ces account rollup schematic glaxosmithkline september 24, 2012
TRANSCRIPT
CES Account Rollup Schematic
GlaxoSmithKline
September 24, 2012
2Property of The Amundsen Group. Do not duplicate or distribute without permission. These slides are the visual part of a presentation and should not be used without the accompanying discussion. Property of The Amundsen Group. Do not duplicate or distribute without permission. These slides are the visual part of a presentation and should not be used without the accompanying discussion.
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“Ha! Meister’s blown his cerebral cortex.”
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CES Account Rollups: Example of all ESI Processed COM Accounts
SHA Account Name GSK Account Name CES Account Name CES PBM NameAbercrombie & Fitch
Adventist HealthBain and Company…
Express Scripts EXPRESS SCRIPTS MISC-COM EXPRESS SCRIPTS PBM-COM
BC of ID BC ID BC ID-COM EXPRESS SCRIPTS PBM-COM
BCBS MA BC/BS MA BC/BS MA-COM EXPRESS SCRIPTS PBM-COM
GSK PBM Contract
Burlington IndustriesCenturyLink
Preferred Choice Magna MEDCO MEDCO MISC-COM MEDCO PBM-COM
Express Scripts
Express Scripts
UPMC Health PlanUPMC Health Plan OHUPMC Health Plan WV
UPMC HEALTH PLAN UPMC HEALTH PLAN-COM
Anthem BC CA…Empire BCBS NJ…
Lumenos AK…Unicare AL…
WELLPOINT WELLPOINT-COM
State of Maryland Actives CATALYST RX MEDCO MEDCO PBM-COMCATALYST RX-COM
NY State Off Vet Affairs…Tricare North…Tricare South…
TRICARE-DOD TRICARE-DOD MISC-COM TRICARE-DOD PBM-COM
Oxford Health Plans IL OXFORD HEALTH PLAN OXFORD HEALTH PLAN-COM UHC E&I (UHC) PBM - COM
MAMSI… UNITED HC (MAMSI) UNITED HC (MAMSI)-COM UHC E&I (UHC) PBM - COM
UHC E&I (UHC)
UHC E&I (UHC)
4Property of The Amundsen Group. Do not duplicate or distribute without permission. These slides are the visual part of a presentation and should not be used without the accompanying discussion. Property of The Amundsen Group. Do not duplicate or distribute without permission. These slides are the visual part of a presentation and should not be used without the accompanying discussion.
Explanation of CES Account Aggregation Logic
All entities under the columns “CES Account Name” and “CES PBM Name” are displayed within the CES account drop-down list. (EXPRESS SCRIPTS PBM – COM, EXPRESS SCRIPTS MISC – COM, BC/BS MA – COM, WELLPOINT – COM, MEDCO MISC – COM, MEDCO PBM – COM).
EXPRESS SCRIPTS PBM – COM and MEDCO PBM – COM represent the entities with which GSK contracts.
The employer plans that are directly managed by ESI roll up into EXPRESS SCRIPTS MISC – COM and also into the contracting entity EXPRESS SCRIPTS PBM – COM. These plans tend to follow the contracted ESI formulary.
Individual plans that are processed by ESI, that are not individually contracted, and that may or may not follow the contracted ESI formulary are rolled into individual accounts as well as the ESI contracting entity. Blue Cross/Blue Shield of MA rolls both into the account BC/BS MA – COM and EXPRESS SCRIPTS PBM – COM.
Accounts that are processed by ESI but are individually contracted are not aggregated into the ESI contracting entity. WellPoint (and the associated Anthem accounts) roll into WELLPOINT – COM but not into EXPRESS SCRIPTS PBM – COM.
PBMs that may in the future be processed by ESI (merger) but are still contracted independently are not aggregated into the ESI contracting entity. Employer groups such as Burlington Industries, which is processed by Medco, roll into MEDCO MISC – COM and MEDCO PBM – COM but not EXPRESS SCRIPTS PBM – COM.
5Property of The Amundsen Group. Do not duplicate or distribute without permission. These slides are the visual part of a presentation and should not be used without the accompanying discussion. Property of The Amundsen Group. Do not duplicate or distribute without permission. These slides are the visual part of a presentation and should not be used without the accompanying discussion.
In Sum
The Express Scripts PBM represents all business (as defined by GSK) that is eligible to accept the rebate offered to Express Scripts
The “MISC” designation is a subset of the Express Scripts PBM that is primarily comprised of employers (and not otherwise broken-out as a separate account)
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