Pharmacy Management Consultants

About Us

Primary Components of Pharmacy Management Consultants:

Prescription Drug Management Initiatives

PMC has ongoing initiatives that provide OHCA with a comprehensive ambulatory pharmacy management program optimizing pharmaceutical therapies to SoonerCare members and ensuring cost-effective utilization of State resources. PMC implements and maintains the following initiatives for OHCA:

  • State Maximum Allowable Cost (SMAC) Initiative

    This initiative includes evaluating the appropriateness of the HCFA Federal Upper Limit (FUL) and establishes the SMAC level reimbursement for generic medications.

  • The Product Based Prior Authorization (PBPA) Initiative

    This program identifies therapeutic categories where medications could be differentially grouped based on clinical efficacy, side effects and the cost of each medication. PMC provides the analysis and production of economic data supporting the proposed additions to the PBPA program in compliance with any mandated statutory format. Support of this program is affected through the Pharmacy Help Desk via the prior authorization process. Total savings from the PBPA program was estimated to be over $5.2 million for Federal Fiscal Year 2009.

  • Provider Education and Profiling Initiative

    This initiative includes enhancing current provider education activities, quarterly provider newsletters and retrospective patient profiles, and includes communication of optimum therapy information, recommended treatment protocols and clinical updates of the literature.

  • Therapy Management Initiative

    This initiative utilizes individual case management techniques for those Medicaid members consistently using a large number or high dollar amount of pharmacy services. Medication profiles are reviewed for therapeutic duplication, drug-drug interactions, drug-disease interactions, contraindications, appropriate dosing and other measures of therapeutic appropriateness using principles of evidence-based medicine.

Pharmacy Lock-In Program

Member lock-in is designed to address pharmacy over-utilization patterns by SoonerCare members. PMC uses statistical norms, referrals and data searches to identify members who fall outside the normal utilization patterns of use. Recommendations are made to OHCA by PMC to lock-in these members. The members can be assigned a primary physician and/or pharmacy.

Data Analysis and Reports Preparation

PMC provides data analysis and report preparation services for OHCA. Projections and trends in pharmaceutical utilization and economic outcome reports are prepared by a research manager and other clinical pharmacists.

Drug Utilization Review (DUR) Services

PMC plans the agenda and supports the monthly DUR Board Meetings under the advisement of the Oklahoma Health Care Authority and the DUR Board members. All DUR Board correspondence is developed and handled by PMC. An annual report prepared by PMC for the Centers of Medicare and Medicaid Services (CMS) describes the nature and scope of the prospective and retrospective DUR programs; summarizes the interventions used in all reviews and the education program of Board activities; and identifies the DUR programís impact on quality of care as well as any cost savings generated by the program.

PMC assists OHCA staff with the development, implementation and maintenance of an on-line prospective DUR system. Clinical reviews and criteria reports are provided by PMC to OHCA and the DUR Board. Total savings from the Prospective DUR program was estimated to be $4.4 million for Federal Fiscal Year 2009.

PMC prepares monthly retrospective drug reviews for OHCA and the DUR Board. These monthly DUR reports include criteria-based reviews, patient management and population-based reviews.

Prior Authorization (PA) Services

PMC evaluates medication prior authorization (PA) requests and provides the results of approval, denial and/or more information requested to the dispensing pharmacy within 24 hours from the time the completed request was received by PMC. Clinical pharmacists are used to evaluate PA requests. Pharmacists respond via phone, fax or mail to providers and patients when questions arise pertaining to the PA process. PMC evaluated over 140,000 PA requests for Federal Fiscal Year 2009.

Pharmacy Help Desk

A call center is provided to help health care providers resolve technical and programmatic issues related to pharmacy coverage and prescription claims adjudication for Oklahoma SoonerCare members. The call center is open seven days per week except for holidays and handled over 135,000 calls from pharmacies, physicians and members in Federal Fiscal Year 2009.

Educational Activities

PMC develops and designs outreach programs to educate practitioners on common drug therapy problems with the aim of improving prescribing and/or dispensing practices. Educational training (experiential learning) is provided to pharmacy students, managed care clinical pharmacist residents and College of Pharmacy faculty. Additionally, graduate research assistants benefit from working on Oklahoma SoonerCare pharmacy program projects of interest to OHCA.