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| Contracting Tool Features
The solution has many soft benefits especially in the Audit process. This HIS solution has a "rules based" editing module similar to a pre and post edit offered by most claims switching companies. The edits are very flexible so that the NCPDP field names are inserted in a "If, Then, Else" rules which has a very simple user interface that guides the user through each step. We can add rules, setup alerts and creates paper or paperless reports to proactively stop or mitigate expensive audits costing thousands of dollars and unfavorable media attention. Additionally, the contract management solution forces process improvement across your organization
The audit rights will tell you how “transparent” the relationship is….disclosure is not transparent Non-Disclosure Agreements
System Features Provide Pharmacies with Similar Reporting Tools Used By the Very Profitable Pharmacy Benefit Management Companies (PBM) Identification and Recovery of All Underpaid Dollars Your Organization can enforce Transparency and inprove Bargaining Power Needed To Negotiate Most Favorable Terms As Opposed To Being Forced To Accept Unprofitable Contracts Contract Modeling Tool can improve Reimbursement Rates, MAC Pricing, And Drug Formularies analyzed using historical data Contract Version Control Solution Negotiating the Most Favorable Contract for Your Business Allows user to create “time stamped” notes that are viewable in client maintenance screens RSS Feeds of Industry NewsLinks to Articles Related to Managed Care Reimbursement IssuesArticles and White Papers Published In addition, the new site will contain a secure section for clients to log-in and review their Reports. Claims Data Warehouse and Reporting Solution Our proven model begins and ends with its powerful claims data warehouse solution that consolidates data files from all pharmacies participating on the network. The pharmacy would login using a standard Internet Browser to view its sales metrics and trending reports at store, state, region, MLS, ZIP Code, Area Code, DAW, Manufacturer, Physician, etc. - Additionally, the database’s “SMART” agents are continuous searching for underpaid claims.
- Once an underpaid claim is discovered the system continues processing until an exhaustive analysis is completed.
- The result is a complete report showing why the claim was underpaid with probability scores, so very little manual work is needed to re-coup underpayments.
Pharmacy Services Administration OrganizationsOur solution allows for Industry wide consolidation and use of decision support tools for better negotiations and bargaining power. Independent Pharmacies, Supermarkets, Mass Merchants, and Small to Medium Drug Store Chains can unite and demand preferred reimbursement terms. | |
| PBM Market Share by Number of Covered Lives
Top 25 Pharmacy Benefit Management Companies and Market Share By Membership, as of 1st Quarter 2009 Atlantic Information Services compiles these data from pharmacy benefit management companies and other publicly available information sources. Company | Rx Covered Lives | Market Share | CVS/Caremark Rx, Inc. | 82,000,000 | 12.02% | Walgreens-OptionCare | 75,000,000 | 10.99% | ICORE Healthcare, Inc. | 60,000,000 | 8.79% | Medco Health Solutions, Inc. | 60,000,000 | 8.79% | Express Scripts/CuraScript | 55,000,000 | 8.06% | NovoLogix (formerly Ancillary Care Management) | 40,000,000 | 5.86% | WellPoint NextRx | 35,049,000 | 5.14% | Argus Health Systems, Inc. | 28,600,000 | 4.19% | MedImpact Healthcare Systems, Inc. | 27,000,000 | 3.96% | HealthTrans | 15,300,000 | 2.24% | Prime Therapeutics, LLC | 14,700,000 | 2.15% | Provider Synergies, LLC | 14,000,000 | 2.05% | ACS, Inc. | 14,000,000 | 2.05% | Health Information Designs, Inc. | 12,000,000 | 1.76% | RxStrategies, Inc. | 12,000,000 | 1.76% | ScriptSave | 12,000,000 | 1.76% | Prescription Solutions | 11,754,249 | 1.72% | Aetna Pharmacy Management (APM) | 11,000,000 | 1.61% | First Health Services Corporation | 10,000,000 | 1.47% | Walgreens Health Services Division | 9,700,000 | 1.42% | CIGNA Pharmacy Management | 6,400,000 | 0.94% | Catalyst Rx | 6,028,140 | 0.88% | RESTAT, LLC | 6,000,000 | 0.88% | Sanovia Corporation | 5,000,000 | 0.73% | Axium Healthcare Pharmacy, Inc. | 5,000,000 | 0.73% | 39 other pharmacy benefit industry participants | 54,807,060 | 8.03% | SOURCE: Atlantic Information Services' (AIS) exclusive quarterly survey of pharmacy benefit management companies conducted by Drug Benefit News during the 1st quarter of 2009. METHODOLOGY: Survey conducted by AIS researchers and supplemented by publicly available information sources. Survey includes companies that describe themselves as PBMs, pharmacy benefit administrators, specialty pharmacy providers and others providing pharmacy benefit services. Membership=lives covered under any/all pharmacy benefit contracts served by the company; members may be served by multiple contracts held by a single company or by multiple companies, and so may be counted more than once. Company market shares calculated as percentage of total industry-wide membership identified in this database. |
| | PBM Market Share by claim volume
Top 25 Pharmacy Benefit Management Companies and Market Share By Annual Prescription Volume, as of 1st Quarter 2009 Atlantic Information Services compiles these data from pharmacy benefit management companies and other publicly available information sources. Company | Total Rx/Year | Market Share | CVS/Caremark Rx, Inc. | 594,999,120 | 15.09% | Medco Health Solutions, Inc. | 586,000,000 | 14.86% | Argus Health Systems, Inc. | 578,000,000 | 14.66% | Express Scripts/CuraScript | 420,400,000 | 10.66% | WellPoint NextRx | 267,651,000 | 6.79% | Prescription Solutions | 254,091,612 | 6.44% | ACS, Inc. | 250,000,000 | 6.34% | MedImpact Healthcare Systems, Inc. | 170,400,000 | 4.32% | First Health Services Corporation | 148,500,000 | 3.77% | Prime Therapeutics, LLC | 120,000,000 | 3.04% | HealthTrans | 97,330,000 | 2.47% | Aetna Pharmacy Management (APM) | 89,709,989 | 2.27% | Walgreens Health Services Division | 84,105,927 | 2.13% | CIGNA Pharmacy Management | 75,000,000 | 1.90% | Catalyst Rx | 51,170,234 | 1.30% | SXC Health Solutions, Inc. | 39,362,980 | 1.00% | RESTAT, LLC | 24,000,000 | 0.61% | ScriptSave | 17,000,000 | 0.43% | FutureScripts | 13,182,861 | 0.33% | PerformRx | 9,771,216 | 0.25% | National Pharmaceutical Services | 8,500,000 | 0.22% | Navitus Health Solutions, LLC | 8,000,000 | 0.20% | BioScrip | 7,735,710 | 0.20% | RegenceRx | 5,237,234 | 0.13% | NovoLogix (formerly Ancillary Care Management) | 4,800,000 | 0.12% | 32 other pharmacy benefit industry participants | 18,572,029 | 0.47% | SOURCE: Atlantic Information Services' (AIS) exclusive quarterly survey of pharmacy benefit management companies conducted by Drug Benefit News during the 1st quarter of 2009.
METHODOLOGY: Survey conducted by AIS researchers and supplemented by publicly available information sources. Survey includes companies that describe themselves as PBMs, pharmacy benefit administrators, specialty pharmacy providers and others providing pharmacy benefit services. Prescriptions=Rx filled via all channels offered by each company, including retail, mail-order and specialty pharmacy. Market shares calculated as percentage of total annual prescriptions reported by companies responding to survey. |
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