US PATENT AND TRADEMARK OFFICE GRANTS PATENT TO VENTEGRA FOR ITS ACQUISITION COST INDEX (ACI) COST-PLUS PRICING REIMBURSEMENT TECHNOLOGY PLATFORM FOR PRESCRIPTION DRUGS
GLENDALE, CA – The US Patent and Trademark Office (USPTO) has granted US patent number 11,023,979 B2 (June 1, 2021) that covers Ventegra's Acquisition Cost Index (ACI) cost-based reimbursement technology (Reference Price Index) through 2034.
Ventegra, a leader in transparent, cost-plus pricing methodology, is a new class-of-trade Medical Benefit Manager (MBM) that manages healthcare costs to help clients gain efficiencies, lower expenditures, and improve the overall quality of care.
This recently issued patent covers the ACI technology that powers Ventegra's reimbursement platform to ensure that Ventegra reimburses pharmacies and bills payors based on current market conditions and drug costs. The technology makes it possible to replace antiquated reimbursement practices, certifying that clients are billed the same amount as the pharmacy was paid.
The ACI was developed out of 400-plus years of combined pharmacy benefit industry experience. Ventegra's industry experts recognized that the reimbursement paradigm needed to be reset, and subsequently began operating a successful ACI pharmacy network based on this proprietary and now patented technology in 2013.
By updating prescription costs daily and eliminating disputes from pharmacies about reimbursement, the ACI renders obsolete manually derived cost lists. Typically used by traditional Pharmacy Benefit Managers (PBM's), these lists are updated arbitrarily with multiple costs possible for a given drug.
Utilizing its patented ACI solution, Ventegra operates its 67,000-plus national pharmacy network with greater administrative efficiency, eliminating the hidden spread, clawbacks, and additional charges that plague the traditional PBM business model.
The ACI provides an auditable trail of the billing and payment of every single claim based upon a single consistent cost for each drug, assuring that payors and patients are never overcharged through hidden margins. Ventegra's ACI is available for evaluation and validation to all participating pharmacies and clients on a daily basis.
The Ventegra ACI claims processing platform reflects information available for each day's drug cost and market availability every 24 hours, 365 days per year in a fully automated and transparent manner. For example, if a drug became available on the market or was subject to a shortage, the Ventegra ACI pricing technology would immediately reflect this in adjudicating prescriptions, consequently ensuring an equitable payment for prescription claims for the payor, patient, and pharmacy.
Ventegra CEO Robert T. Taketomo, Pharm D, MBA, says, "Ventegra is the first and the largest Medical Benefit Manager in the nation, which is not a PBM nor Group Purchasing Organization, to benchmark itself off our patented Acquisition Cost Index (ACI) that provides the real-time data needed to accurately reimburse pharmacies based on current market conditions and drug costs. This system provides our clients with the assurance that what is billed to them is what was paid to the pharmacy, and both client and pharmacies have access to this cost information to validate each transaction."
Adds Taketomo, "We are pleased that the US Patent Trademark Office has recognized the uniqueness of our Ventegra ACI technology and granted this patent. The patent strengthens the differentiation of Ventegra among its competitors and provides the protection of our ACI product for sustainable competitive advantage in the marketplace, further solidifying Ventegra as a 'force for good' and leader in transparent, cost-plus pricing methodology."
ABOUT
Ventegra uses innovative programs and products to ensure appropriate use of prescription drugs while lowering our clients' costs. As a Medical Benefit Manager (MBM), we are a new class-of-trade healthcare model that helps clients gain efficiencies, lower expenditures, and improve the overall quality of care. Our offerings include innovative, cost-saving solutions designed for medical groups, health systems, self-insured plans, TPAs, government entities, brokers and consultants, and nonprofits. Ventegra's leading-edge MBM model coupled with a solid foundation of company stability and community commitments, has made our company a powerful force in the healthcare industry since its formation in 2004. We are part of an elite tier of Certified B Corporations that hold each other accountable to maintaining a balance between purpose and profit. www.ventegra.com
Our drug list and formularies are designed to provide our clients with a choice of pharmacy products that meet all of the essential clinical conditions while addressing economic needs, and providing quality of care, affordability and choice.
Ventegra was founded to create balance between profitability and affordable patient care in an industry burdened by misplaced priorities. Our team applies our core values of integrity and transparency to create new healthcare delivery channels that are more consolidated and efficient. We channel our resources to positively impact the lives of others and create value for society as a whole.
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Ventegra has adopted a General HIPAA Compliance Policy in order to comply with the Health Insurance Portability and Accountability Act (“HIPAA”), as amended by the Health Information Technology for Economic and Clinical Health (“HITECH”) Act of 2009 (Title XIII of division A and Title IV of division B of the American Recovery and Reinvestment Act “ARRA”) and the HIPAA Omnibus Final Rule (Effective Date: March 26, 2013). We acknowledge that full compliance with the HIPAA Final Rule is required by or before September 23, 2013.
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What are Fraud, Waste, and Abuse?
FRAUD is generally defined as knowingly and willfully executing, or attempting to execute, a scheme or artifice to defraud any health care benefit program or to obtain (by means of false or fraudulent pretenses representations, or promises) any of the money or property owned by, or under the custody or control of, any health care benefit program. (18 U.S.C. § 1347)
WASTE is overutilization of services or other practices that, directly or indirectly, result in unnecessary costs to the health care system, including the Medicare and Medicaid programs. It is not generally considered to be caused by criminally negligent actions, but by the misuse of resources.
ABUSE includes any action(s) that may, directly or indirectly, result in one or more of the following:
Unnecessary costs to the health care system, including the Medicare and Medicaid programs
Improper payment for services
Payment for services that fail to meet professionally recognized standards of care
Services that are medically unnecessary
Abuse involves payment for items or services when there is no legal entitlement to that payment.
How to Report Fraud, Waste, and Abuse
If you suspect fraud, waste, or abuse in the healthcare system, please report it. To report suspected fraud, waste, or abuse, you can contact Ventegra:
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