Advanced Pharmacy Concepts

APC Wins "Best Places to Work in Rhode Island" Award

Mon, 14 May 2012 18:23:00 -0400

Advanced Pharmacy Concepts (APC) was selected as one of the Top 40 companies in the Best Places to Work in Rhode Island competition for 2012.

The award is designed to recognize employers in various size categories throughout Rhode Island and Bristol County, Massachusetts that are divided into three groups based on the number of employees - large employers were those with 150 or more local (Rhode Island and Bristol County, Massachusetts) employees, medium employers had between 50 and 149 local workers and small employers had 15 to 49 employees. The winners were chosen based on responses to a management questionnaire as well as a confidential employee survey.

"We are very proud to be part of this select group of employers. As a small business owner, I am grateful to our team for their commitment to our customers and the quality of the hard work they perform everyday," said Dr. Kimberly McDonough, President & CEO. "This recognition is very important to all of us."

The Best Places to Work in Rhode Island award is another proud achievement for the company that was founded in 1997. Dr. McDonough was selected by the U.S. Small Business Administration (SBA) as the 2007 Rhode Island Small Business Entrepreneur of the Year. In 2009, Advanced Pharmacy Concepts received recognition by INC. Magazine as one of the Top 5000 fastest growing companies in the United States.

For more information, please see our website at http://www.apc-rx.com/.

SXC Acquires CatalystRx

Wed, 18 Apr 2012 13:06:00 -0400

On April 18, 2012, SXC Health Solutions announced the purchase of Catalyst Health Solutions for about $4.4 billion in cash and stock. Both companies, each of which have held mid-market positions, have expanded recently through acquisition, with SXC completing the acquisition of HealthTrans in January, and CatalystRx having acquired another PBM, Walgreens Health Initiative just the past summer.

The combination of the two companies positions SXC to compete with the larger PBMs: CVS/Caremark and Express Scripts. Express Scripts won approval in April to acquire Medco, which will create a PBM that will handle about 30% of the prescription market in the United States. More information is available in this MarketWatch article.

Pharmaceutical Industry News - March 5, 2012

Thu, 08 Mar 2012 19:29:00 -0400

Business Strategies, Regulation and Code of Ethics Converge in Shaping Drug Maker Practices

Controversy surrounds drug manufacturer's business practices at home and abroad. In the U.S. promotional strategies and pay for delay arrangements remain controversial. Agreements between drug makers intended to coordinate the introduction of new generic drugs, maximizing profits, are viewed critically. The Federal Trade Commission has been asked to better manage these arrangements. In turn, the FTC has asked for legal backing to minimize deals that might delay introduction of lower cost alternatives to expensive brand name drugs. First Report Now considers the patent situation. In the meantime, drug manufacturers' ethics in foreign business deals are being scrutinized, and some significant financial penalties for drug makers have resulted as allegations of bribery surface. Read more on that in the Wall Street Journal.

Insurance Industry News - Week of March 5th, 2012

Thu, 08 Mar 2012 19:11:00 -0400

CVS leadership contends the firm's business model is best suited to the future of the health care. ESI and Medco await news on a possible merger, and ESI reports ease in transition, eliminating Walgreen from its network.

CVS leadership shared a perspective that the firm's hybrid model is best suited for the future of the health care market place, and distinguished the model from the traditional PBM model for which ESI and Medco are seeking merger approval from the Federal Trade Commission. The Wall Street Journal considers the CVS perspective. The Journal also explores the opposition to the proposed merger voiced in this Houston Chronicle news feature. Finally, the transition for ESI and Walgreens is explored in this WSJ article.

Health Technology News - Week of March 5, 2012

Thu, 08 Mar 2012 18:40:00 -0400

Meaningful Use rules for stage 2 of CMS' electronic health record incentive program have been released. The proposed guidelines frame the second stage of rules for providers demonstrating "meaningful-use" in their adoption of electronic medical records. The rules delay stage 2 implementation until 2014, allowing additional time for development and implementation. Read more in Kaiser Health News and Health Care Finance News.

