Medco Health Solutions (NYSE: MHS) is one of the nation's biggest pharmacy benefit managers (PBMs). Medco provides services through a network of retail pharmacies and its own mail-order pharmacy. Pharmacy benefit managers like Medco generate profits by consolidating buyers to obtain discounts with pharmaceutical manufacturers, distributors, and retail pharmacies, and work with clients to design customized pharmacy benefit plans. By acquiring Accredo in 2005, Medco became one of the largest providers of specialty pharmacy services in the United States as well.
Medco provides clinically-driven pharmacy services designed to improve the quality of care and lower total healthcare costs for private and public employers, health plans, labor unions and government agencies of all sizes, and for individuals served by Medicare Part D Prescription Drug Plans. During the fiscal year ended December 26, 2009, the Company administered 695 million prescriptions.
Company Overview
Medco is one of the national Prescription Drug Plans (PDP) named by the Centers for Medicare and Medicaid Services to administer prescription drug plan benefits for the Medicare-eligible population at large.
Medco's revenue comes primarily from contracting with clients to provide prescription drugs to their members through mail order and Medco's retail network. The PBM client will pay for the drugs dispensed to their members at a discount to average wholesale price plus a dispensing fee. Some clients may also pay center administrative fees attached to services. Increasing these fees is part of the way Medco has been able to increase its rebates to customers.
Business and Financial Metrics
Second Quarter 2010 Results[1]
During the second quarter of 2010, Medco reported GAAP diluted earnings per share (EPS) increased 20.3 percent to a record $0.77 from $0.64. Diluted EPS, excluding $0.06 in amortization of intangible assets from the 2003 spin-off, increased 20.3 percent to a record $0.83 from $0.69 in the second quarter of 2009. Total net revenues increased 9.9 percent to a record $16.4 billion. Specialty pharmacy revenues increased 18.1 percent to a record $2.8 billion. Mail-order prescriptions increased 6.2 percent to a record 27.5 million. Generic dispensing rate increased 3.3 percentage points to a record 70.6 percent
Business Segments
Plant Design[2]
Medco’s client teams take a consultative approach to assisting clients in the development and implementation of plan design, which suit their specific needs. The clients have access to the skills of various Medco professionals, including experienced clinical, financial and information technology specialists. As an integral part of the consultative approach, the account teams use the software tools developed to model the effects of different plan designs based on historical data, including Medco’s EXPERxT Advisor, which provides real-time plan design modeling capability for the clients. Clients can use these models to judge the impact of specific plan design elements before they are implemented.
Clinical Management[2]
The Company offer coverage management and utilization management programs, including drug utilization review, which is a systematic evaluation of individual and population use of prescription drugs, to identify and address over-use, under-use, and misuse of prescription drugs. It has also introduced a portfolio of clinical solutions. RationalMed service, an advanced patient safety program designed to improve patient care and lower total healthcare costs. It analyzes patients’ available prescriptions, inpatient and outpatient medical and laboratory claim records to detect gaps and errors in care, and then engages physicians, pharmacists and patients in making appropriate changes. Medco offer RationalMed as a program to health plans and plan sponsors.
For Medicare Part D plans, Medco offers Medication Therapy Management program, designed to ensure that covered Medicare Part D medications prescribed to focused beneficiaries are appropriately utilized to optimize therapeutic outcomes. Medco uses the Chronic Disease Score, a software algorithm to identify the beneficiaries who meet the criteria established by Centers for Medicare & Medicaid Services (CMS).
Optimal Health is Medco’s health and care support solution, offered through its 10 year alliance with Healthways, Inc. Optimal Health offers plan sponsors health improvement solutions across the entire population of at-risk members with chronic and complex conditions, which extends the therapy management capabilities to include disease management services for those clients looking for healthcare service for their members.
