Aetna Pharmacy Management www.aetna.com/producers/ Drugsbestbuy.com 207-439-2600 www.drugsbestbuy.com Express Scripts Inc. 866-408-3719 www.expressscripts.com/wps/portal/ Number of pharmacies in network More than 59,000 Roughly 11 million lives. Mail order/internet pharmacy/call centers Number of pharmacies in network Mail order / Internet pharmacy/call centers When customers integrate their Aetna pharmacy benefit plan with their Aetna medical benefit plan, only one eligibility submission is required. We offer pharmacy benefit coverage for individuals, families, sole proprietors, small group, middle market and national accounts. We provide a single Preferred Drug List as a standard component of our pharmacy benefit program. APM offers several disease management programs to our customers and members, such as the Controlled Substance Use Program, Migraine Management Program, Heart Care for Life and the Blood Glucose Monitor Program. Yes/No/Yes APM processes more than 99 percent of all retail pharmacy claims online at the point of sale. The online pharmacy claims processing system holds claim history information for a minimum of 36 months after adjudication. APM offers customers extensive reporting capabilities. Our standard pharmacy utilization report package is available on a quarterly basis. This report package highlights key plan information to help customers evaluate plan performance, including cost effectiveness and overall utilization patterns. When a member purchases a prescription at any of our participating retail pharmacies, they can pay their copay or coinsurance amount using any method of accepted payment. For members using Aetna Rx Home Delivery or Aetna Specialty Pharmacy, copayments are collected when orders are placed. More than 80 percent Any amount Anyone or a family member can use the card. Save up to 46 percent on Generic and up to 15 percent on brand name Drugs. Use with your HSA's, high deductable medical plans or groups without cards. At your local pharmacy or the mail order pharmacy if you choose to use. No cost for the card. You are providing a free service for your clients. Number of pharmacies in network More than 60,000 except District of Columbia and Maine Tens of millions Determined by plan sponsor. Determined by plan sponsor. Our formularies are independently designed by our Pharmacy and Therapeutics Committee, with the plan sponsor having full control over the ultimate plan design decisions. Administered via LifeMasters, which offers a high level of specialization. Express Scripts has extensive experience loading historical claims data for a variety of clients of different sizes and complexity. Yes. We offer a variety of billing and payment options, and work with plan sponsors during the implementation process to determine the methods most beneficial for you and Express Scripts. Available directly from Express Scripts
Independent Health's Pharmacy Benefit Dimensions 716-635-7873 www.independenthealth.com informedrx Inc. 630-577-4710 www.sxc.com Pharmacy benefit managers source list Number of pharmacies in network 52,000 400,000 Self-funded funding arrangements 250 employees Standard and customized formularies available Offered in conjunction with self-funded medical option Standard reporting package and adhoc available as needed. ACH debit, wire transfers, business checks Flexible, customized for each broker partner Number of pharmacies in network 58,000 60 million Eligibility Requirements are determined by the client, and we are able to accommodate a variety of plan design options. No minimum informedrx clients will have the option of modifying the informedrx standard formulary or to designing a custom formulary. While informedrx does not provide a disease management program, our clinical management and drug utilization review programs can be customized to target specific disease states. Typically, the most recent 15 months history is made available for online viewing and access. However, we have the ability to store virtually any amount of data on the system for our clients. We provide two main levels of reporting: our standard reporting package, and our online analytical decision support tool RxTRAC.. Pharmacy funding is payable via wire transfer, two-day ACH, or automatic withdrawal. Administrative fees are payable via check, ACH, or wire transfer. informedrx is open to negotiate on case-by-case basis. Millennium Administrators Inc. 866-644-2489 www.millennium-tpa.com Number of pharmacies in network 60,000 ande larger 30,000 Groups from 20 employees or more. 20 Custom or Standard Extensive, dependent upon the clients needs. Mail order/internet pharmacy/call centers Yes/Through our mail-order divisions only/yes Millennium Administrators has a proven track record, our trend has been under 7 percent since 2006. Available on a monthly or quarterly basis. Monthly or bi-weekly. PM/PM Monthly fee BenefitsSellingMag.com November 2008 Benefits Selling
Navitus Health Solutions 480-838-1105 www.navitus.com Number of pharmacies in network 57,000 More than 750,000 lives. Clients include self-funded employers, public sector entities, Taft Hartley groups, and managed care plans, including managed Medicaid, Medicare Part D and health plans. Groups of 100 lives or more through one of our third party administrator relationships and direct contracting with groups of 500 lives or more. Products are based on the lowest net cost, focused on delivering the best clinical outcome, and aligned with the goals of our clients. The Navitus Select Formulary, our most popular formulary, utilizes a high degree of formulary management tools, including prior authorization, step therapy and quantity limits. Offers several levels of disease management to enhance the quality of patient care and lower overall healthcare costs.. Claims operating system, known as NaviClaim Rx, is owned by Navitus, and administered and monitored 24/7 by Navitus IT professionals. Clients have online, real-time access to prescription claims, as well as such online functionalities as eligibility management and prior authorization override capabilities. Our data warehouse is updated nightly to support reporting, with a rolling 26 months of historical claims and membership data maintained. Our preferred payment method is through ACH transaction. Navitus Health Solutions uses a per-member per-month administrative fee that supports the Navitus full pass-through, transparent business model. Outlook RX 800-342-7188 www.outlookvision.com Number of pharmacies in network 56,000 50,000 Discount No Mail order/internet pharmacy/call centers No/No/Yes Based on utilization Point of service Partners Rx Management 480-624-9400 www.partnersrx.com Number of pharmacies in network More than 60,000 367,000 Partners Rx accepts eligibility transmission through File Transfer Protocol, which is our preferred method. 25 Formulary policies/design Yes Yes Mail order/internet pharmacy/call centers Yes, from plan impementation forward. Robust and user-friendly online reporting suite. Electronic Funds Transfer and check.
