NEW YORK – MAY 16, 2012 – In its continued quest to bring software-based technology solutions to the pharmacy benefits industry, Truveris, Inc. welcomes Michael Jacobs, R.Ph., as Vice President of National Accounts. Jacobs brings over 30 years of expertise in the pharmacy and health care field to the Truveris Sales and Marketing Team.  Bryan Birch, Truveris Chairman, President, and CEO remarked: “Michael joining Truveris is a great example of how we are combining our technology-based software solutions with strong prescription benefit domain expertise.  He will undoubtedly improve our already impressive product portfolio with his vast industry experience.  Michael’s reputation is among the very best in the industry and we are pleased that he has elected to work with Truveris to ensure that clients receive the best possible solutions for their prescription benefit needs.”  

Jacobs was most recently Principal and National Pharmacy Practice Leader at a leading human resource benefits consulting firm, where he led efforts to both optimize design, pricing, and administration of integrated pharmacy and clinical benefit programs, and also develop long term pharmaceutical management and compliance strategies for payers.  Prior to his practice leader roles, Jacobs held positions across a broad cross-section of the pharmacy benefits industry, serving as VP of Managed Care Sales at Express Scripts, National Account Manager at Ciba-Geigy, and as a pharmacist at independent retail pharmacies. 

A thought leader in the pharmacy and benefits space, Jacobs is a member of nine professional committees and has authored over 60 publications and presentations, including in the American Journal of Managed Care and the Pharmaceutical Care Management Association.  Jacobs said about Truveris:  “With billions of dollars spent on pharmaceuticals each week in the US, few if any payers validate individual prescription payments within their billing. Truveris allows payers to manage their drug spend better than ever before, capturing the efficiency present in virtually all other business finances and personal expenses.”

Truveris is a health information technology company delivering pharmacy data validation, analytics, and pricing solutions.  Through a SaaS platform, Truveris adjudicates prescription claims and provides clients with valuable insights on drug spend.  Truveris products include:  TruGuard (claim validation), TruBid (online auction and RFP management), and TruReport (prescription claim analytics). 

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Media Inquiries:

Stephanie Louis

New York, NY

slouis@truveris.com

T 800.430.1430 x118 

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I’m proud to announce today that Truveris has closed a $10MM Series B round of funding led by New Leaf Venture Partners and joined by Tribeca Venture Partners, New Atlantic Ventures, and First Round Capital.

Truveris is growing quickly and we’ll be using the new funds to expand our ever growing line of software products.  Our technology is altering the way that pharmacy benefits are being sold and adminstered, and I’m excited that New Leaf Venture Partners is the latest company to recognize its importance.

New Leaf Venture Partners is a great addition due to their expertise in healthcare technology. They have years of experience investing in ideas with big potential and a proven record of success. I am pleased to work together and take Truveris to the next level as an enterprise software-as-a-service platform that will help with cost containment and data analytics.

Bryan Birch
Chairman, President, & CEO
Truveris 

Today I had the opportunity to speak at the UBS 22^nd Annual Global Healthcare Services Conference held in New York. The conference itself featured many thought leaders across many healthcare related industries as well as various media concerns.

I discussed Truveris, our mission, our services, and, in particular, two products – TruBid and TruGuard. TruBid manages pharmacy RFPs from bidding to contract within 30 days and TruGuard ensures accuracy of your contractual terms on an ongoing basis. These products work hand-in-hand and allow the payer to control the full lifecycle of their pharmacy benefit plans.

The drug market is big – 2010 drug spend was estimated at $307B. The unregulated nature of this industry, with complicated relationships amongst pharmacies, drug manufacturers, and employers creates a need for improvement. The Truveris technology brings improvement by bringing efficiency and savings to the pharmacy benefits industry through innovation and operational excellence.

This was a great forum to showcase Truveris and how our company is changing the way pharmacy benefits are being delivered. Stay tuned for more, as we are just getting started. Click here to read the media alert about this conference.

Bryan Birch
Chairman, President, & CEO
Truveris 

We’re excited to announce the launch of TruBid, a Web-based software tool that helps health insurance companies and self-insured organizations negotiate and enforce more favorable contract terms with their Prescription Benefit Managers (PBMs). TruBid is the latest addition to the Truveris product suite which can save customers up to 12 percent annually on prescription drug claims by inviting PBMs to bid for their business through a standardized, automated reverse auction.

