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


Who We Are

Clinical Management Concepts (CMC) offers a pharmacy-coordinated program that brings the knowledge of the health care team together.  Improved communication between physicians and pharmacists within a HIPAA compliant environment helps improve overall patient care and identify patients with special needs. A coordinated health and wellness program is available to further enhance patient outcome and return on investment.


CMC has client relationships reaching beyond Northeast Tennessee, serving employer groups nationwide. Our commitment to the success of the health care team ensures that we continuously look for new ways to control risk and reduce cost.


CMC offers a program, independent of retail pharmacy service, that utilizes the knowledge and expertise of its clinical and technical staff. CMC is a self-insured company and a vendor of pharmacy services, which give it a unique perspective in managing healthcare benefits.


CMC goes far beyond the traditional point-of-sale claims-processing features of other Prescription Benefit Managers (PBM). Our program will reduce prescription drug costs and associated health care costs through Drug Utilization Review (DUR) and appropriate intervention as well as early detection of costly illnesses.

What We Do

To really get to the heart of health care costs, CMC firmly believes that an employer's approach should start with prescription drug utilization management.

    • Prospective DUR program, followed by a strong retrospective DUR program
    • Clinical Intervention Analysis with documented outcomes and potential savings
    • Monthly/quarterly meetings with clients to review reports and progress of the benefit program.
    • Seasonal newsletters and ongoing patient education.
    • Same day service Help Desk to assist enrollees with coverage issues.
    • Hands-on involvement to direct employee enrollment, on-site meetings, etc. freeing up HR Benefit managers.


Our team of experts includes clinical pharmacists, financial experts and HR experts, who partner with employers to improve benefit programs, keeping them affordable and manageable by performing the following:

    • Develop a Core Benefit Program that is employer specific
    • Conduct on-site employee education meetings
    • Develop employer-specific Preferred Drug List (PDL)
    • Encourage Generic Utilization and help employers develop plans for this
    • Analyze copays to help reduce costs
    • Offer a nationwide, traveling pharmacy network
    • Establish a pricing schedule with client involvement
    • Negotiate dispensing fees
    • Offer Competitive Administrative Fees


CMC also provides additional services including Disease Management and Wellness programs that assist employers in achieving optimal financial and clinical outcomes as well as improving employee quality of life and productivity.

How We Do It

The most common drug utilization problems are:
  * Disease-State Management
  * Drug Gender Mismatch
  * Drug Interactions
  * Duplicate Therapy
  * Ineffective/Inappropriate Drugs
  * Non-compliance
  * Over Utilization
  * Pharmacy Data Entry Errors
  * Plan Tracking and Reporting
  * Polypharmacy Multiple Claim Reversals
  * Therapeutic Substitution

DUR stands for drug utilization review.  Most PBM programs have limited Prospective DUR that takes place at the time of claims processing, but CMC is different in that we also view the data after the prescription has been filled. During a Retrospective DUR:


    • The pharmacist uses customized software to view prescription data received from the claims processor.
    • Individualized reports are created that help the pharmacist identify common drug utilization problems that require intervention.
    • The problem identified is discussed with the employee’s physician and/or pharmacist.
    • The intervention may end there or further investigation may take place.