TRICAST combines medical and pharmacy data to identify drug waste, inefficiencies
MILWAUKEE, Nov. 14, 2012 /PRNewswire/ — TRICAST, Inc. announced the debut of its J-Code Analyzer, a process that compares prescription medications paid for and delivered in the medical benefit to the prescription medications paid for and delivered in the pharmacy benefit. The integrated tool identifies prescription drug waste and inefficiencies by combining Medical and Pharmacy data.
"J-Codes" (so-called because they begin with the letter 'J') are part of the Healthcare Common Procedure Coding System (HCPCS) Level II set of procedure codes. J-codes used by Medicare and other managed care organizations to identify injectable drugs and oral immunosuppressive medications specific to specialty.
The TRICAST J-Code Analyzer evaluates drug therapy across three different methods of reimbursement, including the medical, pharmacy, and separate specialty pharmacy benefits. The process employs a set of proprietary benchmarks and algorithms, and utilizes a combination of clinical and financial oversight. The unique comparison employed by the J-Code Analyzer confirms therapeutic duplication and best-price analytics for each method of reimbursement.
According to a study conducted by Pharmacy Benefit Management Institute (PBMI) in the fall of 2011, less than 20% of plan sponsors can track their specialty drug spend covered under the medical benefit (Tracking Specialty Drug Spend Covered Under Medical Benefit, Greatest Gap for Plan Sponsors, finance.yahoo.com).
Additionally, less than 40% of employers require prior authorization under the medical benefit for specialty medications, whereas only 35% of employers and health plans restrict specialty coverage under the medical benefit. Using the advanced technology of TRICAST's J-Code Analyzer, employers can easily identify potential fraud and react in a timely manner, ultimately avoiding unnecessary expenses and potential fraudulent activity.
TRICAST recognizes the inefficiencies of specialty medications processed under the medical benefit, and the J-Code Analyzer helps to reduce overall healthcare costs. TRICAST examines the information gleaned from the cost comparison and the delivery channel comparison in an effort to eliminate waste.
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.
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Media Contact: Kristin Karakis
TRICAST, Inc.
414.302.9733 ext. 245
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