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Pharmacy Benefit Management
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. PBMs operate inside of integrated healthcare systems (e.g., Kaiser Permanente or Veterans Health Administration), as part of retail pharmacies (e.g., CVS Pharmacy), and as part of insurance companies (e.g., UnitedHealth Group). The role of pharmacy benefit managers includes managing formularies, maintaining a pharmacy network, setting up rebate payments to pharmacies, processing prescription drug claims, providing mail order services, and managing drug use. PBMs play a role as the middlemen between pharmacies, drug manufacturers, wholesalers, and health insurance plan companies. As of 2023, PBMs managed pharmacy benefits for 275 million Americans and the three largest PBMs in the US, CVS Caremark, C ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Third-party Administrator
In the United States, a third-party administrator (TPA) is an organization that Insurance claims processing, processes insurance claims or certain aspects of employee benefit plans for a separate entity. It is also a term used to define organizations within the insurance industry which administer other services such as underwriting and customer service. This can be viewed as outsourcing the administration of the claims processing, since the TPA is performing a task traditionally handled by the company providing the insurance or the company itself. Often, in the case of insurance claims, a TPA handles the claims processing for an employer that self-insures its employees. Thus, the employer is acting as an insurance company and Underwriting#Insurance, underwrites the Financial risk, risk. The risk of loss remains with the employer, and not with the TPA. An insurance company may also use a TPA to manage its claims processing, provider networks, utilization review, or membership function ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Copayment
A patient's copayment or copay is the patient's share of the cost for goods or services rendered, with the other share ("co" = with) paid by the patient's insurance company. The patient's co-payment is usually paid directly to the provider, but is instead paid indirectly through their insurance company in the case of Medicare Part D patients enrolled in the Medicare Prescription Payment Plan, which began on January 1st, 2025. It may be defined in an insurance policy and paid by an insured person each time a medical service is accessed. It is technically a form of coinsurance, but is defined differently in health insurance where a coinsurance is a percentage payment after the deductible up to a certain limit. It must be paid before any policy benefit is payable by an insurance company. Copayments do not usually contribute towards any policy out-of-pocket maximum, whereas coinsurance payments do. Insurance companies use copayments to share health care costs to prevent moral haz ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Teva Pharmaceutical Industries
Teva Pharmaceutical Industries Ltd. (also known as Teva Pharmaceuticals) is an Israeli multinational pharmaceutical company. Teva specializes primarily in generic drugs, but other business interests include branded-drugs, active pharmaceutical ingredients (APIs) and, to a lesser extent, contract manufacturing services and an out-licensing platform. Teva's primary branded products include Austedo ( deutetrabenazine) which is used for the treatment of chorea associated with Huntington's disease and tardive dyskinesia; and Ajovy ( fremanezumab), used for the preventive treatment of migraine in adults. Additional branded drugs sold by Teva include Copaxone, Bendeka and Treanda, all of which are primarily sold in the United States. Teva is listed on the Tel Aviv Stock Exchange and the New York Stock Exchange. Its manufacturing facilities are located in Israel, North America, Europe, Australia, and South America. The company is a member of the Pharmaceutical Research and Manufact ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
AbbVie
AbbVie Inc. is an American pharmaceutical company headquartered in North Chicago, Illinois. It is ranked sixth on the list of largest biomedical companies by revenue. In 2023, the company's seat in Forbes Global 2000 was 74, and rank 89 on the 2024 list. The company's primary product is Humira (adalimumab) ($14billion in 2023 revenues, 27percent of total), administered via injection. It is approved to treat autoimmune diseases including rheumatoid arthritis, Crohn's disease, plaque psoriasis, and ulcerative colitis. It developed Skyrizi ($7.8billion in 2023 revenues), an interleukin-23 (IL-23) inhibitor also used to treat autoimmune diseases. Its other major products include Botox ($5.7billion in 2023 revenues), Imbruvica to treat cancer ($3.6billion in 2023 revenues), Rinvoq to treat arthritis ($4billion in 2023 revenues), Venclexta to treat leukemia and lymphoma ($2.3billion in 2023 revenues), Vraylar to treat schizophrenia and bipolar disorder ($2.7billion in 2023 ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Medco Health Solutions
Medco Health Solutions, Inc. was an American Pharmacy Benefits Management (PBM) company. Medco provided pharmacy services to private and public employers, health plans, labor unions, government agencies, and individuals served by Medicare Part D Prescription Drug Plans. Medco was a member of the S&P 500 and ranked number 34 on the 2011 Fortune 500 list, with 2011 revenues of more than $70 billion. From 2008 to 2012, the company was ranked first on Fortune magazine's World's Most Admired Companies list in the Healthcare: Pharmacy and Other Services category. It was acquired by Express Scripts in April 2012. History Medco was founded as National Pharmacies in 1983. In 1984, after an IPO, National Pharmacies became Medco Containment Services, LLC. In 1993, Medco Containment was acquired by Merck & Co., Inc. and became Merck-Medco. On October 2, 2001, UnitedHealth Group, Merck-Medco,and Accenture launched Xceleron Health LLC, a company created to deliver consulting and business a ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
CVS Health
CVS Health Corporation is an American healthcare company that owns CVS Pharmacy, a retail pharmacy chain; CVS Caremark, a pharmacy benefits manager; and Aetna, a health insurance provider, among many other brands. The company is the world's second largest healthcare company, behind UnitedHealth Group. In 2023, the company was ranked 64th in the ''Forbes'' Global 2000. CVS started in Lowell, Massachusetts by brothers Stanley and Sidney Goldstein and their partner Ralph Hoagland. The name stood for Consumer Value Stores. CVS and its subsidiaries have faced numerous controversies, including health and Medicare fraud, patient privacy violations, prescription errors, financial restatements, deceptive business practices, pharmaceutical kickbacks, and involvement in a political corruption case, resulting in hundreds of millions in settlements and widespread criticism. History 1960s The first Consumer Value Store (CVS), selling health and beauty products, was founded in 1963, ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Rite Aid
