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Aetna Inc. (/ ˈ ɛ t n ə / ET-nə) is an American managed health care company that sells traditional and consumer directed health care insurance and related services, such as medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans, primarily through employer-paid (fully or partly) insurance and benefit programs, and through Medicare.
In the United States, a preferred pharmacy network is a group of pharmacies that involves a prescription drug plan that selects a group of preferred pharmacies, which likely include pharmacies willing to give the plans a larger discount than other pharmacies. Consumers are then able to choose between preferred or non-preferred pharmacies.
CVS Specialty is the specialty pharmacy division that provides specialty pharmacy services for individuals with chronic or genetic diseases who require complex and expensive drug therapies. CVS Health operate 24 retail specialty pharmacy stores and 11 specialty mail order pharmacies, making them the largest specialty pharmacy in the United States.
WellCare began operations in 1985 in Tampa, Florida as a Medicaid provider for the State of Florida. [5] In 1992, Kiran Patel, a cardiologist and entrepreneur, purchased the company. [6] [7] In 2002, Patel sold it to a New York investment group led by George Soros and Todd Farha. [7] Also in 2002, Todd Farha joined the company as CEO. [8] [9]
Express Scripts also offers pharmacy benefit management services for workers' compensation insurance programs. The program is accredited by URAC, the nation's largest accrediting body for pharmacy benefit management companies. The company processes pharmaceutical claims for members through a network of retail pharmacies.
Under these laws, pharmacy benefit managers with contracts to Health care service plans are required by law to be registered with the Department of Managed Health Care to disclose information. [58] SB 966: Pharmacy benefits. SB 966: Pharmacy benefits is a California state bill written by state senators Aisha Wahab and Scott Weiner. It is ...
The primary role of pharmacies in the US is to safely and accurately fill prescriptions ordered by healthcare providers for patients. The pharmacy may receive a prescription in many ways, including a hardcopy, verbally over the phone, or electronically from the provider's electronic medical record system (EMR) is linked to the pharmacy. [5]
In the 21st century, commercial payers were increasingly using litigation against providers to combat alleged fraud or abuse. [25] Examples included litigation between Aetna and a group of surgical centers over an out-of-network overbilling scheme and kickbacks for referrals, where Aetna was ultimately awarded $37 million. [25]