TRICAST, Inc. and MedReview: Sign co-marketing agreement to combat pharmacy benefits fraud, waste & abuse

Alliance Offers FWA Oversight as well as Medicare Parts C & D Data Validation

MILWAUKEE & NEW YORK—-TRICAST, Inc. and MedReview, Inc. have entered into a marketing alliance to offer enhanced pharmacy benefit program oversight and fraud waste and abuse (FWA) detection for the New York County Health Services Review Organization (NYCHSRO)/MedReview, established in 1974 as one of the first physicians’ peer review organizations in the United States.

TRICAST, headquartered in Milwaukee, provides consulting, management solutions and applications support for pharmacy benefits claims processing, payment and contracting, and pharmacy fraud, waste and abuse (FWA) oversight. TRICAST’s associates are industry experts and pharmacists who work with a broad range of clients including PBMs, Fortune 500 companies, consulting groups, state & local governments, brokers and unions.

MedReview helps its clients achieve improvements in the quality, appropriateness, and cost-effectiveness of health care services. Over the past 35 years, MedReview has conducted more than 2.5 million peer reviews to evaluate clinical decisions and services rendered by medical practitioners at all levels of the health care continuum.

By reviewing prescription records, TRICAST and MedReview will be able to determine if proper treatment plans are in place for patients and whether patient compliance is effective. Since drug spending is a major component of patient treatment, reviewing prescriptions is an ideal way to root out fraud, waste and abuse (FWA).

“Our clients manage multimillion dollar drug expenditures and complex utilization issues,” says Greg Rucinski, TRICAST President & CEO. “TRICAST’s approach provides a sentinel effect of clarity, accountability and financial opportunity to detect and eliminate FWA while ensuring maximum value is garnered from a pharmacy program.

Among the services to be jointly marketed by MedReview and TRICAST are tools that:

* Lower pharmacy benefits cost with improved budgetary controls

* Customize group Rx plans with different plan designs and co-pays

* Allow employers to provide affordable employee pharmacy benefits

* Monitor effective integration of drugs within case management activities

Just last month, TRICAST began offering Data Validation Readiness (DVR) assessments in light of the Centers for Medicare and Medicaid Services (CMS) decision to require MA-PD and PDP plans to maintain ongoing monitoring of their Medicare Part C and Part D programs. The new Part C and Part D Data Validation requirements are effective calendar year 2010.

Joseph B. Stamm, President and CEO of NYCHSRO/MedReview sees the alliance as a major value- added component for both NYCHSRO/MedReview and TRICAST clients. “Up until now, our clients have not been able to realize the full benefit of their pharmacy and health insurance benefit programs for their members,” Stamm says. “This alliance goes a long way to remedying that situation while, at the same time, helping clients to more effectively manage their overall healthcare costs.”

TRICAST, Inc., founded in Milwaukee in 1997, uses pharmaceutical and medical claims analysis for benchmarking, audits and risk analysis for health benefit plan sponsors. The company also provides timely reporting on vendor performance, allowing opportunities for decisive responses. The net result is better program oversight, lowered plan costs and risk exposure. Please visit http://www.tricast.com to learn more.

MedReview, Inc., a subsidiary of NYCHSRO, was founded in New York City as a 501 (c) (3) not-for-profit corporation in 1974 under the Federal Law mandating Professional Standards Review Organizations (PSROs) for Medicare and Medicaid review. In 2010, NYCHSRO/MedReview, Inc. observes its 36th year of continuous active service in medical review in the tri-state area, as well as select states across the country. Click on http://www.medreview.us to learn more. Contacts

Michael Beightol, Coyote Marsh & Associates, Inc., (847) 277-7353; mbeightol@coyotemarsh.com