Rite Aid Corporation is an American drugstore chain based in Philadelphia, Pennsylvania. It was founded in 1962 in Scranton, Pennsylvania, by Alex Grass under the name Thrift D Discount Center. Prior to its first bankruptcy in 2023, it was the third-largest drugstore chain in the United States. The company has more than 1,200 stores in 15 U.S. states, primarily on the East and West coasts. After several years of growth, Rite Aid adopted its current name and debuted as a public company in 1968. Rite Aid was publicly traded on the New York Stock Exchange under the symbol RAD, and ranked No. 148 in the Fortune 500 in 2022. The company filed for Chapter 11 bankruptcy twice in October 2023 and May 2025, due to a large debt load, thousands of lawsuits alleging involvement in the opioid crisis, and a failed restructuring. History Alex Grass founded the Rite Aid chain in Scranton, Pennsylvania, in September 1962, after marrying into Harrisburg Pennsylvania's Lehrman family in the ea ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
PBM Ownership And Vertical Integration, FTC July 2024
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PBM may refer to: Organizations * ''Parti Bangsa Malaysia'', a registered political party in Malaysia * Progressive British Muslims, former religious organisation in the United Kingdom * PBM Hospital, government hospital in Bikaner, Rajasthan Transport * Johan Adolf Pengel International Airport, Paramaribo, Suriname, IATA code * PBM ''Mariner'', a flying boat * Paul Bird Motorsport, UK Other * Portable bitmap format, an image file format * Pharmacy benefit management * Post-nominal letters for Singapore ''Pingat Bakti Masyarakat'' (Public Service Medal) * Play-by-mail game * PlaqueBoyMax, a Twitch streamer, record producer, and rapper * ''Pretty Bitch Music'', forthcoming studio album by Saweetie * Poultry by-product meal Poultry by-product meal (PBM) is a high-protein ingredient used as a major component in some pet foods. It is made from grinding clean, rendered parts of poultry carcasses and can contain bone A bone is a rigid organ that constitutes p ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Generic Drug
A generic drug is a pharmaceutical drug that contains the same chemical substance as a drug that was originally protected by chemical patents. Generic drugs are allowed for sale after the patents on the original drugs expire. Because the active chemical substance is the same, the medical profile of generics is equivalent in performance compared to their performance at the time when they were patented drugs. A generic drug has the same active pharmaceutical ingredient (API) as the original, but it may differ in some characteristics such as the manufacturing process, formulation, excipients, color, taste, and packaging. Although they may not be associated with a particular company, generic drugs are usually subject to government regulations in the countries in which they are dispensed. They are labeled with the name of the manufacturer and a generic non-proprietary name such as the United States Adopted Name (USAN) or International Nonproprietary Name (INN) of the drug. A generic ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
United HealthGroup
UnitedHealth Group Incorporated is an American multinational for-profit company specializing in health insurance and health care services based in Eden Prairie, Minnesota. Selling insurance products under UnitedHealthcare, and health care services under the Optum brand, it is the world's seventh-largest company by revenue and the largest health care company by revenue. The company is ranked 8th on the 2024 ''Fortune'' Global 500. UnitedHealth Group had a market capitalization of $460.3 billion as of December 20, 2024. UnitedHealth Group has faced numerous investigations, lawsuits, and fines—including SEC enforcement for stock option backdating, Medicare overbilling, unfair claims practices, mental health treatment denials, and anticompetitive behavior—highlighting systemic issues of fraud, patient harm, and corporate misconduct. History 1970s–1990s UnitedHealth Group originated in late 1974, when Minnesota-based Charter Med Incorporated was founded by Richard Tayl ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Health Maintenance Organization
In the United States, a health maintenance organization (HMO) is a medical insurance group that provides health services for a fixed annual fee. It is an organization that provides or arranges managed care for health insurance, self-funded health care benefit plans, individuals, and other entities, acting as a liaison with health care providers (hospitals, doctors, etc.) on a prepaid basis. The US Health Maintenance Organization Act of 1973 required employers with 25 or more employees to offer federally certified HMO options if the employer offers traditional healthcare options. Unlike traditional indemnity insurance, an HMO covers care rendered by those doctors and other professionals who have agreed by contract to treat patients in accordance with the HMO's guidelines and restrictions in exchange for a steady stream of customers. HMOs cover emergency care regardless of the health care provider's contracted status. Operation HMOs often require members to select a primary car ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
Diversified Pharmaceutical Services
Diversified Pharmaceutical Services entered the market in 1976 as the pharmacy benefit manager for United HealthCare, a leading managed care organization. It pioneered many cost containment strategies that are now core pharmacy benefit manager services and became a recognized leader in clinical programs. History Diversified Pharmaceutical Services (DPS) grew out of the pharmacy department within United Healthcare. The company was sold to SmithKline Beecham for $2.3 billion in May 1994. In 1999, it was acquired by Express Scripts Express Scripts Holding Company is a pharmacy benefit management (PBM) organization. In 2017 it was the 22nd-largest company in the United States by total revenue as well as the largest pharmacy benefit management (PBM) organization in the Unit ... in 1999 for $700 million in cash to create what was then the third largest pharmacy benefit manager in the United States. References Health maintenance organizations Life sciences industry M ... [...More Info...] [...Related Items...] OR: [Wikipedia] [Google] [Baidu] |
