[Read on...]

Statistical sampling is okay, but…

It’s long been our position that, while statistical sampling can provide a fairly decent overall view of a point-of-service system, such a small claim sample would not likely detect the 1% variance I mentioned above. For example, if the sample doesn’t include compounded claims, criteria for considering Dispense as Written (DAW) strategies on copay algorithms, or the types of pharmacies submitting claims, the report could provide a less than accurate view of the program.

Accurate assessment of all plan design attributes and the appropriate forensic analysis of the claims and eligibility are essential elements that only a full review can provide. Accordingly, every one of our reports is driven by actual claims re-pricing, not summary reports, with simple discounts and arithmetic applied. Only by re-adjudicating 100% of the PBM’s claims can we review and benchmark variances.

What makes our audits so special?

What else sets a TRICAST audit apart from statistical sampling audits? Take a look:

• We load 100% of the claims for each of our clients and conduct a thorough analysis using fixed files, including both Medi-Span® and First DataBank, to identify the correct attributes of every claim
• We utilize proprietary algorithms to identify that the appropriate identifiers, claims status, and prescribers that are being used on each claim
• We consider all claim attributes to ensure the accuracy of the audit report. This approach is unique and driven by our sole focus on pharmacy claims data. We review over 100 independent claim attributes, such as:
  • Basis of cost status as a paid, reversed, adjusted or rejected claim
  • Claim source as defined as a pharmacy transmitted claim, a batch claim, or manual subscriber submission
  • Correct status of the paid claim, consisting of all positive values

Benchmarks are a by-product

A by-product of our 100% evaluation is a comparative analysis of pricing and contract parameters that enables us to benchmark potential rebates to be considered by the person responsible for oversight of the program.

It’s what we do best

Will TRICAST do statistical sampling? Sure, we can do it, and do it very well. However, we will always recommend doing the full 100%. Not some of the data, not even most of the data. One hundred percent is what we do best, and it’s what sets us apart from everyone else.

[By Greg Rucinski, President and CEO]

Working with the client and PBM, I help put together the project timeline. I also coordinate the receipt of necessary files and plan designs so we can perform the analysis. Then I enter the data into AccuCAST and review and analyze the report through ReCAST. When this is done, I submit the final report to the PBM and the client.

What do you like about what you do for TRICAST?

In my previous job, I worked at a PBM and set up the benefits. Now I’m on the other side of that coin. This position utilizes my analytical and troubleshooting skills more than my previous job and I like that.

What’s your favorite movie?

I don’t really have a number one favorite movie. But I like comedy and action movies best, or anything with Matthew McConaughey. Sahara hit the trifecta on that note.

What do you do for fun outside of work?

Outside of work I like to be outside. I am very busy with two kids and a large black lab. In the summer I like to do anything that will keep me outside: going to the lake or taking the kids to the park. I’ll even do gardening just to be outside. Winter is not fun. When it’s cold or snowing I wonder why I live here.

Give us a Fun Fact:

I decorate my house for every holiday with different ceramic crafts that I’ve made. Ceramics allows me the opportunity to showcase my creative side.

So we’re talking what? Hundreds? Thousands?

No, I’ve got about one hundred or so, mostly Christmas, Easter, and Halloween themed. I keep them in color-coded storage bins.

[Read on...]

The DEA is rarely involved in the actual management or distribution of drugs, but in the case of ADHD drugs they tightly regulate how much of the drug’s active pharmaceutical ingredient (API) can be distributed to manufacturers each year. The system is designed to prevent the creation of stockpiles that could be diverted for inappropriate use.

Quotas Too Strict?

The agency lets each manufacturer decide how to divide its quota between high-priced brand names and cheaper generic versions, with what some say are predictable results: nationwide shortages of low-margin, inexpensive generic ADHD medicines.

Both the FDA and the American Society of Health-System Pharmacists have placed this type of medication on their official shortages lists. The FDA, which receives hundreds of complaints daily about the shortage, insists that the shortages are the DEA’s fault. The DEA questions whether there really are shortages and points the finger at the manufacturers, saying that they chose to make more of the brands than generics.

Further complicating matters are patients who take structured treatment interruptions, or “drug holidays”, for varying lengths of time over the course of a month, in effect stockpiling their medication and contributing to the shortage.

Oh, and there’s even more: demand for the drugs is reaching all-time highs. In 2010, more than 18 million prescriptions were written for Adderall, up 13.4% from 2009, according to IMS Health, which tracks prescription data.

The end result is a situation that is costing the public billions a year because they often have no choice but to switch to a branded product. The insurance companies are then hit with a wave of prior authorizations, and they have to approve these branded drugs.

What is TRICAST Doing About It?

While lobbyists, manufacturers, advocacy groups, and the government struggle to remedy the shortages, TRICAST is offering innovative solutions to our clients.

For example, we are proposing quantity limits that are more consistent with how patients are actually using their medications. Rather than a traditional 30-day supply, why not prescribe a 24-day supply to patients who only take their medication during the week?

Additionally, the data surveillance and FWA monitoring capabilities of some of our products can spot gaps in usage that might indicate stockpiling, and detect patterns of actual abuse by patients, pharmacists, and physicians.

