Magellan Health, Inc. engages in the healthcare management business. The company provides services to health plans and other managed care organizations (MCOs), employers, labor unions, various military and governmental agencies, third party administrators, consultants and brokers. Segments The company operates in Healthcare and Pharmacy Management segments. Healthcare This segment includes the company's management of behavioral healthcare services and employee assistance program (EAP) services; management of other specialty areas, including diagnostic imaging and musculoskeletal management; and the integrated management of physical, behavioral and pharmaceutical healthcare for special populations, delivered through Magellan Complete Care. These special populations include individuals with serious mental illness, dual eligibles, long-term services and supports and other populations with unique and often complex healthcare needs. The company's coordination and management of physical and behavioral healthcare services are provided through its network of medical and behavioral health professionals, clinics, hospitals, and ancillary service providers. This network of credentialed and privileged providers is integrated with clinical and quality improvement programs to improve access to care and the healthcare experience for individuals in need of care. The Healthcare segment's commercial division serves various customers, with services, inclusive of special population management, provided under contracts with health plans and accountable care organizations for some or all of their commercial, Medicaid and Medicare members, as well as with employers. The government division contracts with local, state and federal governmental agencies to provide services to recipients under Medicaid, Medicare and other government programs. The company provides its management services primarily through risk-based products, where it assumes all or a portion of the responsibility for the cost of providing treatment services in exchange for a fixed per member per month fee; and administrative services only products, where the company provides services, such as utilization review, claims administration, and/or provider network management, but does not assume responsibility for the cost of the treatment services. Pharmacy Management This segment comprises products and solutions that provide clinical and financial management of pharmaceuticals paid under medical and pharmacy benefit programs. Pharmacy Management's services include pharmacy benefit management (PBM) services; pharmacy benefit administration (PBA) for state Medicaid and other government sponsored programs; pharmaceutical dispensing operations; clinical and formulary management programs; medical pharmacy management programs; and programs for the integrated management of specialty drugs across both the medical and pharmacy benefit that treat complex conditions, regardless of site of service, method of delivery, or benefit reimbursement. The company’s Pharmacy Management services are provided under contracts with health plans, employers, MCOs, state Medicaid programs, Medicare Part D and other government agencies, and encompass risk-based and fee-for-service arrangements. In addition, Pharmacy Management has subcontract arrangements to provide PBM services for certain healthcare customers. During 2015, Pharmacy Management paid 18.8 million adjusted commercial network claims in its PBM business, 59.2 million adjusted PBA claims and 0.1 million specialty dispensing claims. As of December 31, 2015, Pharmacy Management had a generic dispensing rate of 84.3 percent within its commercial PBM business and served 1.6 million commercial PBM members, 9.6 million members in its medical pharmacy management programs, and 25 states and the District of Columbia in its PBA business. Provider Network The company's managed behavioral healthcare services, integrated healthcare services and EAP treatment services are provided by a contracted network of third-party providers, including physicians, psychiatrists, psychologists, other behavioral and physical health professionals
magellan health inc (MGLN:NASDAQ GS)
4800 Scottsdale Road
Scottsdale, AZ 85251
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