Pharmabayonline offers our members the only accurate and real-time Pharmacy Acquisition Cost (PAC) benchmark in the pharmaceutical industry. There are a multitude of uses for PAC because new federal healthcare legislation is predicated upon the use of cost savings metrics and to this point, no other organization provides the accuracy and real-time cost comparisons found on this website. We are convinced that Medicare Advantage and Part D drug savings will eventually be incorporated under the ACO umbrella.

Accountable Care Organizations were made possible by our new healthcare law and the Centers for Medicare & Medicaid Services (CMS) expect they will improve coordination of benefits while significantly lowering costs.

An Accountable Care Organization (ACO) is a type of payment and delivery reform model that links provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients. A group of coordinated healthcare providers form an ACO, which then provides care to a group of patients.

Pharmabayonline.com provides Accountable Care Organizations with a website to determine the percentage cost savings on each generic pharmaceuticals based on comparisons to the Federal Upper Limit (FUL) which is utilized by the CMS as a benchmark metric ceiling for reimbursement and cost savings.

The Pharmabayonline website provides states with the pharmaceutical compendium for structuring their state Medicaid reimbursement metrics. Payer’s now have the ability to evaluate their formularies for accuracy and transparency and to reconcile costs and reimbursements.

Our PAC is also compared to the National Average Drug Acquisition Cost (NADAC) because this benchmark is provided to all states to be utilized in their Medicaid reimbursement methodology. Our website provides the ACO with real-time data regarding percentage savings available in the marketplace when compared to FUL or NADAC, as well as pharmaceutical savings and costs in comparing generic pharmaceutical substitutions.

The NADAC files are designed to provide information regarding drug prices for state review. If a state chooses to use the NADAC or a different pricing methodology as a basis for payment, it will need to submit a state plan amendment in accordance with the state plan. CMS is issuing these NADAC files to make acquisition cost information available to the states. If states choose to revise their reimbursement methodology and to use NADAC as a basis for payment, they must submit a state plan amendment (SPA).

A review for reimbursement accuracy and need for cost reimbursement adjustment can be substantiated through the CMS help desk. A singular request will initiate an evaluation of accuracy for a given reimbursement. Therefore, Pharmabayonline will prove valuable in correcting inaccuracies in drug reimbursements at all levels, as well as providing ACO’s with drug cost savings on outpatient Medicaid. With the current demand for cost transparency, PAC will soon become the standard pharmacy acquisition cost benchmark in determining commercial MAC reimbursement accuracy and cost savings.