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Wiki Wiki Summary
United States Pharmacopeia The United States Pharmacopeia (USP) is a pharmacopeia (compendium of drug information) for the United States published annually by the United States Pharmacopeial Convention (usually also called the USP), a nonprofit organization that owns the trademark and also owns the copyright on the pharmacopeia itself. The USP is published in a combined volume with the National Formulary (a formulary) as the USP-NF. If a drug ingredient or drug product has an applicable USP quality standard (in the form of a USP-NF monograph), it must conform in order to use the designation "USP" or "NF".
The Second Annual Report The Second Annual Report is the debut album by English industrial music group Throbbing Gristle, released in November 1977 through Industrial Records. It is a combination of live and studio recordings made from October 1976 to September 1977.
Comprehensive annual financial report An Annual Comprehensive Financial Report, formally called Comprehensive Annual Financial Report (CAFR)) is a set of U.S. government financial statements comprising the financial report of a state, municipal or other governmental entity that complies with the accounting requirements promulgated by the Governmental Accounting Standards Board (GASB). GASB provides standards for the content of a Comprehensive Annual Financial Report in its annually updated publication Codification of Governmental Accounting and Financial Reporting Standards.
World Happiness Report The World Happiness Report is a publication of the United Nations Sustainable Development Solutions Network. It contains articles and rankings of national happiness, based on respondent ratings of their own lives, which the report also correlates with various (quality of) life factors.
The First Annual Report The First Annual Report is a bootleg album of music recorded by industrial music pioneers Throbbing Gristle in 1975. The recording originally went unreleased, and the band instead decided to release The Second Annual Report in 1977.
Competition law Competition law is the field of law that promotes or seeks to maintain market competition by regulating anti-competitive conduct by companies. Competition law is implemented through public and private enforcement.
Customer relationship management Customer relationship management (CRM) is a process in which a business or other organization administers its interactions with customers, typically using data analysis to study large amounts of information.CRM systems compile data from a range of different communication channels, including a company's website, telephone, email, live chat, marketing materials and more recently, social media. They allow businesses to learn more about their target audiences and how to best cater for their needs, thus retaining customers and driving sales growth.
Customer In sales, commerce, and economics, a customer (sometimes known as a client, buyer, or purchaser) is the recipient of a good, service, product or an idea - obtained from a seller, vendor, or supplier via a financial transaction or exchange for money or some other valuable consideration.\n\n\n== Etymology and terminology ==\nEarly societies relied on a gift economy based on favours.
Public Investment Fund The Public Investment Fund (PIF; Arabic: صندوق الإستثمارات العامة) is the sovereign wealth fund of Saudi Arabia. It is among the largest sovereign wealth funds in the world with total estimated assets of $600 billion (£490 billion).
Competition Competition is a rivalry where two or more parties strive for a common goal which cannot be shared: where one's gain is the other's loss (an example of which is a zero-sum game). Competition can arise between entities such as organisms, individuals, economic and social groups, etc.
Competitor backlinking Competitor backlinking is a search engine optimization strategy that involves analyzing the backlinks of competing websites within a vertical search. The outcome of this activity is designed to increase organic search engine rankings and to gain an understanding of the link building strategies used by business competitors.By analyzing the backlinks to competitor websites, it is possible to gain a benchmark on the number of links and the quality of links that is required for high search engine rankings.
Competitor Group Competitor Group, Inc. (CGI) is a privately held, for-profit, sports marketing and management company based in Mira Mesa, San Diego, California.
Round-robin tournament A round-robin tournament (or all-play-all tournament) is a competition in which each contestant meets every other participant, usually in turn. A round-robin contrasts with an elimination tournament, in which participants are eliminated after a certain number of losses.
Health insurance Health insurance or medical insurance (also known as medical aid in South Africa) is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance is risk among many individuals.
UnitedHealth Group UnitedHealth Group Incorporated is an American multinational managed healthcare and insurance company based in Minnetonka, Minnesota. It offers health care products and insurance services.
Pharmaceutical industry The pharmaceutical industry discovers, develops, produces, and markets drugs or pharmaceutical drugs for use as medications to be administered to patients (or self-administered), with the aim to cure them, vaccinate them, or alleviate symptoms. Pharmaceutical companies may deal in generic or brand medications and medical devices.
