AdvancePCS是美国最大的医疗改善服务提供商，提供最广泛的医疗卫生资源。该公司拥有7500万医疗计划会员（相当于每4个美国人中就有一个是该公司会员），和5万8千多药店网络链接，每年管理着280亿美元的医药支出。
其主要业务模式有：
Refill Prescriptions & Check Order Status 处方新购和查看订单状态 Lookup Drug Coverage & Pricing查找药品用途和价格信息 Prescription Plan Summary处方计划汇总 Locate a Pharmacy网上查找药店 Drug Dictionary药品词典
Drug to Drug Interaction Checker药品交叉反应检查工具 Online Drugstore在线药店 SpecialtyRx 专业处方
RxSavings Plan 处方费用节省服务 Online Forms 在线表格
Litigation Summary: 法律诉讼简要：
In March 2003, the Prescription Access Litigation (PAL) Project in collaboration with the American Federation of State, County and Municipal Employees (AFSCME), AFL-CIO, brought suit against the nation's four largest PBMs charging that they inflate prescription drug prices. The four PBMs named in this lawsuit are Advance PCS; Caremark Rx, Inc.; Express Scripts; and Medco Health. Through a variety of business practices, these four companies influence the choice of pharmaceuticals used by a substantial percentage of health plans and their members in the U.S. Together, they comprise over 80 percent of the PBM market, covering over 200 million Americans.
2003年3月的“处方获取诉讼”（PAL）项目，由美国联邦政府、州、县、市雇员协会（AFSCME）和AFL-CIO 联手以抬高处方药价格为由将全国最大的四家PBMs告上了法庭。卷入此案的四家被告是Advance PCS、Caremark Rx. Inc.、Express Scripts和Medco Health。 因业务量巨大，这四家公司已经实质影响到美国多数医保计划及其成员的用药选择，四家合计占有PBM市场80%以上，涉及2亿多美国人。
Because of their strong purchasing power, PBMs have been able to generate pricing margins and discounts at numerous points throughout the drug distribution system. The problem, the complaint alleges, is that they have consistently failed to pass the resulting savings along to health plans and their members-choosing instead to pocket the savings and increase their own profits. In so doing, this lawsuit charges, the four named PBMs have willfully contributed to escalating drug costs, and have failed in their fiduciary duty to those client health plans.
由于拥有强大的采购力，PBM已经能够在药品分销系统的许多环节创造利润和价差。投诉方宣称问题在于他们已经不再将医保计划及其成员因用药选择形成的费用节省贡献出来，而
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是代之以存入自家腰包和提高自身经营利润。因而，法庭判定四家被起诉的PBM故意抬高用药成本，辜负了客户的信任。
In addition, the four PBMs named in the complaint have refused to disclose the amount of the rebates that drug manufacturers pay PBMs for placement on their formularies. It is therefore impossible to know what percentage-if any-goes back to health plans and their members as savings. But PBMs clearly factor those rebates into their revenue projections. The complaint quotes PBM executives stating that manufacturer rebates have become essential to PBM profits.
另外，四家PBM拒绝披露药品生产企业为了让产品进入PBM药品清单而给予的折扣返点价值，因此，外界不可能知道健康计划组织及其成员到底能节省多大比例的费用，如果有的话。但PBM们清楚地把那些返点折扣收入计入了他们的营业收益，诉讼引述PBM高管们的陈述表明制药商的返点让利已经成为PBM利润的关键来源。
Finally, the complaint alleges that the PBMs fraudulently use the Average Wholesale Price (AWP) to inflate brand-name drug prices. AWPs, which are set by drug manufacturers, function as a kind of \artificially inflated. In addition, PBMs generally pay retail pharmacies less than what they charge the health plans. Because the PBMs consider the contracting relationship with retail pharmacies confidential, they refuse to divulge how much they pay pharmacies. The savings, the difference between the price charged health plans and the price paid pharmacies, or what is called \consumers, according to the complaint.
