TRICAST® Gap-Onomics: Best Practices Validation Services for Pharmaceutical Manufacturers

MILWAUKEE, Feb. 22, 2012 /PRNewswire/ -- TRICAST, Inc. announced today that it is deploying a new analytical oversight program to support pharmaceutical manufacturers who need to validate the prescription dollars being spent on Medicare, within the Coverage Gap, or "Donut Hole."

Pharmaceutical companies have long been concerned about the quality of the Medicare data they receive from the Centers for Medicare & Medicaid Services. With good reason, as it turns out: Several manufacturers were stunned to see dramatic increases in their fourth quarter Medicare Gap invoices for 2011. Increases came as a direct result of low volume claims being added, due to CMS billing for low volume claims on a single calendar year interval.

"This dramatic dollar amount increase was not anticipated within their invoice cycle and some manufacturers are now looking to verify the validity of their pharmacy claims. What became a small outlay on the onset has become a major liability in terms of funding," said Rob Shelley, Sr. Vice President of Business Development.

How Can TRICAST Help?

By leveraging Medicare Part D experience and identifying these issues, TRICAST(R) has developed unique software and applications to help identify and validate correct application of the Gap invoice.

"Drug manufacturers are among the many stakeholders within the Medicare Part D benefit that require verification that dollars related to Medicare claims are correctly administered," said Shelley. "Many manufacturers have expressed concerns that once all applicable discounts are applied to their drugs that the cumulative amount of discounts exceed the cost of the medications."

TRICAST can ensure that GAP invoices are being appropriately administered and will minimize manufacturer exposure. The main objectives of this type of audit include:

• Understanding the financial obligations to the program
• Execution of timely audits on the invoices and Medicare Part D records

Understanding that the quarterly invoices depend on the accuracy of the Medicare records generated by the Medicare Advantage Prescription Drug Plans (MAPDs), Prescription Drugs Plans (PDPs) and delegated Pharmacy Benefit Managers (PBMs), the oversight of this program requires an entity that provides a "trained eye" on the validity of those records.

The staff at TRICAST has completed extensive pharmacy benefit manager (PBM) data assessments and Part D audits, including full reviews of Prescription Drug Event Data, PBM processes and procedures. TRICAST also maintains information technology staff familiar with PBM software code and process flows.

Through the Medicare Part D Gap Discount audit, TRICAST provides intensive support for manufacturer oversight of this new program.

About TRICAST

Founded in 1997, TRICAST, Inc. is a leading next-generation health information entity built specific to pharmacy benefits. We provide risk analysis and applications that support analysis and risk modeling for the healthcare industry. Our suite of software applications, expert audit and consulting services assist health plans in managing and forecasting pharmacy costs. Visit www.tricast.com to learn more.

Media Contact:

Kristin Karakis
TRICAST, Inc.
414.302.9733 ext. 245
[email protected]

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SOURCE TRICAST, Inc.