News from the FDA - Week of March 5, 2012

Thu, 08 Mar 2012 17:57:00 -0400

Drug Shortages Impacted by Many Factors

The prescription drug shortages are the result of a number of circumstances, policies, and events. Unfortunately, the implications of these shortages are increasingly affecting patient's well- being and health outcomes.

There are so many considerations and factors influencing the drug shortage situation in the U.S. that it is difficult to fully cover each. Patient groups are advocating for those without access to important or even life-saving therapies; pharmacy groups are reporting that shortages are driving up drug costs as characterized in this Drug Topics article; drug manufacturers contend that the shortages, for certain drugs, are driven by DEA efforts to prevent drug abuse and misuse. The pharmaceutical companies indicate that for controlled drugs, limitations upon how much of a particular controlled substance can be manufactured have exacerbated drug shortages.

Reactions to Draft Guidance on Biosimilar

Comments are being accepted regarding the February 9, 2012 release of FDA Draft Guidance on Biosimilar product development. In total, there are three draft documents. There is some concern amongst manufacturers that the guidelines include many caveats. There's a general sense that the guidelines are developed form a conservative perspective. We will update as the guidelines are revised and finalized. In the meantime, http://aishealth.com/archive/nref022712-06 considers the guidelines in further detail.

As Physician Payment Cuts Are Stopped, CMS Chief Actuary Discusses Financial Challenges Ahead

Thu, 08 Mar 2012 17:42:00 -0400

It appears another short term "fix" was implemented when Congress avoided instituting the pay cuts for physicians providing care for Medicare beneficiaries last month. However, the problem must be addressed once again at the end of 2012.

Meanwhile, Kaiser Health News reports that CMS Chief Actuary, in testimony before the House Budget Committee, is warning, as he has in the past, that controlling cost growth is critical to the longevity and sustainability of the program.

APC Health Policy News - Week of March 5, 2012

Thu, 08 Mar 2012 17:33:00 -0400

Health Care remains part of political conversations at all levels. This week HHS secretary Sebelius appeared before the House Ways and Means Committee. The Secretary defended the health law and indicated the administration was vetting candidates for the Independent Payment Advisory Board, (IPAB) as covered by Kaiser Health News.

Meanwhile, the House Energy and Commerce Health subcommittee voted in support of repealing the IPAB provision of the reform law, according to HIMSS and others. The full committee is scheduled to vote on the proposed legislation on March 5. That vote, is anticipated by many as putting pressure upon the Senate to vote on the same issue. Most political analysts suggest that with a Democrat majority, it is unlikely the legislation would win approval there. The role of the IPAB remains contentious as critics object to decisions being made by a non-elected group, as voiced within this Forbes article.

The administration's preparations for defending the health reform law before the Supreme Court are featured in this Politico feature, which considers strategies that may be employed for framing arguments before the high court. The Medication Therapy Management Benefits Act, H.R. 891 is getting some press as representatives are urging colleagues to support the legislation as highlighted in this article in Drug Topics. Finally, seven groups will receive low interest federal loans worth $638 million to be used for establishing consumer-governed health insurance plans in eight states. Kaiser covers the topic further.

Advanced Pharmacy Concepts Celebrates 15 Years of Success

Mon, 20 Feb 2012 19:50:00 -0400

Advanced Pharmacy Concepts (APC) is proud to commemorate its 15^th anniversary in the pharmacy benefit consulting and audit industry.

Dr. Kimberly P. McDonough founded the company as a small operation that assisted health plans and physician practice groups with analysis of clinical pharmacy programs. By leveraging her extensive clinical pharmacy experience in a variety of managed care, hospital and long-term care settings, Dr. McDonough designed processes and clinical programs to assist managed care organizations (MCO), Medicaid, Medicare, and commercial plan sponsors control the costs of their prescription drug programs.

