What is the total number of adjusted mail order prescriptions (aka
claims or scripts) that were issued by PBMs (Pharmacy Benefit
Managers, such as Medco, Express Scripts, etc.) in 2003?   Sources
that might be helpful is AIS Health (www.aishealth.org) or IMS Health.
 One analyst report said that is was ~2.86B in 2004, but there was no
data on 2003.  Thanks for your help..

---

Clarification of Question by belliot2-ga on 25 May 2005 18:30 PDT

P.S.  Timeframe is short for the project I'm on, so would need it in a
day. Will tip 20% if answered promptly.  Appreciate the help!

---

Request for Question Clarification by bobbie7-ga on 25 May 2005 21:53 PDT

Hello Belliot2,

Please take a look at my findings in the comment box below. Is this
the type of information you?re looking for?

Thanks,
Bobbie7

---

Clarification of Question by belliot2-ga on 26 May 2005 11:23 PDT

Bobbie7,

Sorry about the delayed response... was in a meeting. This is close,
the last piece of data you found from AIS is exactly what we need, but
for 2003 (don't need quarterly, just total.) The data just may not be
out there, but I got tempted when I saw numbers for 2002.

The quote that says "Today 13.1% of all prescriptions covered by PBMs
are villed via mail order" would help us back into the number (because
we have numbers on total prescriptions covered by PBMs), but that
percentage isn't for 2003.

We don't need specific company info, just total number of
prescriptions filled by PBM mail order in hte US in 2003.  To give you
some background, PBMs cover a certain portion of perscriptions in the
US, and the PBMs only fill a portion of those via mail order.   Hope
that helps and thanks again for your diligence!

---

Request for Question Clarification by bobbie7-ga on 26 May 2005 12:21 PDT

Belliot2,

I'll see what else I can find for you.

Thanks,
Bobbie7

---

Request for Question Clarification by bobbie7-ga on 26 May 2005 13:52 PDT

Belliot2,

I didn?t find the total number of mail order prescriptions filled,
however by searching the SEC filings, I did locate the number of mail
order prescriptions filled in 2003 for Medco, Caremark, Express
Scripts and AdvancePCS.



2003 Mail Order Statistics 

Company                 Mail Order Prescriptions 
Medco                   78 million
Caremark                24.9 million
Express Scripts         32.3 million
AdvancePCS              15.4 million


---------------------------
MEDCO HEALTH SOLUTIONS INC 
---------------------------

According to Medco?s 10-k filed in March 2004, for the fiscal year
ended December 27, 2003:

?In 2003, our network of mail order pharmacies filled approximately 78
million prescriptions, exceeding the number of mail order
prescriptions filled by the mail order operations of our three largest
competitors combined.?

?Our mail order service is the industry?s largest in terms of the
number of prescriptions filled. We dispensed approximately 78 million
prescriptions in 2003 through our mail order pharmacies.?

 ?Mail order pharmacies currently fill only approximately 13.2% of
total prescription drug sales in the United States, an increase from
approximately 12.9% in 2002. Favorable demographics and increasing
mail order capabilities should enable this trend to continue.?


Source: 
MEDCO HEALTH SOLUTIONS INC 
10-K filed on 03/26/2004
http://www.hoovers.com/free/co/secdoc.xhtml?ID=105515&ipage=2693070&doc=1


---------------
CAREMARK RX INC 
---------------

According to Caremark?s 10-k filed filed on 03/09/2004 for the year
ended December 31, 2003:

?During 2003, we processed approximately 24.9 million prescriptions
through our mail service pharmacies and processed approximately 89.9
million retail pharmacy claims.?

Source: 
CAREMARK RX INC 
10-K filed on 03/09/2004
http://www.hoovers.com/free/co/secdoc.xhtml?ID=42793&ipage=2656927&doc=1


-------------------
EXPRESS SCRIPTS INC 
-------------------

According to EXPRESS SCRIPTS  10-K filed on 02/25/2004 for the fiscal
year ended December 31, 2003:

?In 2003, we processed 378.9 million network pharmacy claims and
dispensed 32.3 million mail pharmacy prescriptions. We also dispensed
3.6 million specialty distribution prescriptions.?

Source: 
EXPRESS SCRIPTS INC 
10-K filed on 02/25/2004
http://www.hoovers.com/free/co/secdoc.xhtml?ID=15773&ipage=2629739&doc=1


----------
AdvancePCS  
----------

During fiscal year 2003, we filled approximately 15 million
prescriptions through our mail pharmacies. The number of mail pharmacy
prescriptions dispensed increased from 11.0 million in fiscal year
2002 to 15.4 million for fiscal year 2003.

