OCS Slideshow

  • View

  • Download

Embed Size (px)


Slideshow for OCS reps to train and show their practitioner prospects.

Text of OCS Slideshow

  • 1. 1

2. About Us 2 What we do We are a clinical software management platform, not a compounding pharmacy. We are not asking you to send us prescriptions. Our service helps doctors manage the complex process of dispensing compounded topical medications from their own offices. We offer a turnkey solution designed to minimally impact the providers daily workflow. Results Highly effective and convenient treatment for patients. More than 75% of your patients would prefer receiving their medications during their office visit Bring additional revenue in-house. Increase patient compliance. Cost containment to healthcare system. 30% of all prescriptions are never filled According to the Institution for Safe Medicine Practices, pharmacy "call backs" cost your practice an average of $6 per call or $30,000/year. 3.3 Million adverse drug events occur each year from inaccurate information relayed to the pharmacy at a cost of $250B annually. 3. What is Compounding Before the widespread distribution of manufactured products, most prescriptions were compounded. Today only about 5% of prescriptions are compounded. Compounding exists today as a means to create custom tailored medications for a patient without having to go through the FDA approval process. When to use a compounded medication? Combining medications that are not commercially available. Creating custom doses that not commercially available. Altering the administration route of a medication (vs. oral). Sterile vs. Non-sterile compounding. 3 4. Pharmacist Recommended Formulas Pain Management 4 ID Formulation Anticipated Use PM-1 4.0% Flurbiprofen 4.0% Cyclobenzaprine 4.0% Baclofen MSK Pain PM-2 4.0% Flurbiprofen 4.0% Piroxicam 4.0% Lidocaine Joint Pain PM-3 4.0% Gabapentin 4.0% Baclofen 4.0% Lidocaine Neuro Pain * Custom formulations available on request Drug Info Classification Flurbiprofen Non-steroidal Anti-inflammatory (NSAID) Cycloenzaprine Muscle Relaxant Lidocaine Local Anasthetic Baclofen Muscle Relaxant Piroxicam Non-steroidal Anti-inflammatory (NSAID) Gabapentin Anticonvulsive Agent PLO Base Transdermal Cream, Absorbs Hydrophilic and Lipophilic Drugs 5. Pharmacist Recommended Formulas WoundCare & Scar Prevention 5 ID Formulation Anticipated Use WS-1 4.0% Phenytoin 4.0% Itraconazole 4.0% Muprirocin 4.0% Lidocaine 2.5% Pentofixylline Post-operative formulation for accelerated wound healing and pain relief. WS-2 4.5% Phenytoin 4.5% Metronidazole For wounds with no pain but have odor WS-3 4.1% Phenytoin 4.1% Metronidazole 8.2% Lidocaine For painful wounds with odor WS-4 4.3% Metronidazole 4.3% Pentofixylline 4.3% Lidocaine For diabetic ulcers and pressure sores Drug Info Classification Phenytoin Promotes granulation, decreases exudates, alleviates pain, has antimicrobial properties, and counteracts inflammation Itraconazole Anti-fungal Agent Lidocaine Local Anasthetic Mupirocin Antibiotic Agent Metronidazole Antibacterial and antiprotozoal agent with effective coverage against many anaerobic organisms and used topically it provides control of wound odor Pentoxifylline Increases blood flow and oxygen delivery to the wound site improving circulation and when used topically, it can improve the rate of wound healing by improving the ability of calcium blockers to reach the wound tissue. SteraBase Water Washable Wound Care Base 6. Compounding vs. Manufacturing A compound is by definition a Patient Specific Medication. Not regulated by the FDA, our system does not go through FDA approval process. Ingredients are FDA approved for safety and stability. Compounding is instead governed by USP 795 Guidelines. Repackaging and re-labeling not state or federal compliant. A compound is called by its generic name. (ex: 20% Baclofen) Free samples / promotion of compounds are not common practice. Compounds cannot be transferred or sold between pharmacies. 6 7. Physician Dispensing Regulations State by State 7 8. OCS Requirements Provider Licensing (differs state by state) Compounding can be performed by any clinical employee but must be signed off by MD, like any prescription normally would. Governed by same state pharmacy laws as dispensing. Governed federally by USP 795 Guidelines for low risk non-sterile compounding. Most states do not mandate / enforce that these guidelines are upheld, however OCS will require you to. Facility Requirements The designated workspace should be in a clean well lit area. A minimum of 3 x 3 of counter top is recommended. Cabinet to store medications. Computer with internet access nearby. OCS will provide all other necessary equipment (Mixing machine, label printer, labels, scale, small refrigerator, etc.) 8 