While we can’t necessarily influence public policy, we can help our clients work more efficiently within the constraints that the various shortages have created.

[By Rob Shelley, Senior Vice President, Business Development]

This is a full time position with excellent salary and benefits including health, dental, life insurance, and a paid time off program (PTO).

Local Candidates only. We are unable to sponsor visa candidates at this time. Travel Required: none. Telecommute: no

Experience Required

Computer Science degree or equivalent work experience including 2-4 years of exposure to Microsoft development tools and the .NET platform.

Successful candidates will have experience:

• Creating automated and manual test scripts, test plans and test cases
• Participating in functional testing, regression testing and performance testing of .NET applications
• Identifying bugs, issues, risks, and bottlenecks within the software system
• Communicating test results to both technical and non-technical people
• Multi-tasking and prioritizing concurrent testing assignments

Favored candidates will demonstrate:

• A strong work ethic and the ability to deliver under tight deadlines
• Proven ability to learn complex systems rapidly
• An understanding of software project development concepts and quality control methodologies
• A solid working experience with Linux and Java
• Experience with using stress test tools for web-based applications is a plus
• Ability to work independently and report results and metrics with quality insights to manager and executives
• An understanding of OOP, SOA and AOP principles
• The willingness to keep up with a rapidly growing company and environment

Technical Skill Requirements

• 2-4 years of hands on experience testing large scale software systems written for the .NET platform
• Functional knowledge of ASP.NET, HTML, C#, RDBMS (SQL Server, MySQL), IIS 6-7, Windows OS

Technical Skill Advantages

• Functional knowledge of Crystal Reports and Business Objects
• Exposure to Linux and Java development environments

Interested? Contact careers@tricast.com.

I’m responsible for software user assistance: online help, user guides, quick reference guides, interface content and design, and technical marketing materials. I established our usability testing program, the results of  which can potentially make all those user assistance tasks a lot easier. This stuff can generally all be lumped under the “User Experience” banner, and it’s all pretty cool.

I helped redesign this web site, and created a bunch of the content that’s going into it, and I’m currently helping set up an editorial calendar, and an overall content strategy for both the site and TRICAST in general. We’ve got a lot of knowledge around here that we need to gather and use to our advantage. A good strategy will make sure that happens.

We’re dabbling in a little bit of video production, which is exciting. I’ve worked on several miscellaneous writing and editing projects, too. If it has words in it, chances are that I’ve looked at it lately.

What do you like about what you do for TRICAST?

I really like that it’s actually more than just technical writing, I get to do a lot more than plain old online help. The opportunity to wear a few different hats keeps things from getting stale. Throw in the fact that much of what we’re doing right now is foundational—setting up processes and policies and standards and such—it’s all very challenging and quite awesome.

What’s your favorite movie?

Off the top of my head, Airplane!  An unfortunately large portion of my brain is used to store quotes from this movie. I guess the foot’s on the other hand now, isn’t it Kramer?

What do you do for fun outside of work?

I mess around with woodworking (I’m making some cabinets for our bathroom right now), and I help out with my son’s Boy Scout troop. I also love cross-country skiing and especially trail running–the rockier, the hillier, and the longer the trail–the better.

Wait…this is fun for you?

That’s debatable sometimes, I have to admit.

Give us a Fun Fact:

I haven’t owned a comb for over 20 years.

This is a full time position with excellent salary and benefits including health, dental, life insurance, and a paid time off program (PTO).

Local Candidates only. We are unable to sponsor visa candidates at this time. Travel Required: None. Telecommute: No

Experience Requirements

Computer Science Degree or equivalent work experience including 5-8 years of development with progressively increasing responsibilities. Successful candidates will have experience:

• Developing for the Windows platform including a thorough knowledge of the .NET 3.5/4.0 Framework, SQL Server 2005/2008, Visual Studio 2008/2010, WCF Web Services, and ADO.NET
• Lead, mentor and educate junior developers
• Providing accurate individual effort analyses
• Working as part of a team and individually
• Working with business people to translate requirements into a system design
• Building and implementing from a design
• Communicating ideas to both technical and non-technical people
• Multi-tasking and prioritizing

Favored candidates will demonstrate:

• Potential to develop on emerging technologies created to solve Big Data problems.
• Familiarity with the concepts of Distributed Computing, Data-Parallelism and Non-Relational Data Stores
• The ability to understand, and refactor complex legacy code systems
• An understanding of OOP, SOA and AOP principles
• Persuasive advocacy of alternative architectural or development techniques
• Knowledge of and comfort with the Linux operating system
• The willingness to keep up with a rapidly growing company and environment

Technical Skill Requirements

• 5 to 8 years of experience developing with C#/.NET
• 5 to 8 years of experience creating Stored Procedures, Functions and Views with T-SQL
• 2 to 3 years Windows Desktop Development

Technical Skill Advantages

• Linux Administration
• Java development in Eclipse
• ASP.NET
• Windows Communication Foundation (WCF)
• SSRS, SSIS
• HTML/JavaScript/CSS
• Microsoft Office Interop Library Development (Excel, Word, etc.)

Send your resume to careers@tricast.com.