Source: 
10-K for ADVANCEPCS http://www.marketwatch.com/tools/quotes/secarticle.asp?&sid=437913&symb=ADVP&siteid=mktw&guid=%7BD161CF10%2D9E80%2D418B%2D9A93%2DB1FB48ACA707%7D&type=1


Does this help?

Thanks, 
Bobbie7

---

Clarification of Question by belliot2-ga on 26 May 2005 14:45 PDT

Bobbie7,
Honestly, if you can't find it, then I'd believe it's not out there.
Thanks for your help.  Please close the question so that I can remit
payment and tip.
Thanks!
Brian

Dear Brian,

Thank you for kindly accepting my findings, even though it isn't what you wanted.

In any case I sent off an email asking about the total number of PBM
mail order prescriptions filled in 2003.

If I receive a reply, I'll let you know.

Best wishes,
Bobbie7

---

Clarification of Answer by bobbie7-ga on 26 May 2005 15:31 PDT

Brian,

Thank you for the five stars and generous tip! 

A publication from the Coalition for Quality Healthcare states:
"All large PBMs own and run mail-order pharmacies, which have become
vital profit centers that account for about 17 percent of all retail
prescription sales in the United States." Unfortunatley they don't
state if the figure is for 2003 or 2004.
http://www.pharmacychoices.org/PBMoverview.pdf

In any case I will keep on looking for the exact answer for you.

Best regards,
Bobbie7

---

Clarification of Answer by bobbie7-ga on 26 May 2005 15:54 PDT

From the Drug Cost Management Report,  Sept 12, 2003:  


According to AIS's data, a total industry average of 11% of claims are
processed by mail-order pharmacies on an adjusted basis (adjusted
where one mail claim (90 days) = three retail claims (30 days)), as of
the second quarter of 2003.

PBMs are currently processing more than 350 million mail-order claims
(adjusted) on an annual basis.


Figure 1. Adjusted Claims Processed by Sales Channel, 2001-2003, for 23 PBMs

                2001         2002          2003
              2 billion   2.1 billion   2.5 billion
               scripts      scripts       scripts

Mail            16.24%       20.39%        34.98%
Chain           70.78%       65.83%        51.53%
Independent     12.99%       13.77%        13.49%

Source: AIS


Figure 2. Top 10 PBMs by Mail-Order Volume, 2Q 2003

                                                    Mail-Order
Company Name                                           Scripts

Medco Health Solutions, Inc.                        82,000,000
Express Scripts, Inc.                               81,481,383
Caremark Rx, Inc.                                   60,600,000
AdvancePCS                                          46,200,000
ACS State Healthcare (formerly Consultec)            8,000,000
CIGNA Pharmacy Management                            5,000,000
Aetna Pharmacy Management (APM)                      4,638,300
Prescription Solutions                               4,000,000
WellPoint Pharmacy Management                        3,344,613
National Prescription Administrators, Inc. (NPA)     3,000,000



Figure 3. Top 10 PBMs by Mail-Order Penetration Rate, 2Q 2003

                                                    Mail-Order
PBM                                                Penetration

Pequot Pharmaceutical Network                           54.00%
Caremark Rx, Inc.                                       39.84%
Innoviant Prescription Benefits Administrator           37.77%
National Pharmaceutical Services                        27.14%
Northwest Pharmacy Services (NWPS)                      20.82%
Pharmacy Services Group                                 20.00%
Express Scripts, Inc.                                   18.54%
Medco Health Solutions, Inc.                            14.67%
CBCA Rx                                                 13.92%
EBRx, Inc.                                              11.11%



http://www.findarticles.com/p/articles/mi_m0NKV/is_11_4/ai_108118251

Honestly, if Bobbie7 can't find it, it's not out there.  I fully trust
Bobbie7's research abilities and have been very pleased with Bobbie7's
deliverables.

Dear Belliot2,

Here are my findings. Please let me know if this information meets your needs.

Best regards,
Bobbie7


According to a July 2004 article in Managed Care Magazine  titled
?Wish List: 10 Things You Want From Your PBM? by Maureen Glabman, 
Pharmacy Benefit Managers process about 75 percent of the more-than-3
billion prescriptions dispensed annually in the United States. That
would be about 2.25 billion prescriptions.