9. Compounding Area Setup Most facilities can be setup in less than an hour! 9 10. Workflow Integration 10 Designed with minimal impact to workflow. Each compound takes less than 3 minutes to make and dispense. Medications will come pre-measured for weight and volume. Utilize innovative mixing & dispensing jar. Value of Software Automated inventory & expiration management and private insurance adjudication. Generates labels, formula worksheets, and records compliant with USP 795 Guidelines. Accounting, Reporting and Tracking Features Once dispensed, the prescription is transferred over to our highly specialized billing team. OCS will bill and work the claim on the providers behalf, returning 50% of net collections on a monthly basis. Starting 45 days after dispensing the provider will begin to receive reimbursement from the insurance companies. 11. Medication Packaging 100g PLO Kit (2 part) Highly effective transdermal gel used in pharmacy compounding. Two part kit, when combined transforms into smooth cream. Hydrophilic Absorbs hydrophilic drugs. Liquefies below room temp. Lipophilic Absorbs lipophilic drugs. Liquefies at room temp. Prepackaged Medications Highly Accurate (Tested to within 1% of expected weight). 11 12. Innovative Mixing / Dispensing Jar Integrated Mixing / Dispensing Jar Easily attaches to OCS mixing machine. Integrated design, no need to transfer after mixing. Disposable blade will stay in jar after mixing. Designed to hold up 100g-140g of topical cream (30 day supply). Patient friendly design, push bottom to dispense. 12 13. Covered Insurances Commercial Insurance Electronic Billing About 50% of plans will cover compounding, and co-pay may be involved Adjudication is real-time, payment cycle is 30 days. MD never has to roll the dice or guess for coverage and patient responsibility Workers Compensation & PIP Paper Billing on HCFA 1500 Bills under codes 99070, DSPNS, COMPD (Depending on Carrier) Billing cycle takes anywhere from 45-120+ days Medicare OCS will not work any federal funds for our program. Medicare will not cover compounded medications. Cash Pay Providers may bill patients directly if the service is not covered. OCS will charge a $30 software/service fee for these claims. 14 14. 15 Coverage and Patient Responsibility may vary across plans and carriers There is no way of knowing this prior to adjudication, however provider may discover patterns with certain carriers. Reimbursement is determined off contracts negotiated with Payors and PBMs prior to starting. OCS works as a PSAO (Pharmacy Service Administration Organization) to actively negotiate and maintain these contracts on behalf of the provider. We work in a standard fashion as a 3rd party billing service. Typical contracts are for 70%-80% of AWP (Average Wholesale Price or maximum allowable by state). Commercial Contracting Overview 15. Commercial Insurance - Process 16 Using OCS Rx the provider submits a request for adjudication. Our specialized team submits the claim electronically and within 15 minutes returns adjudication information. Reimbursed Amount Patient Responsibility The provider will then have the option to dispense to the patient or to return the compound to inventory. If returned claim will be reversed within 24 hours. In the event a compound is not reimbursed, the cost of meds will be refunded back to the MD On a monthly basis OCS will return 50% of net collections to the provider and provide detailed reports for accounting. Net Collections = Gross Collections Cost of Medications 16. Billing Information WorkersComp / PersonalInjury- Overview 17 At the time of dispensing the provider will submit their Usual & Customary Charges. OCS will verify patient / insurance information, then generate and send the claim out on a certified claim form (HCFA-1500). Codes Used: 99070, DSPNS, or COMPD. Each component submitted as a line item detail. OCSs highly specialized billing team will work the claim and post payments w/ EOBs attached. On a monthly basis OCS will return 50% of net collections to the provider and provide detailed reports for accounting. Net Collections = Gross Collections Cost of Medications 17. Representative Role Quoting and Enrollment 1. Gather desired formulary and ingredients from MD 2. Negotiate 50/50 or 40/60 terms 3. Acquire volumes by payor (WC & Commercial) 4. Create Pro-Forma and generate forms (with initial order $) 5. Include proposals and legal letter of opinion in marketing folder 6. Collect signatures and down payment 7. Scan all necessary documents 8. Upload into software for approval 9. Contact distributor to arrange training/setup schedule ***BECOME A MASTER THE SOFTWARE, IT IS OUR VALUE AND THE CORE OF OUR BUSINESS!!*** 18 18. www.officecompounding.com matthew@diagnosticsalesconsultants.com (423) 310-0233 19