Prescription Solutions 760-215-3639 www.rxsolutions.com Number of pharmacies in network 62,400 10.7 million. Prescription Solutions supports many eligibility enrollment methods. There are no minimum size requirements. We promote formulary compliance and generic utilization by including most generics and effective brand drugs on formulary and placing less effective brand drugs in non-preferred or non-formulary positions. Our disease management approach is unique and straightforward: to design and implement actionable pharmacy-based interventions for patients with high-impact, high-cost diseases. Member profiles and eligibility history are maintained on the active online system for at least three years. After removal, all claims history and member records are archived and stored off site for a minimum of seven years. Offers robust reporting capabilities to clients to enable them not only to track costs and utilization but to use this information to identify ways to reduce drug spend while maintaining the therapeutic efficacy of the medications used by their members. Payments to the provider will be made on behalf of the plan sponsor each week, no later than 30 days after the first claim is submitted. Commission structures typically range between $0.25 and $1 per claim. Prime Therapeutics 651-414-4198 www.primetherapeutics.com RESTAT 800-926-5858 www.restat.com Number of pharmacies in network 59,000 14.6 million Formulary policies/design Number of pharmacies in network 60,640 4,269,434 Mail order/internet pharmacy/call centers Prime works side-by-side with our Blue Cross and Blue Shield client owners in Illinois, Kansas, Minnesota, Nebraska, New Mexico, North Dakota, Oklahoma, Texas and Wyoming to provide pharmacy and medical expertise and cost-effective health care management to employer groups in those markets. No minimum Prime s P&T committee makes formulary decisions to ensure safety and efficacy of all prescriptions. Prime s clinical program, PrimeImpact, is a disease-focused approach to managing pharmacy care. Reporting tools have detailed drill down capabilities, and high-level summary data. Offer full administrative connectivity through its ScriptWise claim adjudication system, allowing clients to enroll members and update member eligibility data online. No minimum. The optimal plan is an open formulary that uses our Preferred Product Formulary. No ScriptWise, RESTAT s online claims adjudication system uses the latest NCPDP-compliant version allowing electronic claim submissions to pass through the client s customized program edits. RESTAT utilizes REPortal, a Wransfer of eligibility and utilization data. The client will receive billing invoices from RESTAT for two separate categories of prescription benefit costs; pharmacy claim costs and prescription benefit plan administrative costs. RESTAT will work with each broker individually on a commission structure.
ScripNet Inc. 818-878-0296 www.scripnet.com TADCO Capital Insurance Managers Inc. & Texas Capital Insurance Managers Inc. 800-233-6145 www.capitalinsurancemanagers.com Number of pharmacies in network 59,000 2.5 million (workers' comp only) Ideally, ScripNet will receive a daily eligibility file from the client. Number of pharmacies in network 58,000 Confidential ScripNet adds the most benefit to employers or groups that spend at least $500,000 on workers' compensation prescription drugs per year. Drug Formulary Development, Protection & Support. Provides disease management information for certain disease classifications which may be identified from time to time by our clients or the committee. Yes / Yes / Yes. Most important to achieving a claimant's timely access to the benefits of the ScripNet program is our identification of who those claimants are, what medications they are receiving, and where they presently have those medications filled. Sends standard reports to its clients on a monthly basis with a fiscal year roll up once a year. ScripNet is flexible with regard to payment from its clients. Yes. Available for groups of full-time employees. Employer must pay at least 51 percent of employee premium. At least 51 percent participation required. Prefer at least 75 percent. 5 We offer 3 tier Open Formulary plans. Closed Formulary also available. Available in 2009. Yes / Refills may be obtained via Internet from the mail order pharmacy. / Yes Confidential Detailed claims vs. premium experience available at renewal prior to group's anniversary date. Monthly premium may be paid by check or ACH. Attractive. Negotiable.