Excerpt:

 ?As the rising cost of health care continues to be a national
concern, all facets of pharmaceuticals, from manufacturing to
distribution, are caught squarely in the health care klieg light.
Pharmacy benefit managers, which process about 75 percent of the
more-than-3 billion prescriptions dispensed annually in the United
States, are under increasing pressure to reveal revenue sources and
cut prices.?

Source:
MANAGED CARE July 2004
Wish List: 10 Things You Want From Your PBM
By Maureen Glabman
http://www.managedcaremag.com/archives/0407/0407.pbms.html


--------------------------------------------------------------

From the Generic Pharmaceutical Association:
August 2003

?Pharmacy benefit management (PBM) companies that administer drug
plans for employers and insurers continue to grow. In 2002,
approximately 3.1 billion prescriptions were dispensed and 1.5 billion
prescriptions were administered and paid for through the 4 largest
PBMs (see below).?

PBM                Retail       Rx Mail-order   Rx Total 
AdvancePCS         488 million  15 million      503 million  
Medco Health 
Solutions          466 million   82 million     548 million 
Express Scripts    356 million   27 million     383 million  
Caremark            71 million   20 million      91 million  

http://www.gphaonline.org/news/ABS.aug03.html

Belliot2,

Here is some additional material. Would you need more information to
complete your answer?

Thanks, Bobbie7


---------------------------------

In 2003, Medco dispensed 78 million mail order prescriptions.
https://client21.medcohealth.com/login_wilson_rxb.html


PBMs Report Growth of Mail, Generic Use

Express Scripts 

?Express Scripts said its mail-order prescriptions jumped 20% to 9.8
million during the 2004 quarter from 8.1 million a year earlier.

MIM reported a 29% increase in specialty and mail prescriptions
compared with the same quarter in 2003.

Caremark's mail pharmacy revenues totaled $2.1 billion, an increase of
$1 billion, while mail prescriptions totaled 11.4 million, an increase
of 5.3 million prescriptions from the second quarter of 2003.

Generic drugs comprised 45.5% of Medco's total prescriptions in the
second quarter of 2004, up from 43.4% one year ago, and the company
processed 22 million mail-order prescriptions in the second quarter of
this year, representing a 15.2% increase from 19.1 million in the
second quarter last year.

According to Snow, the PBM has added some 3 million members to
mandatory mail programs this year, and those clients are already
experiencing desired results. He anticipates adding another 300,000
lives to mandatory mail by the end of 2004.?
http://www.aishealth.com/DrugCosts/DCMPBMsGrowGeneric.html


---------------------------------


Medco 
"Medco said it filled a record 87.7 million prescriptions via its
mail-service pharmacies in 2004, an increase of 12.3% from the level
in 2003. On a script-adjusted basis, mail scripts reached 39.2% of
total prescriptions in the quarter, up nearly six percentage points
from 33.4% in the fourth quarter of 2003."

Caremark
"For the fourth quarter of 2004, Caremark reported record net revenues
of $8 billion, which includes $2.3 billion in mail pharmacy revenues,
an increase of $1.1 billion from the fourth quarter of 2003. Mail
claims for the quarter totaled 12.5 million, up from 6.6 million
claims in the last quarter of 2003. The 2004 results include the
acquisition of AdvancePCS, completed March 24, 2004."

http://www.aishealth.com/DrugCosts/DBNMajorPBMsProfit.html


---------------------------------


PBMs: The Basics and an Industry Overview


PBMs manage about 70 percent of the more than 3 billion prescriptions dispensed
in the United States each year

13-16% of prescription sales are through mail order pharmacy.

Source: 
The Health Strategies Consultancy, LLC
June 26, 2003
http://www.ftc.gov/ogc/healthcarehearings/docs/030626richardson.pdf

---------------------------------

Belliot2,

"Today, 13.11% of all prescriptions covered by a PBM are filled via
mail order (figure 3). This percentage has increased since 2000, with
a particularly dramatic jump from the second to third quarters of
2002."

Figure 3. Percentage of PBM Prescriptions Filled via Mail Order,
1Q2000-4Q2002

1Q00       4.21%
2Q00       5.07%
3Q00       2.80%
4Q00       2.81%
1Q01       3.03%
2Q01       3.53%
3Q01       6.30%
4Q01       6.60%
1Q02       6.30%
2Q02       6.59%
3Q02      13.11%
4Q02      13.11%

Source: AIS

Read the full text of this article here.
http://www.findarticles.com/p/articles/mi_m0NKV/is_3_4/ai_98626330