ANNUAL DIRECTORY OF PRESCRIPTION BENEFIT MANAGERS
Posted On: Aug. 3, 1997 12:00 AM CSTC
Caremark Prescription Services
2211 Sanders Road, Northbrook, Ill. 60062; 847-559-4700;
fax: 847-559-5256
1996 revenues
Total gross revenues$888,000,000
PBM gross revenues$888,000,000
PBM Clients
Total1,300
Employer/group plans with direct service663
Lives Covered
Group Health:
Total15,000,000
through employers75%
through third-party vendors15%
through Medicare/Medicaid10%
Retail Network
Pharmacy locations51,000
Mail-order services
Percentage of prescription volume96%
Generic usage
Percentage of prescription volume45%
Staff
Total6,000
Professionals4,000
Includes: 300 registered pharmacists
PBM services since: 1984.
Parent: MedPartners; primary business: physician practice management.
Services: Retail pharmacy network, mail-order distribution, claims processing, online claims processing, concurrent utilization review, disease management, retrospective utilization review, benefit design consulting, formulary management/review, monitoring of physician prescribing practices, patient education, case management.
Formularies offered: Open, closed, restricted/customized.
Pharmacies contracted: Independently owned, retail chains.
Reports provided: Physician prescribing patterns, generic vs. name brands dispensed analysis, employee utilization.
Service area: Nationwide.
Billing methods: Capitated rate, fee per claim. Volume discounts to employers via rebates.
Officers: Michael Cannizzaro, president; Todd Martin, senior vp-field management; Richard Scardina, senior vp-operations management; Jay Messeroff, senior vp-clinical services/trade relations; Mark Thierer, vp-marketing/field operations; John Moss, vp-quality assurance/regulatory affairs; Cliff Berman, vp-legal.
Contact: Todd Martin.
CLAIMSPRO Health Claims Services Inc.
24370 Northwestern Highway, Suite 200, Southfield, Mich. 48075; 248-352-2852; fax: 248-352-3714
1996 revenues
Total gross revenues$5,092,008
PBM gross revenues$4,837,407
PBM unbundled revenues$3,309,805
PBM Clients
Total7,000
Employer/group plans with direct service800
Lives Covered
Group Health:
Total900,000
through employers75%
through third-party vendors23%
through Medicare/Medicaid2%
Retail Network
Pharmacy locations40,000
Mail-order services
Percentage of prescription volume3%
Generic usage
Percentage of prescription volume40.5%
Staff
Total35
Professionals18
Includes: 1 registered pharmacist
Services: Retail pharmacy network, mail-order distribution*, claims processing, online claims processing, concurrent utilization review, disease management, retrospective utilization review, benefit design consulting, formulary management/review, monitoring of physician prescribing practices, patient education*.
Formularies offered: Open.
Pharmacies contracted: Independently owned; retail chains, including Arbor Drugs, Eckerd, Kmart, Kroger, Meijer, Revco, Rite-Aid, Walgreens and Wal-Mart.
Reports provided: Physician prescribing patterns, generic vs. name brands dispensed analysis, employee utilization, high potential medical claim triggers.
Service area: United States, nationwide; Puerto Rico; Virgin Islands.
Billing methods: Capitated rate, fee per claim.
Officers: Ron Klein, executive vp; Bruce Liebowitz, president; Jeff Pultorak, vp-information systems.
Contact: Ron Klein.
**Subcontracted.