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Caremark operates a national retail pharmacy network linking over 50,000 participating locations. The network employs a sophisticated point-of-sale system featuring on-line, real-time claims processing to ensure that only covered drugs are dispensed under Caremark plans, and only to currently eligible participants. It also automatically conducts Drug Utilization Review (DUR) to ensure safety and clinical appropriateness (see below). Patients simply show their Caremark prescription cards to the pharmacist or sales clerk, and receive their prescription for only a low co-payment and with no claims form to fill out or submit. In 1999, the retail network dispensed approximately 40 million prescriptions.
For plan sponsors that prefer a traditional paper-claims reimbursement method, or for instances in which participants must use out-of-network pharmacies, Caremark offers paper claims adjudication and processing.
Caremark's mail service pharmacy reduces the cost of maintenance medications for both plan sponsors and their participants, while offering greater convenience to each. Patients send prescriptions or refill orders to the mail service pharmacy, where they are processed, dispensed, and checked before being mailed to the patient's home or office. The process eliminates claim forms and reduces dispensing fees, plan billing expenses, and related paperwork. Participants enjoy the convenience of having their medications delivered to their door and not having to file claims or wait for reimbursement.
Caremark builds in safety to its mail service operation. Every prescription is quality checked and dispensed by an experienced registered pharmacist, assisted by on-line DUR and plan-specific checks for coverage, compliance, patient eligibility, etc. Caremark is also the only prescription benefit manager to have defined and published its own Pharmacy Practice Standards to promote safety and excellence in mail service dispensing.
In 1998, Caremark's commitment to quality in mail service operations led to a new, state-of-the-art pharmacy automation system known as TriStar Pharmacy Manager. The proprietary system, a unique Caremark asset, integrates the latest information technology, intelligent conveyors, imaging, and robotics to improve the speed, accuracy, and productivity of prescription dispensing. TriStar benefits both plan sponsors and patients by improving turnaround times, reducing costs and paperwork, customizing order forms for individual patients, and expanding the patient-counseling leaflets generated with each prescription. TriStar is already operating in the San Antonio mail service pharmacy, with a second facility planned for 2000.
For patients with certain chronic or genetic illnesses, Caremark offers
specialized home or office delivery of high-cost, biotech pharmaceuticals
and related therapeutic services, including compliance management, emergency
telephone counseling, education programs, and, where necessary, coordination
of in-home nursing services. The medications, which include injectable
and other specialized-infusion drugs, are delivered via express courier
from Caremark's 17 JCAHO-accredited pharmacies to patients in all 50 states.
Ancillary medical supplies and EPA-approved disposal kits are also furnished.
A dedicated Caremark CareTeam, comprised of a pharmacist and a home patient
representative, is assigned to each patient to provide personalized support,
monitor product supply and ordering needs, and assess clinical progress.
Caremark's Therapeutic Services programs currently serve more than 34,000
patients, delivering more than 322,000 specialized prescriptions per year.
The programs successfully control plan expenses for ongoing biotech therapies
while providing patients the assistance they need to administer their
treatment themselves. Surveys report patient satisfaction ratings of 97%.
Caremark Therapeutic Services provides specialized pharmaceutical services for the biotech and pharmaceutical industry. Caremark Therapeutic Services works closely with biotech pharmaceutical manufacturers to customize its services to meet the specific needs of those individuals utilizing their product. To learn more about the services provided to manufacturers, view the CTS presentation:
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Caremark is the first and only PBM to achieve Full Patient and Practitioner Accreditation from NCQA for asthma, CHF, coronary artery disease, and diabetes disease management programs (Effective 9/02 - 9/05). |
Caremark's most intensive clinical offering is CarePatterns™ Disease Management Programs. This portfolio of disease-specific, patient-centered programs is currently available for ten chronic medical conditions, including some of the highest cost-per-patient diseases covered by plans today. By monitoring a patient's entire care, not just drug therapy, and by coordinating the activities of all parties - patient, physician, pharmacist, and Caremark's own team of specially trained CarePatterns™ nurses and case managers - the CarePatterns™ programs improve the patient's quality of life while reducing the overall cost of treating their disease.
Each CarePatterns™ program stresses patient education and compliance with prescribed treatment. Specially-trained nurses at the CarePatterns™ Call Center in San Antonio, Texas communicate regularly with patients to educate them about their disease and any symptoms or complications they have experienced, to offer counseling on lifestyle concerns, and to monitor compliance with the physician's prescribed treatment. Based in patient's reports during these phone calls, the CarePatterns™ team sends targeted educational materials describing the specific medical and lifestyle aspects of the disease that the patient is experiencing. These educational efforts are designed to empower the patient and encourage self-care. Research has shown that compliance and self-care can significantly reduce the frequency of emergency room visits, hospitalizations, and unscheduled doctor's office visits, while reducing symptom severity and improving overall quality of care. CarePatterns™ programs evaluate all outcomes, comparing pre- and post-enrollment measures for cost, utilization, symptom severity, and patient functionality.
The CarePatterns™ integrated approach makes powerful use of Caremark's synergies across clinical, distribution, and information management areas. CarePatterns™ broadens the company's mandate from simple prescription benefit services to proactively managing and reducing the long-term costs of disease for its clients, while improving quality of care and patients' quality of life.
Through Caremark's Clinical Research Operations group, we offer a broad range of services to pharmaceutical manufacturers and biotech organizations. These services support product development programs spanning Phase I through Phase IV including product repackaging, warehousing, distribution, accountability and destruction. We also tap the rich resources and expertise of Caremark Pharmacy Benefit Management and Specialized Therapeutic Services divisions to provide a range of unique solutions that make the clinical trials process more efficient and productive. These include:
- Identification of physicians to function as investigators for study protocols.
- Management of home care nursing and pharmacy services for clinical trials where administering study medications and performing data collection in the home environment will enhance patient recruitment and compliance.
- Design of study-specific "benefit plans" that allow study patients to receive their trial products via our mail service pharmacy or at over 50,000 retail locations in Caremark's national pharmacy network-perfect for Phase IV post-marketing studies.
- Repackaging and labeling of study-specific product lots at our FDA-approved repackaging facility.
In response to client needs to access and maximize the value of prescription drug information, Caremark has developed RxNavigator, a proprietary system that provides timely, user-friendly, online access to pharmaceutical claims data.
Today, RxNavigator has many potential uses that begin with the ability to broadly aggregate prescription drug utilization data or focus on specific analysis including:
- targeting high risk, high cost patients
- monitoring effectiveness of prescription benefit programs
- effectiveness of specific drugs and therapies
- understanding and reviewing prescribing patterns
- pharmacy dispensing
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