In the world of infused or injected drugs, there’s a little technical term called J Codes. And, they are considered to be one of the biggest enemies of your benefits plan.
WHAT IS A J CODE?
Essentially, a J Code is the designation given to a drug that requires infusion or injection by a medical professional in a medical facility. Therefore, a J Code is billed through your insurance benefits as a medical expense. Here’s the catch: drugs that are billed as a medical expense are a lot more expensive than drugs billed as a pharmacy expense. But, you wouldn’t know that, because no one is going to tell you.
So, the more often you can move drugs out of the J Codes designation and bill them as a pharmacy expense, the better (and cheaper). There’s a lot more to it, but that’s the gist.
HOW CAN YOU REDUCE COST?
Our True Codes program has several levers to pull to reduce cost. We all know that as soon as you walk into a hospital, it will be expensive. Hospitals are prepared to treat many urgent and life-saving emergencies. However, for some patients, infusion treatments are not emergency situations and do not need to be administered in a hospital setting. Our nurse navigators can find the same treatment available at an infusion center, rather than through a hospital. For further care, convenience, and cost savings to the patient, our nurse navigators may discover a more convenient location to administer infusions, turning a one-hour commute into a 10-minute commute.
AN EXAMPLE OF COST SAVINGS
Moving from a medical cost to a pharmacy cost, let’s break it down to dollars and sense. One of our patients is a firefighter. He was receiving an infusion for Remicade at a local hospital. Working hand-in-hand with the doctor, our nurse navigator found an infusion center five miles away from the firefighter’s home. The infusion center provides longer hours during the week and weekend hours, perfect for a first responder’s schedule. He now receives the exact same medication infusion in a location with more convenient hours and closer to his home. The employer, a city providing benefits funded by taxpayers, saves thousands of dollars. Our nurse navigators can find savings with every single patient prescribed Remicade with patient care always as the priority.
THE BOTTOM LINE
Our True Codes program can optimize the care and convenience of the patient, while reducing costs for the employer. This is just one of the ways that True Rx Health Strategists can find hidden paths to cost containment.