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|Founded||Birmingham, Alabama, United States (1993 )|
|Products||Prescription Benefit Management|
Number of employees
CVS Caremark (formerly Caremark Rx) (stylized as
In the United States, a pharmacy benefit manager (PBM) is a third-party administrator of prescription drug programs for commercial health plans, self-insured employer plans, Medicare Part D plans, the Federal Employees Health Benefits Program, and state government employee plans. According to the American Pharmacists Association, "PBMs are primarily responsible for developing and maintaining the formulary, contracting with pharmacies, negotiating discounts and rebates with drug manufacturers, and processing and paying prescription drug claims. For the most part, they work with self-insured companies and government programs striving to maintain or reduce the pharmacy expenditures of the plan while concurrently trying to improve health care outcomes." PBMs operate inside of integrated healthcare systems, as part of retail pharmacies, and as part of insurance companies.
CVS Health Corporation is an American retail pharmacy and Pharmacy Benefit Manager headquartered in Woonsocket, Rhode Island. Consumer Value Stores (CVS) began in 1963 with three partners, brothers Stanley and Sidney Goldstein and partner Ralph Hoagland, who grew the venture from a parent company, Mark Steven, Inc., that helped retailers manage their health and beauty aid product lines. The business began as a chain of health and beauty aid stores, but within several years, pharmacies were added. To facilitate growth and expansion, the company joined The Melville Corporation, which managed a string of retail businesses. Following a period of growth in the 1980s and 1990s, CVS Corporation spun off from Melville in 1996, becoming a standalone company trading on the New York Stock Exchange as CVS.
Woonsocket is a city in Providence County, Rhode Island, United States. The population was 41,186 at the 2010 census, making it the sixth largest city in the state. Woonsocket lies directly south of the Massachusetts state line and constitutes part of both the Providence metropolitan area and the larger Greater Boston Combined Statistical Area.
Caremark was founded in 1993 in Birmingham, Alabama as MedPartners, Inc. by HealthSouth Corporation along with Richard Scrushy, former CEO of HealthSouth, and one time HealthSouth Chief Operating Officer Larry House as a physician practice management (PPM) company. After going public in February 21 of 1995, MedPartners quickly became the largest PPM company through many acquisitions (see Ross-Loos Medical Group). By 1998 MedPartner's had revenues of $7 billion.
Birmingham is a city in the north central region of the U.S. state of Alabama. With an estimated 2017 population of 210,710, it is the most populous city in Alabama. Birmingham is the seat of Jefferson County, Alabama's most populous and fifth largest county. As of 2017, the Birmingham-Hoover Metropolitan Statistical Area had a population of 1,149,807, making it the most populous in Alabama and 49th-most populous in the United States. Birmingham serves as an important regional hub and is associated with the Deep South, Piedmont, and Appalachian regions of the nation.
Richard Marin Scrushy is an American businessman and convicted felon. He is the founder of HealthSouth Corporation, a global healthcare company based in Birmingham, Alabama.
Ross-Loos Medical Group was a comprehensive prepaid health services plan with 29 medical offices throughout Los Angeles, Orange, Riverside, and San Bernardino Counties in California and a large multi-specialty hospital located on Temple Street, Los Angeles.
MedPartners originally acquired Northbrook, Illinois-based Caremark International, which was founded as a unit of Baxter International and was spun off from Baxter in 1992 as a publicly traded company. On May 15, 1996, Caremark International announced it would be acquired by MedPartners with MedPartners ending up with Caremark's PPM division and prescription benefit management (PBM) division and disposing of Caremark's rehabilitation Business to HealthSouth. It expanded to the distribution of drugs for other conditions, including human growth hormone and multiple sclerosis.
Northbrook is a suburb of Chicago, located at the northern edge of Cook County, Illinois, United States.
Baxter International Inc. is a Fortune 500 American health care company with headquarters in Deerfield, Illinois. The company primarily focuses on products to treat hemophilia, kidney disease, immune disorders and other chronic and acute medical conditions. The company had 2017 sales of $10.6 billion, across two businesses: BioScience and Medical Products. Baxter's BioScience business produces recombinant and blood plasma proteins to treat hemophilia and other bleeding disorders; plasma-based therapies to treat immune deficiencies and other chronic and acute blood-related conditions; products for regenerative medicine, and vaccines. Baxter's Medical Products business produces intravenous products and other products used in the delivery of fluids and drugs to patients; inhalational anaesthetics; contract manufacturing services; and products to treat end-stage renal disease, or irreversible kidney failure, including products for peritoneal dialysis and hemodialysis.
