Biotech Modeling

Fully automated, digital, customizable, web-based modeling of the impact of Specialty Medications on budget impact, plan/group filters, total cost of care, age/gender demographics, comparative and clinical impact.
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Map Your Current Biotech Utilization and Spend

Pro Pharma utilizes both the Medical and Pharmacy paid claims to analyze previous claims experience and to develop a model to project future trends. These issues center on the need for drug specific claims information, processing rules to ensure accurate quantities and maximum payment amounts, and rules for processing miscellaneous claims. The model can be updated with enhancements expeditiously given new Medical and Pharmacy claims experience.

Pro Pharma can identify immediate savings opportunities through e-modeling of claims processing procedures, and longer-term savings through technology assessment and utilization management. Additional research and analyses can be performed to determine the biotechnology drug driven costs in procedures, diagnostics, and provider time. It is expected that these adjunctive costs will represent an ever-larger portion of the ambulatory experience downstream.

We are able to:


  • Map your current Biotech utilization and spend
  • Project Biotech trend
  • Model Biotech utilization by drug category or any other drug grouping (client specific)
  • Identify cost by ICD9, CPT HCPC code


The cost of the biotechnology drug segment is increasing nationally at 17% per annum. There are currently over 100 biotechnology drugs on the market. These medications are manufactured from living organisms that produce genetically modified molecules or genetic variations of naturally occurring molecules.


For Pricing Call: (888) 701-5438