Clinical Services, Specialty Pharmacy[2]
Medco works with the patient and the patient’s physician to implement the prescribed plan of care. The patient is supported by a team consisting of a pharmacist, a customer service representative and a reimbursement specialist, and with certain therapies, a registered nurse. It assist patients and their families in coping with a variety of difficult emotional and social challenges presented by their diseases, and in some cases participate in patient advocacy organizations, assist in the formation of patient support groups, and advocate legislation to advance patient interests.
Pharmacy Management[2]
In 2009, the Medco Pharmacy, the mail order service filed 103.1 million prescriptions. The pharmacy benefit management (PBM) mail-order pharmacy operations consist of seven prescription order processing pharmacies, which are located throughout the United States.
In the prescription order processing pharmacies, the pharmacists, technicians and other staff focuses on pharmacy activities such as reviewing, recording and interpreting incoming prescriptions, screening for interactions based on each patient’s drug history profile, resolving benefit issues with rules that are determined by plan sponsors, resolving clinical or prescription clarification issues with physicians and collecting the copayment from the patient. It uses the image-based technology, which provides for access to prescription orders and promotes efficient processing.
In the dispensing pharmacies, the focus is on the fulfillment and distribution of medications to patients. The dispensing pharmacies uses automated technology to dispense tablets and capsules, as well as items dispensed in original packaging.
PolyMedica provides diabetes testing supplies, prescriptions and related products to patients with diabetes through its Liberty brand. PolyMedica meets the needs of diabetes patients by providing delivery of supplies through locations in Florida and Virginia. For these services, PolyMedica bills Medicare, other government agencies and/or private insurance companies directly, for those diabetes-related supplies.
Medco Therapeutic Resource Centers located within the mail-order pharmacy operations, are designed around the theory that specialization leads to better pharmacy care for members with chronic and complex conditions. Accredo Health Group provides an improved level of care to patients taking specialty medicines to treat complex or chronic conditions. Accredo Health Group focuses on dispensing infused, injectable, inhaled, and oral drugs, which require a higher level of patient services and support compared to what typically is available from the pharmacies.
Medco have contractual relationships covering approximately 60,000 independent and chain retail pharmacies, which have agreed to participate in one or more of the retail networks. The Company operates call center pharmacies, each of which is licensed as a pharmacy in the state in which it is located and is staffed by pharmacists and service representatives.
Physician Services[2]
The Company offers a number of programs from the Physician’s Service Center, which is dedicated to answering physician questions and accepting phone prescriptions, to products like RationalMed. Physician Practice Summaries inform physicians about prescribing options and patterns for their Medco patients.
Internet-based Services[2]
The Company’s Internet-based services offer sites for clients and retail pharmacists, which provide interactive tools focused on improving compliance with plan goals, simplifying benefit administration, and providing critical benefit and medical information. The My Rx Choices prescription savings program provides members with transparency around their benefits and facilitates more informed patient-physician dialogue.
The member Website capabilities allow members to self-manage their prescription benefits, while encouraging the use of safe, effective therapies that comply with their plan’s provisions. The member Website also supports pre-enrollment and post-enrollment activities on behalf of the Medicare PDP and programs serving multiple clients. The client Website provides online access to Medco’s tools for reporting, analyzing and modeling data, clinical-utilization management and decision-support, plan administration, including eligibility and claims reviews, the latest industry news, and easy submission and tracking of service requests. The Pharmacist Resource Center offers online support for retail pharmacies, which participate in the national networks.
Partnerships and Acquisitions[3]
In January 2010, the Company completed the acquisition of DNA Direct Inc. In April 2008, Medco acquired a majority interest in Europa Apotheek Venlo B.V. (Europa Apotheek), which provides mail-order pharmacy services in Germany. In 2009, Medco formed a joint venture with United Drug plc, a pan-European healthcare provider, to provide home-based pharmacy care services in the United Kingdom for patients covered by the country’s National Health Service.
Labels: HEALTH
2 yorum:
This post was great. Really informative. If you need resources for a sober buddy then you should check these guys out and get your life back on track.
This post was great. Really informative. If you need resources for a sober buddy then you should check these guys out and get your life back on track.
Yorum Gönder