Multiple sclerosis (MS) is a demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This damage disrupts the ability of parts of the nervous system to communicate, resulting in a range of signs and symptoms, including physical, mental, and sometimes psychiatric problems. Specific symptoms can include double vision, blindness in one eye, muscle weakness, trouble with sensation, or trouble with coordination. MS takes several forms, with new symptoms either occurring in isolated attacks or building up over time. Between attacks, symptoms may disappear completely; however, permanent neurological problems often remain, especially as the disease advances.
In October 1997, PhyCor, the second largest PPM at the time, announced they would be acquiring MedPartners for $8 billion in stock and assumed debt. However the merger agreement was terminated in January 1998. The companies cited significant operational and strategic differences as the reason for the termination of the merger.MedPartners then announced that they would suffer a net loss of $841 million for the 4th quarter of 1997. Chairman, President and CEO Larry House resigned, with Richard Scrushy taking over as interim chairman, president and CEO. Scrushy announced that he would not change his role at HealthSouth as a result of him taking over at MedPartners. On March 18, 1998, Scrushy chose Edwin "Mac" Crawford to become the new president and CEO of MedPartners. Scrushy remained as chairman until November 1998, but remained on the board. After taking over, Mac Crawford announced that MedPartners was exiting its PPM business and refocusing on its PBM business. In 2000, after it had sold all of its PPM practices, MedPartners changed its name to Caremark Rx. In 2001 Scrushy sold his remaining shares in Caremark and left its board to continue as chairman and CEO of HealthSouth.
In 2003 it merged with AdvancePCS seen as a key move in ensuring the growth and profitability of the company. By retaining key leaders from the AdvancePCS organization, and adopting many of its key principles, Caremark Rx was able to bolster its position within the PBM industry.
AdvancePCS Inc. was a large prescription benefit plan administrator from the United States, also known as a PBM.
In 2004, Caremark moved its headquarters from Birmingham, Alabama, to Nashville, Tennessee, where the company only maintains a small executive staff. The company still has a large presence in Birmingham. Many believed the move was an effort to hide the company's HealthSouth past due to the fact the company announced the move not long after the HealthSouth scandal. There is recent speculation that the company will close its relatively small Nashville office and combine it with its operational office in Northbrook, Illinois.
Alabama is a state in the southeastern region of the United States. It is bordered by Tennessee to the north, Georgia to the east, Florida and the Gulf of Mexico to the south, and Mississippi to the west. Alabama is the 30th largest by area and the 24th-most populous of the U.S. states. With a total of 1,500 miles (2,400 km) of inland waterways, Alabama has among the most of any state.
Nashville is the capital and most populous city of the U.S. state of Tennessee. The city is the county seat of Davidson County and is located on the Cumberland River. The city's population ranks 24th in the U.S. According to 2017 estimates from the U.S. Census Bureau, the total consolidated city-county population stood at 691,243. The "balance" population, which excludes semi-independent municipalities within Davidson County, was 667,560 in 2017.
Tennessee is a state located in the southeastern region of the United States. Tennessee is the 36th largest and the 16th most populous of the 50 United States. Tennessee is bordered by Kentucky to the north, Virginia to the northeast, North Carolina to the east, Georgia, Alabama, and Mississippi to the south, Arkansas to the west, and Missouri to the northwest. The Appalachian Mountains dominate the eastern part of the state, and the Mississippi River forms the state's western border. Nashville is the state's capital and largest city, with a 2017 population of 667,560 and a 2017 metro population of 1,903,045. Tennessee's second largest city is Memphis, which had a population of 652,236 in 2017.
Caremark currently has approximately 16,000 employees.
It is the second largest prescription management and pharmaceutical services business in the United States.
In March 2007, Caremark merged with CVS Corporation to create CVS Caremark, later re-branded as CVS Health.
Today the company is one of the nation's leading pharmacy benefit management (PBM) companies, provides comprehensive prescription benefit management services to over 2,000 health plans, including corporations, managed care organizations, insurance companies, unions and government entities. With net revenue of approximately $37 billion (including approximately $5.8 billion of retail copayments) in 2006, they are also one of the largest PBMs. Caremark operates a national retail pharmacy network with over 60,000 participating pharmacies, as well as 56 retail specialty pharmacy stores, 20 specialty mail order pharmacies and 9 mail service pharmacies located in 26 states and the District of Columbia.
