Clinical Management Concepts, Inc

    Be assured that

    * the right drug is given

    * to the right person

    * for the right reason



525 N State of Franklin

Johnson City, TN 37602

Phone: 423-928-7898

Fax: 423-928-4309


Frequently Asked Questions

 Q. Does your PBM manage utilization or just process claims?

 A. CMC manages utilization by pharmacist review of problem areas each quarter.

 Q. Does your PBM perform drug utilization reviews?
 A. CMC performs not only prospective DUR on-line thru their claims processor, but also performs back-end or retrospective DUR through a pharmacist-driven claims review each month and each quarter.

 Q. Does your PBM identify high-risk patient drug interactions?
 A. CMC does by reviewing the medications utilized in the prescription benefit.  After the clinically-trained pharmacist reviews the medications, they can identify individuals who need special attention for either high-risk disease states or patients using 8 or more medications.

 Q. Does your PBM identify over-utilization and take the necessary steps to reduce it?
 A. CMC does this by utilizing both prospective and retrospective DUR.  Many claims are filled that do not trigger the on-line edits in place by the typical PBM.  The pharmacist-driven retrospective review monitors claims for possible overuse of medications, especially narcotic prescription use.  The physicians are contacted directly by the pharmacist when an intervention is necessary.

 Q. Does your PBM have a local customer service center to handle requests fast and efficiently?
 A. We are located in Johnson City and we strive to bring innovative customer service to our clients.  Our prescription help desk is staffed with knowledgeable technicians who have worked in the retail setting and who know how to deal with problems promptly and completely.

 Q. Will your PBM meet with managers on a quarterly basis to share data and program results?
 A. At CMC, we focus on bringing timely and efficient results to our clients throughout the year.  CMC believes that its clients can make better benefit decisions when they know how their benefit is operating.  CMC will provide HIPAA compliant reports on the status of the benefit throughout the year.  Most PBMs wait until the end of the year to provide any data on the status of their prescription benefit.

 Q. Does your PBM look out for ways to reduce costs throughout the year based on your individual utilization?
 A. CMC provides regular analysis of the utilization.  CMC is a pharmacy-based company with the clinical knowledge of the latest drug utilization. CMC’s motto "The Right Drug, for the Right Person, for the Right Reason" embodies the philosophy that CMC desires the most cost-effective and most clinically-effective drugs used for each client.