Since then, Advanced Pharmacy Concepts has grown to become one of the most respected health care consulting firms in the country and is the premier organization specializing in the pharmacy benefit industry. The team is comprised of 30 veterans from the pharmacy benefit management (PBM) and managed care industries as well as retail and clinical pharmacy operations. This high level of expertise has been sought by a wide variety of commercial, Medicare and Medicaid plan sponsors across the country, ranging from under 2,000 to over 33 Million covered lives. The company has also become a highly valued partner in the design and testing of quality measures for several industry-leading resources such as the National Committee for Quality Assurance (NCQA) and the Pharmacy Quality Alliance (PQA).

Beginning in 2005, The Centers for Medicare and Medicaid Services (CMS) relied upon Advanced Pharmacy Concepts for support with several mission critical initiatives that shaped the creation of the Medicare Part D pharmacy benefit program resulting from the adoption of the Medicare Modernization Act (MMA). CMS engaged the company in the early stages of program to assist in the development of the Part D formulary, program audit criteria and the review of prospective plan sponsor applications. Today, Advanced Pharmacy Concepts continues to play a vital role in assisting the agency with the development and implementation of new quality measurement tools for Special Needs Programs (SNP) to ensure optimal levels of care for patients living with particular high-cost chronic diseases.

"Our fifteenth anniversary marks a very important milestone in our company's history, and I am very proud of our talented team and their unwavering commitment to providing an outstanding customer experience to our valued clients" said Dr. Kimberly P. McDonough, President and CEO of Advanced Pharmacy Concepts. "We are excited about the future, particularly as we launch our next generation of services to support the changing requirements of plan sponsors, particularly those that offer Medicare Part D programs."

More About Advanced Pharmacy Concepts

Advanced Pharmacy Concepts provides comprehensive pharmacy benefit consulting services, PBM compliance auditing, clinical program support and benefit strategy for commercial and managed care plan sponsors across the country. Advanced Pharmacy Concepts is registered in the Central Contractor Registry of the Federal Government and is a certified small woman-owned business (SWOB) in the states of Massachusetts, North Carolina and Indiana. Dr. McDonough was selected by the U.S. Small Business Administration (SBA) as the 2007 Rhode Island Small Business Entrepreneur of the Year. In 2009, Advanced Pharmacy Concepts received recognition by INC. Magazine as one of the Top 5000 fastest growing companies in the United States. For more information, please see our website at http://www.apc-rx.com/.

Contact:

David C. Fetherston - Vice President of Marketing

dfetherston@apc-rx.com

401-295-7660 ext. 235 (direct)

401-295-8815 (Fax)

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Job Opportunity - Experienced Healthcare Audit Analyst

Wed, 08 Feb 2012 18:47:00 -0400

Due to the impresseive growth of our PBM Audit Services business, Advanced Pharmacy Concepts is seeking professionals with experience in pharmacy insurance benefits to work in our dynamic and respected firm as a Health Care Audit Analyst.

We are looking for qualified candidates who possess excellent attention to detail, project management skills, and the ability to work well in a team environment. Ideally, applicants should have 3+ years of health care related experience in pharmacy benefits management, health insurance, or health policy. However, candidates from the financial services industry with demonstrated analytical and mathematics expertise will certainly be considered. Applicants must have strong computer skills, including proficiency in Microsoft Excel, SQL or other programming languages. Excellent writing skills and the ability to travel will also be required from a successful candidate.

A Bachelor degree in a relevant field is required; quantitative analysis is a plus. Veterans and minorities are encouraged to apply.

Advanced Pharmacy Concepts is a nationally respected, independent source for expertise in area of pharmacy benefit programs and services. We support the needs of a diverse customer base of managed care organizations, employer groups, Taft-Hartley funds, insurance companies as well as State and Federal government agencies. Our team of industry professionals has an average of over 13 years of PBM, managed care, hospital operations and clinical pharmacy experience which provides our clients with single source for consulting, compliance auditing, data analytics and clinical program support.

Please send all resumes and cover letters to hpetrone@apc-rx.com.

Come join our growing team!

Job Opportunity - Senior Healthcare Consultant

Wed, 08 Feb 2012 18:44:00 -0400

Advanced Pharmacy Concepts is seeking experienced professionals to join our dynamic firm as a Senior Healthcare Consultant as we continue to grow our pharmacy benefit consulting services practice.