Osco Drug and Sav-on Drugs were the names of a pair of chain pharmacies that operated in the United States. Osco Drug was founded by the Skaggs family. Alpha Beta grocery store was purchased by American Stores in 1961. Skaggs Drug Centers bought American Stores in 1979 and assumed the American Stores name. Sav-on Drugs was a California-based pharmacy chain that was acquired by Osco's parent company in 1980. Both Osco and Sav-on stores eventually came under the ownership of American Stores, then Albertsons, and finally SuperValu before the stores were sold off.
CVS Pharmacy is a subsidiary of the American retail and health care company CVS Health, headquartered in Woonsocket, Rhode Island. It was also known as, and originally named, the Consumer Value Store and was founded in Lowell, Massachusetts, in 1963. The chain was owned by its original holding company Melville Corporation since its inception until its current parent company was spun off into its own company in 1996. CVS Pharmacy is currently the largest pharmacy chain in the United States by number of locations and total prescription revenue. Its parent company ranks as the 7th largest U.S. corporation by FY2017 revenues in the Fortune 500. The parent company of CVS Pharmacy's leading competitor ranked 19th for the same time period.
Walgreen Company or simply Walgreens is an American company that operates as the second-largest pharmacy store chain in the United States behind CVS Health. It specializes in filling prescriptions, health and wellness products, health information, and photo services. As of August 31, 2018, the company operated 9,560 stores in all 50 states, the District of Columbia and the US territories of Puerto Rico and the U.S. Virgin Islands. It was founded in Chicago, Illinois, in 1901. The Walgreens headquarters office is in the Chicago suburb of Deerfield, Illinois.
Encompass Health Corporation, based in Birmingham, Alabama, is one of the United States' largest providers of post-acute healthcare services, offering both facility-based and home-based post-acute services in 36 states and Puerto Rico through its network of inpatient rehabilitation hospitals, home health agencies, and hospice agencies. Effective January 2, 2018, the organization changed its name to Encompass Health Corporation and its New York Stock Exchange (NYSE) ticker symbol from HLS to EHC.
Rite Aid Corporation is a drugstore chain in the United States. The company ranked No. 94 in the 2018 Fortune 500 list of the largest United States corporations by total revenue. It is headquartered in Camp Hill, East Pennsboro Township, Cumberland County, Pennsylvania, near Harrisburg. Rite Aid is the largest drugstore chain on the East Coast and the third largest in the U.S.
Revco Discount Drug Stores, once based in Twinsburg, Ohio, was a major drug store chain operating through the Ohio Valley, the Mid-Atlantic states, and the Southeastern United States. The chain's stock was traded on the New York Stock Exchange under the ticker symbol RXR. Revco was sold to CVS Pharmacy for $2.8 billion in February 1998. When it was sold, the chain had over 2,500 stores.
Longs Drugs is an American chain with approximately 40 drugstores throughout the state of Hawaii.
Express Scripts Holding Company is an American Fortune 100 company. As of 2018, the company is the 25th-largest in the United States by total revenue as well as the largest pharmacy benefit management (PBM) organization in the United States. Express Scripts had 2016 revenues of $100.752 billion. Since December 20, 2018, the company has been a subsidiary of Cigna.
Catamaran Corporation is the former name of a company that now operates within UnitedHealth Group's OptumRX division. It sells pharmacy benefit management and medical record keeping services to businesses in the United States. Working independently of the government and insurance companies allowed it to operate as a third party verifier; the RxCLAIM online claim processing system allowed for prescription drug claims to be processed online if the customer lived in and filled his/her prescription in the United States. SXC had three separate but interrelated business segments which dealt with prescription drug programs. For 2013 23% of company revenue came from Cigna Corporation.
Linda Cahn is the founder and president of a nationwide consulting firm, Pharmacy Benefit Consultants. The firm assists corporations, unions, government entities and insurance companies in improving their prescription coverage benefits and decreasing their prescription coverage costs.
Change Healthcare is a provider of revenue and payment cycle management and clinical information exchange solutions, connecting payers, providers, and patients in the U.S. healthcare system. The name also refers to a company founded in 2007 which subsequently became part of the current conglomerate. The company operates the largest financial and administrative information exchange in the United States.