Medication Meditation is a practice in which an individual uses a technique – such as mindfulness, or focusing the mind on a particular object, thought, or activity – to train attention and awareness, and achieve a mentally clear and emotionally calm and stable state.Meditation is practiced in numerous religious traditions. The earliest records of meditation (dhyana) are found in the Upanishads of Hindu philosophy, and meditation plays a salient role in the contemplative repertoire of Buddhism and Hinduism.
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. According to the American Pharmacists Association, "PBMs are primarily responsible for developing and maintaining the formulary, contracting with pharmacies, negotiating discounts and rebates with drug manufacturers, and processing and paying prescription drug claims." PBMs operate inside of integrated healthcare systems (e.g., Kaiser Permanente or Veterans Health Administration), as part of retail pharmacies (e.g., CVS Pharmacy or Rite-Aid), and as part of insurance companies (e.g., UnitedHealth Group).As of 2016, PBMs managed pharmacy benefits for 266 million Americans.
List of drugs: Cf–Ch This multi-page article lists pharmaceutical drugs alphabetically by name. Many drugs have more than one name and, therefore, the same drug may be listed more than once.
Tylenol (brand) Tylenol () is a brand of drugs advertised for reducing pain, reducing fever, and relieving the symptoms of allergies, cold, cough, headache, and influenza. The active ingredient of its original flagship product is paracetamol (known in the United States, Canada, and various other countries as acetaminophen), an analgesic and antipyretic.
Metamizole Metamizole, or dipyrone, is a painkiller, spasm reliever, and fever reliever that also has anti-inflammatory effects. It is most commonly given by mouth or by intravenous infusion.Although it is available over-the-counter in some countries, it is banned in others, due to its potential for adverse events, including agranulocytosis.
Aspirin/paracetamol/caffeine Aspirin/paracetamol(acetaminophen)/caffeine is a combination drug for the treatment of pain, especially tension headache and migraine. It is sold in the US under the trade names Goody's Powder and Excedrin, although not all products sold under the Excedrin brand contain this combination.
Prescription drug A prescription drug (also prescription medication or prescription medicine) is a pharmaceutical drug that legally requires a medical prescription to be dispensed. In contrast, over-the-counter drugs can be obtained without a prescription.
Liability insurance Liability insurance (also called third-party insurance) is a part of the general insurance system of risk financing to protect the purchaser (the "insured") from the risks of liabilities imposed by lawsuits and similar claims and protects the insured if the purchaser is sued for claims that come within the coverage of the insurance policy.\nOriginally, individual companies that faced a common peril formed a group and created a self-help fund out of which to pay compensation should any member incur loss (in other words, a mutual insurance arrangement).
Australian Government The Australian Government, also known as the Commonwealth Government, is the national government of Australia, a federal parliamentary constitutional monarchy. Like other Westminster-style systems of government, the Australian Government is made up of three branches: the executive (the prime minister, the ministers, and government departments), the legislative (the Parliament of Australia), and the judicial.
Adverse food reaction An adverse food reaction is an adverse response by the body to food or a specific type of food.The most common adverse reaction is a food allergy, which is an adverse immune response to either a specific type or a range of food proteins.\nHowever, other adverse responses to food are not allergies.
Adverse party An adverse party is an opposing party in a lawsuit under an adversary system of law. In general, an adverse party is a party against whom judgment is sought or "a party interested in sustaining a judgment or decree." For example, the adverse party for a defendant is the plaintiff.
Material adverse change In the fields of mergers and acquisitions and corporate finance, a material adverse change (abbreviated MAC), material adverse event (MAE), or material adverse effect (also MAE) is a change in circumstances that significantly reduces the value of a company. A contract to acquire, invest in, or lend money to a company often contains a term that allows the acquirer, investor, or lender to cancel the transaction if a material adverse change occurs.
Regulation (European Union) A regulation is a legal act of the European Union that becomes immediately enforceable as law in all member states simultaneously. Regulations can be distinguished from directives which, at least in principle, need to be transposed into national law.
