Fallon decided to use the Zynchros.com platform to streamline their Medicare Part D formulary management and submission.

Presbyterian Health Plan
For nearly 100 years, Presbyterian has been committed to a single purpose -- improving the health of individuals, families and communities throughout New Mexico. Presbyterian is a vertically-integrated healthcare system with both a healthcare delivery network and an insurance company. They are extremely focused on quality and have achieved NCQA ratings of “Excellent” in 3 separate lines of business. The Zynchros approach to Pharmacy Quality Management resonated with this initiative and we were a simple choice for expanding quality at Presbyterian.  Presbyterian is using the Zynchros.com platform to manage formularies in each of their Medicare, Medicaid and Commercial lines.

Thank you for your business and welcome to the Zynchros.com family.

Enhanced Member Formulary Service

If you are still wrestling with producing member formulary reports that meet your marketing requirements and the CMS marketing guidelines, please stop now!

Zynchros, the leader in Medicare Part D solutions, has introduced a new service to produce member formulary reports to your exact specifications:

• Custom therapeutic classification schemes

• Abridged and Comprehensive formats

• Utilization management edits

• Tier and coverage information by drug name and/or strength

• Guaranteed to meet or exceed CMS specifications

• Delivery as a finished report or in a broad range of intermediate formats including Microsoft® Word, Adobe® InDesign® and Adobe® PDF

• Monthly, quarterly or annual production

To reduce the cost and effort of producing CMS-compliant member formulary reports please call one of our CMS experts at 1.866.ZYNCHROS (1.866.996.2476) or e-mail us at member.formulary@zynchros.com.

Tips and Tricks: Formulary Identities

By Scott Pillsbury, Director, Customer Service and IT

If you intend to export a file in either the DestinationRx, RxHub*, or NCPDP file format out of Zynchros you will need to use the "Identities" feature to populate key information that will uniquely identify your exported formulary to the recipient.

Depending upon the export format you choose, you will need to provide additional information such as:

• Unique formulary ID

• Username

• Password

• Contract ID

• Version

This additional information is used to identify your formulary and is typically supplied to you by the recipient of the file. Once you've saved these parameters within Zynchros.com, they will be available to you each time you export.

To use the Identities feature simply login to Zynchros.com, navigate to your formulary list, and select the "Identity" button located to the right of the formulary name. You will now be in the "Manage Your Formulary Identities" screen.  From here you will select the “Edit” button and enter the appropriate information for the type of export you are making.  When finished, you will then need to “Save” your changes.

It's that simple! Each formulary may have multiple identities associated to it. This allows you to create unique file exports for Destination RX, RXHub, and NCPDP formats, using the exact same formulary data; saving you time and ensuring consistency of your data across all of your export recipients.

If you have any requests for future installments of “Zynchros Tips and Tricks” please send them to scott.pillsbury@zynchros.com. We look forward to hearing from you.

*RxHub export available to subscribed customers only.