Surescripts is an Arlington, Virginia based information technology company that supports e-prescription, the electronic transmission of prescriptions between health care organizations and pharmacies, as well as general health information exchange (HIE) of medical records.
Specialty drugs or specialty pharmaceuticals are a recent designation of pharmaceuticals that are classified as high-cost, high complexity and/or high touch. Specialty drugs are often biologics—"drugs derived from living cells" that are injectable or infused. They are used to treat complex or rare chronic conditions such as cancer, rheumatoid arthritis, hemophilia, H.I.V. psoriasis, inflammatory bowel disease and hepatitis C. In 1990 there were 10 specialty drugs on the market, in the mid-1990s there were fewer than 30, by 2008 there were 200, and by 2015 there were 300. Drugs are often defined as specialty because their price is much higher than that of non-specialty drugs. Medicare defines any drug for which the negotiated price is $670 per month or more, as a specialty drug which is placed in a specialty tier that requires a higher patient cost sharing. Drugs are also identified as specialty when there is a special handling requirement or the drug is only available via a limited distributions network. By 2015 "specialty medications accounted for one-third of all spending on drugs in the United States, up from 19 percent in 2004 and heading toward 50 percent in the next 10 years", according to IMS Health, which tracks prescriptions. According to a 2010 article in Forbes, specialty drugs for rare diseases became more expensive "than anyone imagined" and their success came "at a time when the traditional drug business of selling medicines to the masses" was "in decline". In 2015 analysis by The Wall Street Journal suggested the large premium was due to the perceived value of rare disease treatments which usually are very expensive when compared to treatments for more common diseases.
Specialty pharmacy refers to distribution channels designed to handle specialty drugs — pharmaceutical therapies that are either high cost, high complexity and/or high touch. High touch refers to higher degree of complexity in terms of distribution, administration, or patient management which drives up the cost of the drugs. In the early years specialty pharmacy providers attached "high-touch services to their overall price tags" arguing that patients who receive specialty pharmaceuticals "need high levels of ancillary and follow-up care to ensure that the drug spend is not wasted on them." An example of a specialty drug that would only be available through specialty pharmacy is interferon beta-1a (Avonex), a treatment for MS that requires a refrigerated chain of distribution and costs $17,000 a year. Some specialty pharmacies deal in pharmaceuticals that treat complex or rare chronic conditions such as cancer, rheumatoid arthritis, hemophilia, H.I.V. psoriasis, inflammatory bowel disease (IBD) or Hepatitis C. "Specialty pharmacies are seen as a reliable distribution channel for expensive drugs, offering patients convenience and lower costs while maximizing insurance reimbursements from those companies that cover the drug. Patients typically pay the same co-payments whether or not their insurers cover the drug." As the market demanded specialization in drug distribution and clinical management of complex therapies, specialized pharma (SP) evolved. Specialty pharmacies may handle therapies that are biologics, and are injectable or infused. By 2008 the pharmacy benefit management dominated the specialty pharmacies market having acquired smaller specialty pharmacies. PBMs administer specialty pharmacies in their network and can "negotiate better prices and frequently offer a complete menu of specialty pharmaceuticals and related services to serve as an attractive 'one-stop shop' for health plans and employers."
Diplomat Pharmacy, Inc. is the largest independent provider of specialty pharmacy services in the United States. The company partners with manufacturers, payers, providers, hospitals, and more. Headquartered in Flint, Michigan, Diplomat has facilities across the United States and dispenses drugs in all 50 states. Diplomat offers specialized medication and medication management programs for patients with complex and chronic conditions such as cancer, hepatitis, multiple sclerosis, HIV and others.
Optum, a part of UnitedHealth Group, is a pharmacy benefit manager and care services group operating across 150 countries in North America, South America, Europe, Asia Pacific and the Middle East. In 2011, United HealthGroup formed Optum by merging its existing pharmacy and care delivery services into the single Optum brand, comprising three main businesses: OptumHealth, OptumInsight and OptumRx. In 2017, Optum accounted for 44 percent of UnitedHealth Group's profits and as of 2019, Optum's revenues have surpassed $100 billion. Also in early 2019, Optum gained significant media attention regarding a trade secrets lawsuit that the company filed against former executive David William Smith, after Smith left Optum to join the Amazon, JP Morgan and Berkshire-Hathaway joint healthcare venture, Haven. Optum's headquarters are located in Eden Prairie, Minnesota.