Today PillarRx’s Vice President, Tammy Miller, is sharing with you about an opportunity with J-Codes and pharmaceuticals.

Watch the full video below:

What are J-Codes?

A J-Code is a service ID that is used in the medical world. Clinics, physicians, and hospitals will submit J-Code IDs on the invoice to either the carrier or the payer for services rendered to a patient.

J-Code IDs can represent a variety of services including procedures, lab tests, pharmaceutical products that are actually filled within the clinic setting.

Related: J-Code Analysis: An Overview for Managing Specialty Drug Costs

Is it more price advantageous to go through the pharmacy benefit or the medical benefit for pharmaceuticals?

With all of the analyses we have done at PillarRx, we have found time and time again that for most drugs, it is more advantageous to go through the pharmacy benefit. There are a couple of reasons for that:

  1. PBMs are working constantly to drive overall costs down. They are contracting with pharmacies to garner better discounts on the drug cost itself
  2. Rebates in the pharmaceutical world are more aggressive than what we find in the medical setting. There are a lot more savings to be garnered through that channel as well.

Clinical Standpoint – What is the best practice?

There are some products that should be administered in a clinical setting. That doesn’t mean the cost of those products needs to go through the medical benefit. You can have the best of both worlds for some of those products. You can fill that prescription through the pharmacy benefit side, then the pharmacy would shift or send that to the clinic setting to be administered to the patient.

We see 10% savings sometimes greater on the rebates alone, which doesn’t include the lower costs you can garner through the pharmacy benefit. It is worth your while to see where it is best for you that those drugs are being filled through.

Double Dipping

Sometimes we find pharmaceutical products are being filled both in the medical and the pharmacy benefit at the same time. That is wasteful spending, so what we will do is help identify those opportunities and have that only going through the pharmacy benefit or the medical benefit, depending on which is more advantageous.

Interested in learning more about J-Code analysis? Reach out to us at sales@PillarRx.com. We welcome your questions and are here should you need pharmacy expert assistance.