TruBid joins our concurrent pharmacy bill review product now called TruGuard. These two products work hand in hand helping payers of pharmacy benefits control the full lifecycle of their pharmacy plan. TruBid automates the RFP process and provides an apples-to-apples comparison to help drive down pharmacy costs.  Then, once a clear, well-written contract is in place, TruGuard will help enforce your contract by reviewing your invoices before you pay to ensure that you pay only what you owe.

TruBid can be implemented directly or through your existing consultant or broker. You can read the full press release here. And reach out to our team with any questions.

Truveris is excited to announce the additions of Dr. Jan Berger and David Smith to our advisory board today. As the company continues to scale and fulfill on its mission to transform the pharmacy benefits industry, it needs leaders who can help shape its growth trajectory. 

Dr. Jan Berger brings 25 years of PBM experience and was a former Senior Vice President and Chief Clinical Officer for CVS Caremark where she directed policy and strategy for all clinical aspects of the organization including pharmacy benefit services, specialty pharmacy, Medicare Part D, disease and health management and health information technology.

David Smith spent 10 years as Chairman, President and CEO of PSS World Medical, Inc., a medical distributor that serves physicians, nursing homes and home care providers. There, he restructured the organization and re-aligned operations with state-of-the-art software and systems. Smith grew PSS World Medical into a billion dollar organization and took the company public.

Both Jan and David are invaluable resources to the new advisory board and the company is grateful for their expertise and leadership.

The much anticipated launch of the generic version of Lipitor is highlighting the pricing conundrum of the generic exclusivity period where often a new-to-market generic is more expensive than the brand version net of rebate. With generic Lipitor being more expensive than the brand, payers are contemplating encouraging the brand but wondering if this is a “penny wise and pound foolish” strategy. Much negative and often one-sided press is written about Brand Pharma’s tactics to maintain market share when they provide aggressive rebates to reduce the total brand cost below the first to market generic. The good news is that payers can purchase the lowest cost drug, whether brand or generic, by utilizing the following strategies and asking about key Pharmacy Benefit Manager (PBM) contracting provisions which are detailed below.

Payers should consider different pricing strategies at retail and mail (or 90-day at retail through captive retailers like CVSCaremark).

At mail (or captive 90-day retail chain network), the pharmacy can dispense the lowest priced product (typically the brand net of rebate), which is often referred to as the “house brand” for the generic until the generic price is the lowest.

At retail, payers have several options:

• Option 1: The most cost efficient tactic is to block the generic NDC until the price falls below the brand product net of only the payer’s portion of the rebate. Members should be allowed to fill brand Lipitor at the generic copay under this strategy.
• Option 2: Place brand Lipitor on the 1^st tier and the generic on the 3^rd tier. Again, this strategy should only be implemented as long as the brand price net of the PAYER’S portion of the rebate is more advantageous for the plan sponsor.
  
• Option 3: Absorbing the new-to-market generic exclusivity costs (typically 180 days) to migrate as many members as possible to the generic. After the generic exclusivity period ends and multiple manufacturers enter the market, there has historically been significant price advantages (even net of the brand rebates) to maximizing generic utilization.

*Note – Once the generic is less expensive than the brand, to maximize generic utilization, payers should consider adding a penalty each time the brand name medication is filled.

There are some key contractual and cost share questions you should ask your PBM before diving into one of these strategies headfirst:

• Will you receive 100% of the rebate for the substitution (or will the PBM)? If the PBM shares in your rebates earned or you have a guaranteed per script rebate the net cost should be adjusted to show the true cost to your organization.

• How will the “house brand” claims be accounted for in the discount guarantees (brands, generics, or excluded)?
   
• How will this affect your generic dispensing rate guarantees?
   
• How will this affect member cost share contributions (depending on the strategy selected)?

Truveris can help with these strategies and review accurate claims adjudication prior to payment.

For recent articles on this topic, try these sources:

WSJ
New York Times
Forbes 

Kristin Begley, Pharm.D.
Strategic Initiatives
Truveris 

Our goal at Truveris is to ensure claims accuracy for our clients and their members. We want to work with PBMs and reach a state with minimal to no errors on a bi-weekly basis. Lately, we have had some wonderful success with PBMs supporting our clients’ wishes to review their bill prior to payment.  These PBMs are realizing that the plan integrity aspect of our program is resonating with many large clients in the country. 

For those clients that have government subsidies, government revenue or co-insurance, it is imperative that their invoices are reviewed and correctly paid the first time vs. the current pay and chase model that exists today. I want to thank those PBMs that have helped their clients with this objective and look forward to working with more PBMs so that together we can reach a point where claims processing is nearly error-free.

