AdvancePCS

AdvancePCS is one of the largest Pharmacy Benefit Management (PBM) companies in the United States. The company provides a wide range of services to manage prescription drug benefits on behalf of health insurers, self-insured employers, and government agencies.

History

AdvancePCS was formed in 1999 through the merger of PCS Health Systems and Advance Paradigm. The company was acquired by Caremark Rx in 2004, which later merged with CVS Health in 2007.

Services

AdvancePCS provides a variety of services to manage prescription drug benefits. These include:

• Formulary Management: AdvancePCS develops and manages a list of preferred drugs, known as a formulary, for its clients. The formulary is designed to encourage the use of cost-effective drugs.

• Pharmacy Network Management: The company contracts with pharmacies to provide prescription drugs to members at negotiated prices.

• Claims Processing: AdvancePCS processes prescription drug claims on behalf of its clients. This includes verifying member eligibility, applying the appropriate copayment, and reimbursing the pharmacy.

• Drug Utilization Review: The company reviews prescription drug use to identify potential issues, such as drug interactions or overuse.

• Disease Management: AdvancePCS offers programs to help manage chronic conditions, such as diabetes or asthma. These programs provide education, medication reminders, and other support to help members manage their health.

Impact

As one of the largest PBMs in the U.S., AdvancePCS plays a significant role in the healthcare system. The company's services can help to control prescription drug costs, improve medication adherence, and enhance patient outcomes.

Criticism

Like other PBMs, AdvancePCS has faced criticism for its role in the high cost of prescription drugs. Critics argue that PBMs contribute to high drug prices by negotiating rebates from drug manufacturers, which are not always passed on to consumers.

See Also

• Pharmacy Benefit Management
• Caremark Rx
• CVS Health