Title: Commercial growth/diversification balances Medicar
1Bear Stearns 2005 London Health Care
Conference May 10, 2005 The Four Seasons, London
PacifiCare Health Systems Gregory W.
Scott Executive Vice President and CFO
2Cautionary Statement
The statements made during this presentation that
are not historical facts are forward-looking
statements within the meaning of the Federal
securities laws, and may involve a number of
risks and uncertainties. Factors that could
cause actual results to differ materially from
expectations include, but are not limited to, the
risks discussed in the company's most recent
filings with the SEC, including the Form10K filed
as of December 31, 2004.
3Strategy of a growth company
PHS 8 health plan markets before acquisitions
- A Fortune 200 company with
- 12 billion in revenue
- 2.6 million commercial lives
- 715K Medicare Advantage
- lives
- 10 million specialty lives
4Expansion through recent acquisitions
28 Additional medical states after American
Medical Security Group acquisition
- A Fortune 200 company with 2005 goals of
- 14.1 billion in revenue
- 2.7 million commercial lives
- 743K Medicare Advantage
- lives
- 11.8 million specialty lives
5Expansion through recent acquisitions
Significant additional overlap with Pacific Life
acquisition
6Benefits of AMS and Pacific Life acquisitions
-
- Adds a total of more than 370K ISG PPO lives
15 commercial member increase - Focus on important ISG market segment
- Expanded network of independent agents increases
distribution for PHS products/services - Commercial growth/diversification balances
Medicare Advantage business - Geographic expansion diversifies outside of CA
7Earnings growth
370-385
303
Excluding effect of the adoption of FAS 142
relating to the amortization of goodwill
Includes acquisition of American Medical Security
Group proposed acquisition of Pacific Lifes
group health insurance business
82005 Guidance
Includes effect of FAS 123R on equity based
compensation
9PacifiCare Vision
10PacifiCare offers a total solution
11Specialty company growth- Pharmacy Benefit
Management Company (PBM)
Prescription Solutions Unaffiliated Membership
12Specialty company growth
1,647
Breakout of internal vs. external revenue is
not available prior to CY 2002. Revenue
increases related to a change in contracting
methodology from the gross method to the net
method for retail prescription drug transactions
50M in 2004, 890M in 2005 mainly for PHS
contract.
13Specialty company growth
25.3
26.0
20.6
20.3
18.4
18.7
14Specialty company growth- Recent PBM recognition
- Among MCOs Top rated PBM on 5 of 8 evaluation
factors - Recent Flashpohler Research survey - Of 2nd tier PBMs, mentioned more than any other
PBM - CSFB report, 10/04 - Outperforms the industry in pharmacy management
and doing an excellent job regarding its primary
functions rebates, network management, mail
service and generic fill rates - CapGemini
Benchmarking study, 2004 - 2 among all PBMs in mail order satisfaction
PCMA 2004 - Rx Benefit Innovation Award- The Pharmacy
Benefit Management Institute
15Medicare opportunities
- Medicare Advantage HMO/ Private Fee for Service
- Part D Administration- Prescription Drug Plan
(PDP) - Medicare Supplement
- Medicare Advantage Regional PPO
16Medicare opportunities
- Goals of Medicare Modernization Act
- Stabilize membership through increased benefits
and provider payments - Nationwide 04 MA Risk member increase 98,500
- PHS had 3 of 4 fastest growing plans in U.S.
- PHS had 22K net adds in 04 target growth in 05
39K - Position MA for growth in 2006
- Broker distribution
- Geographic expansion
- Preferred provider relationships Value Plans
- Community faith-based organization marketing
- Small acquisitions
- CMS demonstration project
17Medicare opportunities
- Part D Administration- Potential market
35.7 million
17 million
18Medicare opportunities
- Part D Administration- Model of potential market
share
- PHS to offer benefits nationally, in all 34 PDP
regions - Assume 10 national/large PDPs 3 regional PDPs
in each region - Assume equal distribution of 17 million assumed
06 membership - Example
- Potential revenue excludes additional subsidies
for low income, institutionalization, etc. - PHS will issue specific guidance late 2005
19Medicare opportunities
- Part D Administration- PHS capabilities
- Captive PBM w/ external focus (new mail order
facility in planning) - Broad distribution capabilities
- State-of-the-art mail facility
- National pharmacy network
- Risk-based business model
- 10 years of senior prescription drug data
- Managed care tools to control costs, improve
outcomes - Additional marketing channels
- Direct TV/radio advertising
- Direct mail
- Recent acquisitions
- Broker distribution