Medicare Part D coverage gap The Medicare Part D coverage gap (informally known as the Medicare doughnut hole) is a period of consumer payment for prescription medication costs which lies between the initial coverage limit and the catastrophic-coverage threshold, when the consumer is a member of a Medicare Part D prescription-drug program administered by the United States federal government. The gap is reached after shared insurer payment - consumer payment for all covered prescription drugs reaches a government-set amount, and is left only after the consumer has paid full, unshared costs of an additional amount for the same prescriptions.
Medicare Prescription Drug, Improvement, and Modernization Act The Medicare Prescription Drug, Improvement, and Modernization Act, also called the Medicare Modernization Act or MMA, is a federal law of the United States, enacted in 2003. It produced the largest overhaul of Medicare in the public health program's 38-year history.
Out-of-pocket expense An out-of-pocket expense (or out-of-pocket cost, OOP) is the direct payment of money that may or may not be later reimbursed from a third-party source.\nFor example, when operating a vehicle, gasoline, parking fees and tolls are considered out-of-pocket expenses for a trip.
Health system A health system, also known as health care system or healthcare system, is the organization of people, institutions, and resources that deliver health care services to meet the health needs of target populations.\nThere is a wide variety of health systems around the world, with as many histories and organizational structures as there are nations.
Health care in the United States Health care in the United States is provided by many distinct organizations, made up of insurance companies, healthcare providers, hospital systems, and independent providers. Health care facilities are largely owned and operated by private sector businesses.
Risk Factors
CAREMARK RX INC Item 1A Risk Factors In addition to the other information included and incorporated by reference in this Annual Report on Form 10-K, including the listing of factors that may affect future results presented on page i, “Forward-Looking Statements and Factors That May Affect Future Results,” you should carefully consider the following risks before making an investment decision concerning Caremark Rx, Inc
You should also read and consider the other information in this Annual Report on Form 10-K and the other documents incorporated by reference in this Annual Report on Form 10-K See Part I, Item 1, “Business—Address and Availability of Information” on page 1
The PBM industry is extremely competitive and competition could impair our ability to maintain existing customers and attract new customers, which could harm our business and financial results
The PBM industry is extremely competitive
Some of our competitors are large, well-established and profitable companies
These competitors include several large health insurers, managed health care plans, retail chain stores and independent PBMs that may possess greater financial, marketing and other resources than we 17 ______________________________________________________________________ do
Some of these competitors may offer services and pricing terms that we, as an independent PBM company, may not be able to offer
This competition may make it more difficult to maintain existing customers and attract new customers and may cause us to face the risk of declining reimbursement levels without achieving corresponding reductions in costs of revenues
As a result, we may not continue to remain competitive, and competition could have an adverse effect on our business and financial results
If we lose relationships with one or more key pharmaceutical manufacturers or if the payments made by pharmaceutical manufacturers decline, our business and financial results could be adversely affected
We have business relationships with numerous pharmaceutical manufacturers that pay rebates, administrative fees or other discounts based on use of selected drugs by participants in the benefit plans we manage for our customers
We also have contractual arrangements under which we receive fees from pharmaceutical manufacturers for other programs and services that we provide
Our business and financial results could be adversely affected if: • we were to lose relationships with one or more key pharmaceutical manufacturers; • rebates or other discounts decline due to changes in utilization of specified pharmaceutical products by health plan sponsors and other clients; • legal restrictions are imposed on the ability of pharmaceutical manufacturers to offer rebates, administrative fees or other discounts or to purchase our programs or services; or • pharmaceutical manufacturers choose not to offer rebates, administrative fees or other discounts or to purchase our programs or services
The launch of generic pharmaceuticals into the marketplace may impact our financial results
Rebates on drugs on which patents are expected to expire over the next several years currently contribute significantly to our earned rebates
During 2006 and 2007 patents are expected to expire on brand-name drugs representing approximately dlra20 billion in annual sales in the United States
As these patents expire, the introduction of generic products may substantially reduce the market share of the brand-name drugs and the rebates manufacturers provide to us for their brand-name drugs that are included on the formularies we manage
We also may not be able to negotiate rebates for new brand-name drugs comparable to those rebates we are earning on brand-name drugs on which patents are expected to expire