We are seeking a detail-oriented and analytical individual who will help us fulfill the increased demand for our expertise. Duties will include department and client support in providing proactive reporting solutions and advanced data analytics; predictive pricing model creation for drug benefit programs; analysis of drug utilization and quality metrics; production of client reports (scheduled and ad hoc); client support for specific major clients in all areas of operations; data analysis in RFP process and financial analysis of claims and cost information for clients; contribution to analysis of proposals as part of RFP process. The successful candidate will be capable of taking responsibility for entire RFP process; benefit design implementation and analysis of third party prescription plans through an understanding of plan parameters required by insurance companies, managed care organizations, and third party administrators. The Senior Consultant will develop proposals for new business as required; participate in presentations to clients and prospective clients as required and take on new duties as needed to support all initiatives of Advanced Pharmacy Concepts.

Experience/skills required for this position include 5+ Years relevant work experience in Pharmacy or Managed Care industry; 2+ Years relevant work experience in data analytics and financial analysis; advanced analytical and problem solving skills; well-developed business sense (finance, accounting, statistics, risk management, project management); knowledge of drug reimbursement methodologies and managed care principles; proven ability to perform difficult analytical tasks with minimal supervision; benefit and plan design implementation experience with a managed care/pharmacy benefit environment; comprehensive understanding of insurance company, managed care organizations and third party administrator pharmacy benefit plan parameters; strong quantitative analysis skills; strong PC computer skills, including all MS Office products; excellent communication skills, both written and verbal; ability to interface effectively with internal and external customers; strong organizational skills.

Please send all resumes and cover letters to hpetrone@apc-rx.com.

Come join our growing team!

FDA Recommendations for User Fee Programs Sent to Congress

Wed, 01 Feb 2012 18:51:00 -0400

The agency proposed three user fee programs to Congress earlier this month.

Our Take: The programs include the fifth authorization of the original Prescription Drug User Fee Act (PDUFA) as well as the new generic and biosimilar programs. The recommendation were sent to Congress, but there's been little published to date about their status. We'll keep you posted as they are considered and information becomes available.

Medicare Physician Pay Cuts Loom

Wed, 01 Feb 2012 18:49:00 -0400

Medical societies urge use of other funding sources to avoid imminent cuts.

Our Take: Cuts to the level of physician pay for services provided to Medicare beneficiaries are, once again, looming in the near future. Each time the issue has arisen, efforts by Congress, to avoid the cuts have been aggressively undertaken. However, with each delay, the potential cut has grown. Presently that rate cut would be 27.4%, effective on March 1. The push has been to repeal the sustainable growth rate formula (SGR) which is driving the rate cut. While there's been a repeated effort to do just that, it's not been accomplished to date. In this Medscape article, read more about strategies proposed by organized medical groups to address the pay cut. The New York Times also explores the topic.

Articles Probe Financial Benefits of ACO's

Wed, 01 Feb 2012 18:47:00 -0400

Accountable Care Organizations remain in the headlines on a variety of topics. This week several sources explored the potential financial returns they may or may not generate.

Our Take: This issue appears to have gained visibility in light of extremely high projected savings forecasted as being possible for ACOs. Estimates that the Pioneer program could produce up to $1.1 billion in savings in five years plunged the topic of financials associated with ACOs further into the forefront. Among considerations being discussed are the startup costs, accreditation costs and infrastructure expenses associated with the ACO's. There will definitely be much more written on this topic. In the meantime the scrutiny is likely to increase in light of this month's CBO Report indicating that some Medicare demonstration projects have not provided the financial returns that were originally anticipated.

Patient Centered Outcomes Research Institute Report Released

Wed, 01 Feb 2012 18:44:00 -0400

Our Take: We touched on this in the Health Policy section above. The long awaited report has triggered a range of responses, with stakeholders suggesting that although the lack of specifics was safe and avoided controversy, it might limit the potential impact the institute will have. Kaiser Health News offers an overview of the coverage on this subject.