BUSINESS INSURANCE DIRECTORY OF PRESCRIPTION BENEFIT MANAGERS: C
Posted On: Aug. 2, 1998 12:00 AM CSTCaremark Inc.
2211 Sanders Road, Northbrook, Ill. 60062; 847-559-4700
www.caremark.com/pharmacy
1997 revenues
Total gross revenues$1,400,000,000
PBM gross revenues$1,000,000,000
PBM clients
Total973
Employer/group plans with direct service973
Lives covered
Group Health:
Total8,441,000
Active enrollees6,330,000
Through employers97.3%
Through Medicare/Medicaid2.7%
Retail network
Pharmacy locations51,000
Mail-order services
Percent of prescription volume96.3%
PBM services since: 1985.
Parent: MedPartners; primary business: physician practice manager.
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, closed, based on incentives.
Pharmacies contracted: Independently owned; retail chains.
Reports provided: Physician prescribing patterns, generic vs. name brands dispensed analysis, employee utilization.
Service area: Nationwide.
Billing methods: Client-specific.
Officers: John Arlotta, president; Sara J. Finley, vp/secretary; Peter J. Clemens, vp/treasurer.
CLAIMSPRO Health Claims Services Inc.
24370 Northwestern Highway, Suite 200, Southfield, Mich. 48075; 248-352-2852; fax: 248-352-3714
www.claimspro.com
1997 revenues
Total gross revenues$7,383,412
PBM gross revenues$7,014,241
PBM unbundled revenues$5,962,105
PBM clients
Total960
Lives covered
Through employers70%
Through third-party vendors27%
Through Medicare/Medicaid3%
Retail network
Pharmacy locations43,000
Mail-order services
Percent of prescription volume6%
Generic usage
Percent of prescription volume40.5%
Staff
Total46
Professionals27
Includes: 1 registered pharmacist
PBM services since: 1989.
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*, high potential medical claimants.
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, high potential medical claim trigger.
Service area: Nationwide, Puerto Rico, Virgin Islands.
Billing methods: Capitated rate, fee per claim.
Officers: Ron Klein, executive vp; Bruce Liebowitz, president.
Contact: Ron Klein.
* Subcontracted.