We generally earn higher margins on generic drugs dispensed by our mail service pharmacies than we earn on brand-name drugs
However, manufacturers of newly-introduced generic drugs sometimes benefit from an exclusive marketing period, generally six months, during which we may be unable to earn these higher margins
The typically higher margins we earn on generic drugs and the rebates we earn by adding newly-approved, brand-name drugs to our formularies may not offset any decline in rebates for brand-name drugs on which patents expire
We may be subject to liability claims for damages and other expenses that are not covered by insurance
A successful product or professional liability claim in excess of our insurance coverage could harm our financial condition and results of operations
Various aspects of our business may subject us to litigation and liability for damages, including the performance of PBM services, including formulary management and health improvement and clinical services, and the operation of our pharmacies and websites
We believe that most of the claims described in Note 14, “Contingencies,” to our consolidated financial statements included in Part II, Item 8 of this Annual Report on Form 10-K are unlikely to be covered by insurance
18 ______________________________________________________________________ Existing and new government legislative and regulatory action could adversely affect our business and financial results
As a participant in the healthcare and PBM industries, our operations are subject to complex and evolving federal and state laws and regulations and enforcement by federal and state governmental agencies
These laws and regulations are described in detail at Part I, Item 1, “Business—Government Regulation
Uncertainty regarding the implementation and impact of Medicare Part D may adversely impact our business and financial results
The MMA created a new, voluntary prescription drug benefit for Medicare beneficiaries entitled to Medicare benefits under Part A or enrolled in Medicare Part B The Medicare Drug Benefit became effective on January 1, 2006
We participate in the administration of the Medicare Drug Benefit: (i) through the provision of PBM services to our health plan clients and other clients that have qualified as a Medicare Part D prescription drug plan, (ii) through the offering of Medicare Part D pharmacy benefits by our subsidiary, SilverScript Insurance Company, which has been approved by CMS as a prescription drug plan under Medicare Part D in all regions of the country, and (iii) by assisting employer, union and other health plan clients that qualify for the retiree drug subsidy available under Medicare Part D by collecting and submitting eligibility and/or drug cost data to CMS for them in order to obtain the subsidy
Our clients could decide to discontinue providing prescription drug benefits to their Medicare-eligible members
If this occurs, the adverse effects of the Part D benefit may outweigh any opportunities for new business generated by the new benefit
We are not yet able to assess the impact that Medicare Part D will have on our clients’ decisions to continue to offer a prescription drug benefit to their Medicare-eligible members
In addition, if the cost and complexity of the recent changes exceed our expectations or prevent effective program implementation; if the government alters or reduces funding of Medicare programs because of the higher-than-anticipated cost to taxpayers of the MMA or for other reasons; if we fail to design and maintain programs that are attractive to Medicare participants; or if we are not successful in retaining enrollees, or winning contract renewals or new contracts under the MMA’s competitive bidding process, our current Medicare business and our ability to expand our Medicare operations could be materially and adversely affected, and we may not be able to realize any return on our investments in Medicare initiatives
Efforts to reduce health care costs and alter health care financing practices could adversely affect our business
During the past several years, the US healthcare industry has been subject to an increase in governmental regulation at both the federal and state levels
Efforts to control healthcare costs, including prescription drug costs, are underway at the federal and state government levels
Changing political, economic and regulatory influences may affect health care financing and reimbursement practices
If the current health care financing and reimbursement system changes significantly, our business could be materially adversely affected
Congress periodically considers proposals to reform the US health care system
These proposals may increase government involvement in health care and regulation of PBM services, or otherwise change the way our clients do business
Health plan sponsors may react to these proposals and the uncertainty surrounding them by reducing or delaying purchases of cost control mechanisms and related services that we provide
We cannot predict what effect, if any, these proposals may have on our business
Other legislative or market-driven changes in the health care system that we cannot anticipate could also materially adversely affect our consolidated results of operations, consolidated financial position and/or consolidated cash flow from operations
We are the subject of various legal proceedings
We are parties to legal proceedings challenging certain of their business practices
The material legal proceedings affecting us are described in