Profile: Catamaran Corp (CTRX.O)
11 Jul 2014
Catamaran Corporation (Catamaran), formerly SXC Health Solutions Corp., incorporated on June 27, 2007, is a provider of pharmacy benefit management (PBM) services and healthcare information technology (HCIT) solutions to the healthcare benefit management industry. The Company’s product offerings and solutions combine a range of applications and PBM services designed to assist its customers in reducing the cost and managing the complexity of their prescription drug programs. The Company’s customers include organizations in the pharmaceutical supply chain, such as pharmacy benefit managers, managed care organizations, self-insured employer groups, unions, third party health care plan administrators, and state and federal government entities. In January 2012, the Company completed its acquisition of HealthTran LLC (HealthTran). On July 2, 2012, the Company acquired Catalyst Health Solutions, Inc. On October 1, 2013, the Company acquired RESTAT, LLC.
The Company’s PBM services, which are marketed under the Catamaran PBM brand, include electronic point-of-sale pharmacy claims management, retail pharmacy network management, mail pharmacy claims management, specialty pharmacy claims management, Medicare Part D services, benefit design consultation, preferred drug management programs, drug review and analysis, consulting services, data access, and reporting and information analysis. The Company's PBM services include owning and operating a network of mail and specialty pharmacies. In addition, the Company is a national provider of drug benefits to its customers under the federal government’s Medicare Part D program. The Company’s HCIT solutions include RxCLAIM, an on-line transaction processing system that provides instant adjudication of prescription drug claims, RxMAX, the Company’s rebate management system, RxTRACK, the Company’s data warehouse and analysis system, Zynchros, the Company’s suite of on-demand formulary management tools, the Company’s pharmacy management system for retail, chain, institutional and mail-order pharmacies, as well as a number of other software products for customers in the pharmaceutical supply chain. The Company’s HCIT solutions are available on a license basis with on-going maintenance and support or on a transaction fee basis using an application service provider (ASP) model.
The Company’s informedRx offering is a suite of customizable PBM services that provide an alternative to traditional PBM offerings typically employed by health plans, government agencies and employers. The Company provides a range of pharmacy spend management solutions and information technology capabilities to managed care organizations, self-insured employer groups, unions, third party health care plan administrators, and state and federal government entities. Formulary Administration provides support for customers’ existing formularies and preferred drug lists or collaborate to create models supported by formulary predictive modeling and impact analysis. Pharmacist, physician and member-focused intervention protocols provide controls to drive generics, preferred drug products and appropriate use. Formularies are administered based on specific plan designs, or by enabling customers with the tools to maintain their own custom formularies online.
The Company specializes in applying data-driven insights to help customers understand the medical risk drivers within their population and take a strategic approach to plan design. The Company provides benefit design configuration and support to customers, in accordance with mutually developed processes. Benefit designs can be modified online, in real time, by the Company or by the customer’s staff. Pharmacy Network Management provides a range of retail network options, including supporting existing networks or assisting customers in developing networks that meet specific geographic access requirements, desired price discounts, or other service requirements. A national retail network, which consists of pharmacies in all 50 states and in Puerto Rico, Guam and the Virgin Islands, provides access to the Company’s customers.
Drug Utilization Review (DUR) is pre-dispensing DUR edit checks are performed on an online, real-time basis between mail and retail pharmacies to encourage appropriate drug utilization, enhance member outcomes, and reduce drug costs. All prescriptions are checked for member eligibility and plan design features and are then compared against previous histories of prescriptions filled by the same pharmacy, by other participating retail network pharmacies and by the mail service pharmacy. Clinical Services and Consulting provides consultative and technical expertise to augment, develop, deploy, and support any additional clinical programs. Reporting and Information Analysis Solutions provides two levels of reporting: a reporting package (which includes a menu of reports), and an online analytical decision support tool, RxTRACK. The Company offers mail and specialty services to its PBM members, as well as other members of its pharmacy network. suite of Web-based services that enables customers to interact with the claims processing system using a standardized protocol in a secure environment. A member Website, RxPORTAL, invites members to learn more about their prescription benefit programs, medication histories, drug information and related industry news. RxPROVIDER PORTAL is a Web-based interface that allows pharmacists and physicians to obtain information from RxCLAIM on a member's plan to assist in providing more cost effective prescription medications.
The Company's HCIT offerings deliver applications on a license, ASP, or fee-for-service basis to customers who administer and manage pharmacy benefits. HCIT products and services serve a diversified group of payor customers that include health plans, federal, state and provincial government programs, pharmacy benefit managers, workers' compensation programs, and long-term and/or chronic care facility operators. In addition, SXC's technology serves as the engine for the Company's service PBM solutions.
Technology Products and Services
RxCLAIM is an on-line transaction processing system designed to provide instant on-line adjudication of third-party prescription drug claims at the point of service, including claims management, as well as payment and billing support and real-time functionality for updating benefit, price, member, provider and drug details. RxCLAIM is designed to provide the Company’s customers control by facilitating the real-time processing of pharmacy claims and payments against eligibility, plan benefits, formularies, price, drug utilization review, prior authorization, and rebates in addition to many other features.
Integrail Pathfinder PRO is a software application that enables a array of users to understand the impact of healthcare resource allocation and medical decision-making through the incorporation of risk prediction and episode profiling technologies. The application offers users an intuitive system for integrating disparate data sources to pinpoint variations in resource utilization and care. IntegrailRx features the ability to measure and predict both pharmacy and total risk using pharmacy claims. RxBUILDER is a Web-based interface for formulary creation and maintenance utilizing a Medi-Span based product file. RxPORTAL allows customers to interact with the patient's formulary and drug history in a secure environment allowing patients and health plans to access industry tools and up to date information. RxAUTH is a prior authorization (PA) management solution, which offers automating the PA process from end-to-end. RxAUTH is also available in a Web-based application. RxMAX is a rebate management system that is designed to assist health plans in managing their relationships with pharmaceutical manufacturers through contract management, record keeping, calculating market share, and creating billing details and summaries. Zynchros provides a suite of on-demand formulary management tools to help payors effectively manage their formulary programs, and to maintain Medicare Part D compliance in their programs. Enhanced Coordination of Benefits integrates external data sources with unique algorithms and eligibility data to identify beneficiaries with other coverage. This enables accurate identification of third party liability in real-time prior to the claim being paid.
Medicare Part D
The Company has offered an array of services to the Medicare marketplace, all compliant with Centers for Medicare and Medicaid Services (CMS) regulations. As a full-service PBM and a National Prescription Drug Plan, the Company supports a variety of Medicare Part D Plan Sponsors. The Company provides prescription benefit management support for Medicare Advantage Prescription Drug plans (MAPDs) and prescription drug plans (PDPs), including implementation of specific Medicare Part D plan designs, creation and maintenance of Medicare Part D formularies (including CMS submission), CMS reporting requirements and consultative, proactive account management.
The Company competes with Express Scripts, Inc., CVS/Caremark Corporation and OptumRx.
1600 MCCONNOR PARKWAY
SCHAUMBURG IL 60173-6801