Bryan Birch
Chairman, President, & CEO
Truveris 

In my first few weeks at Truveris as Chairman, President, and CEO, I’ve come to personally experience the great momentum that the company has. We’re tackling a $300 billion market opportunity and finally bringing transparency to the PBM industry.  Better yet, we are creating new products and offerings that use our unique, high performing assets.  After having spent many years in the health industry covering pharmacy benefits management, health plans, and insurance, I’m very familiar with the inefficiencies in the health industry. Particularly in the prescription drug market, the complex contracts, legacy systems, and large data sets make real transparency and operational excellence very difficult. That’s the great thing about innovation and technology - it allows for the efficient disruption of existing business practices that will eventually benefit all involved including the payers, members, providers and PBMs.  At Truveris, we are utilizing our cloud based software-as-a-service technology to help with cost containment and plan integrity.  Stay tuned because there will be more to come from Truveris.

Bryan Birch
Chairman, President, and CEO
Truveris 

Since 2006, the HR Policy Association has certified Pharmacy Benefit Managers (“PBMs”) according to their willingness to be open about their financial performance.  This certification, called the Transparency in Pharmaceutical Purchasing Solutions or TIPPS^TM allows PBMs to say that they are transparent with their pricing and profit calculations.  Presumably, this means they are not making money using hidden fees, spread pricing or unknown payments from manufacturers.

One of the factors used in TIPPS certification is the publication of the Actual Average Inventory Cost (“AAIC”) for mail order pharmacies.  The AAIC is intended to provide some insight into the pharmacies’ actual costs for drug they dispense.  Prime Therapeutics recently issued a press release that made a big deal out of their release of AAICs and their appointment as a TIPPS Tier 1 PBM.  However, if you understand what AAICs really are, you’ll see that this is as transparent as a lead shield.

Inventory Cost is simply the price paid for products sitting on the shelf before they are sold.  This is true for pharmacy as it is for any company that produces products.  How Inventory Cost is determined is up to the people calculating it.  There are several options, including:

·         Use the price actually paid for each bottle on the shelf

·         Use the price paid for the most recent purchase and apply it to all the             bottles on the shelf

·         Use the price paid on some arbitrary date (first of the month, first of                the quarter, etc.)

Some pharmacy chains even use the results of their annual inventory count and use that cost until their next inventory is done.

Even if the pharmacy says they use the actual prices paid, they don’t actually use the actual prices paid. Why is this? Pharmacies often receive discounts based on how much they buy and how quickly they pay their bill.  They can also receive free product or special discounts as incentives for bulk purchases.  Occasionally, pharmacies will buy product when they expect a price increase, or will buy product from a secondary supplier when they can get a reduced price.  In any of these scenarios, the pharmacy is not obligated to include these lower prices or discounts in their inventory cost – they can use the “regular” price for the product to value their inventory since that is what they would pay to replace it.

Some pharmacies, those eligible for 340B or other government discounts, can purchase product with discounts of up to 40% off standard list prices.  Although much of these purchases are used for indigent and low-income patients, pharmacies can use them for prescriptions covered by commercial health plans.  Some pharmacies will use the “regular” or commercial price to value their inventory, not the actual reduced purchase price.

The end result is that pharmacy’s true cost can be 5-40% lower than what they are disclosing by using AAIC.  This is not transparent.  It is a way for PBMs to claim transparency while still hiding their true costs and profit margins.  The only way to really know what the PBMs are paying is to get copies of their invoices, the ones that include all of the discounts.  The sun will rise over California before that happens.

About the Author

Dr. Tony Zappa is responsible for design of Truveris’ claims review procedures, including the pricing and payments comparisons. He is also in charge of quality assurance of analytic results, as well as development of new analytic methods.

I’m proud to announce today that PBM and healthcare industry veteran Bryan Birch is joining as the Chairman, President, and CEO of Truveris.

We unveiled the news during our presentation today at the New York Capital Association’s Ingenuity Conference, which brings together entrepreneurs that have caught the eye of respected investors, media, and major players in the New York Community.

Bryan has held senior executive roles at Medco Health Solutions, Empire Blue Cross Blue Shield and Oxford Health Plans. He has a track record of scaling multi-billion dollar operations. Bryan’s a big asset and we’re lucky to have him coming on board. More details are in our official announcement here.

AJ Loiacono

Co-Founder, Truveris