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About Client

The Client, a leading U.S. pharmacy benefits manager, provides automated solutions that help community health organizations such as labor unions, private & public employers, government agencies, and individuals manage 340B, PAP, GPO, and other discount drug programs and conform to government-specified regulations. For nearly a decade, The Client has been delivering Pharmacy Benefit Management (PBM) solutions to large employer groups.

Back in the year 2008, this pharmacy benefits manager (The Client) had started partnering with leading community health administrators, doctors, and pharmacists. The goal was to empower them to access their flagship 340B simplified software solution to help them serve their patient population and the community at large. Today, the community healthcare organizations nationwide rely on The Client for the US federal government approved 340B and other drug discount programs that are simple, cost-effective and worry-free to manage.

PROJECT DESCRIPTION

The Client implementation is a Virtual Inventory System (VIS) which supports the 340B federal drug program. It’s a federally-compliant program that provides drugs at significantly discounted prices to eligible safety-net healthcare organizations/covered entities known as Health Centers in the US.

The virtual inventory software technology was designed to provide Health Centers (340B-eligible entities and pharmacies) with greater inventory control over its specialty 340B prescription drug program. The federal 340B program combines traditional Prescription Benefit Management (PBM) with the power of user-friendly, web-based technology to allow the Health Centers to track eligibility, manage inventory and ultimately provide greater access to 340B meds for patients.

PROJECT GOALS

The objective of the flexible and fully configurable web-based Virtual Inventory (340B) solution was to fulfill the 340B goals of the eligible Health Centers nationwide. In accordance with federal regulations, the application is HIPAA/HITECH regulation compliant.

Apart from the automated wholesale ordering and approval process, the web-based system manages the flow of information, payments, and inventory interfacing between Covered Entities, Pharmacies, and Wholesalers, in a fully transparent way. The implementation benefits of the new virtual information system deployed were:

• Patient Assistance Program (PAP) – enrollment, eligibility, and reporting is now easier than before
• Helps in excellent coordination and billing to 3rd parties.
• Creates med order for 340B NDCs meeting thresholds
• Manages “Medicaid drug carve-out” prescriptions to increase revenue
• Reduces time in maintaining expired inventory and carrying costs
• Automated drug formulary and sliding fee program schedule
• Economies of scale and reduced paperwork
• Opportunity for out-of-pocket cost savings for patients
• Faster processing time for payment of claims
• Automated reporting and reduced paperwork
• Ensures patients pay the lowest price for medications

Eclature’s Solution & Contribution

Upon careful consideration of a number of software solution providers, The Client preferred partnering with Eclature Technologies to conduct detailed case evaluations of the PBMs and develop a solution that simplifies program administration for covered entities, automate their processes, and keeps track of medications dispensed to 340B patients.

Eclature implemented the Virtual Inventory System, specialized replenishment, and management software, which is not only scalable, robust, and reusable but also a high-performance automated system. Shown below are some of the finer characteristics of the flexible and fully configurable VIS application we developed for The Client:

• Ideate, Build, and Support – the end-to-end application development.
• Technology Partner – as an IT think-tank to automate and upgrade The Client’s software applications and processes.
• Workflows Automation – all the workflows are automated to ensure that each transaction happens in real-time.
• Integration Engine – implemented BizTalk Server, an integration engine to process incoming messages for automation.
• Claims Processing – processing of incoming claims file and applying the business rules.
• Purchase Order Processing – processing Purchase Orders and correlating the incoming purchase order acknowledgments with correct purchase orders.
• Order Update – oversees stock levels with 360-degree, real-time visibility, and up-to-date status of drug prescription orders and the inventory system in real-time, a real-time inventory order replenishment.
• Third-Party Integration – the new system integrates with different third-parties like 340B‐qualified Health Centers (FQHC), Pharmacy Benefit Manager (MedImpact), Wholesalers (Cardinal), and Switches (switch vendors) which required running the 340B program in real-time using MS BizTalk Server.

Core Applications

  • Virtual Inventory 340B Discount Drug Pricing Program
  • Back Office System
  • EDI Processing Engine
  • Business Intelligence
  • Data Warehousing

Eclature’s Offering

• Custom Application Development
• Application Integration
• Mobile Application Development
• Workflows Automation
• Integration Engine – BizTalk Server
• Automated Nightly builds with NAnt and CruiseControl.NET
• Secure client intellectual property in Source Control
• Implement Efficient Design Patterns
• Code Capitalization
• Stand up Meetings
• Business Intelligence and Data Warehousing Implementation
• Production Support

Technologies Used
  • .NET
  • AJAX
  • BizTalk 2006 R2
  • SQL Server 2008
  • SQL Server Reporting Services
  • Web Services