最后。投诉方宣称，PBM欺骗性地利用平均批发价格（AWP）抬高了品牌药品价格。平均批发价格（AWPs）是由制药商设定的一种“标价”，被广泛认为是人为抬高的药价。另外，PBM一般支付给零售商的费用要低于向医保计划组织收取的。PBM把和零售商的合同关系看成是机密，拒绝透露他们支付给药房的费用。按照投诉方的意思，节省部分，即向医保计划组织收取的药价和支付给药房的药价之间的差额，或者被称做“进销差价”，应该分派给医保计划组织和消费者。
PBMs claim that is what they do, but the complaint alleges that the PBMs usually pocket \with higher AWP prices-by listing those drugs on their formularies.
PBM申诉他们正式如此做的，但投诉方宣称PBM通常私吞了“进销差价”。“进销差价”在财务上给予PBM以动机去鼓励人们使用列入处方一览表具有更高“平均批发价格”的药品。
This lawsuit was brought under California's Unfair Competition Law. 这一诉讼案件已经由加州非公平竞争法介入裁定。 For more information:
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Ahaviah Glaser
(617) 275-2822
glaser@communitycatalyst.org
Medco Health Solutions, Inc.
We are the nation's largest pharmacy benefit manager, or PBM, based on our 2002 net revenues. We provide sophisticated programs and services for our clients and the members of their pharmacy benefit plans, as well as for the physicians and pharmacies the members use. We believe that our ability to consistently deliver programs and services that help our clients provide a high-quality, cost-effective prescription drug program to their members has made us a market leader.
依照2002年净收入，我们是全美最大的PBM。我们为客户及其药品福利计划会员和会员所用的医生药师提供最全面成熟的服务项目。我们相信我们能始终如一帮助客户向其会员提供高质量、符合成本-效益原则的处方药方案的能力使我们成为市场领先者。
We actively pursue initiatives to reduce the rate of increase in our clients' drug expenditures, referred to in our industry as \trend\to save members money and to improve the services we provide both our clients and their members. We continue to expand our pre-eminent home delivery business, which reduces drug costs for our clients and provides enhanced reliability and service to their members.
我们主动寻求创新产品以降低客户的“药品费用增长率”（即行内所谓“药品趋势”）来节省会员的钱，同时不断改善我们的服务。我们持续扩大业已成功的送货到家业务以减少客户的药品费用、对其会员提供增强的可靠性服务。 In 2002, our national network of home delivery pharmacies filled
approximately 82 million prescriptions, representing about 30% more than the number of prescriptions filled by the mail service operations of our three largest competitors combined. We seek to contain costs for our clients and their members by encouraging the prescribing of drugs on a plan's approved list of drugs, or \appropriate generic drugs through our generic education and substitution programs.
2002年，我们全国性的送药到家药店处理了8200万个处方，占同期其它3家竞争对手合计药品邮购业务的30%以上。我们通过对列入药品福利计划准入的药品清单（处方一览表）药品的使用，以及通过用药指南或替代项目服务引导的符合临床用药合理性的普药使用，为客户及其会员寻求成本限制手段。
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Our high-quality service, advanced technology and cost containment initiatives enabled us to limit the average drug trend for plans that include both retail and home delivery to 14.0% in each of 2000 and 2001 and 12.9% in 2002, compared to the national average of 17.3% in 2000, 15.7% in 2001 and an estimated 14.3% in 2002 as reported by the Centers for Medicare & Medicaid Services, or CMS.
我们的高质量服务、先进技术、和创新性成本限制手段使我们的覆盖了药品邮购和零售药店的药品福利计划对平均“药品趋势”的限制在2000、2001、2002分别达到了14%、14%、和12.9%，按Medicare和Medicaid服务中心的统计分别高于同期全国平均的17.3%、15.7%、和14.3%。
We have a large number of clients in each of the major industry segments, including Blue Cross/Blue Shield plans; managed care organizations; insurance carriers; third-party benefit plan administrators; employers; federal, state and local government agencies; and union-sponsored benefit plans. As of June 2003, the plans we administered for our clients covered 190 of the Fortune 500, including 52 of the Fortune 100, 12 of the country's 42 Blue Cross/Blue Shield plans and several large managed care organizations.
In addition, our Systemed, L.L.C. subsidiary capitalizes on our extensive PBM capabilities to meet the specific needs of small to mid-size clients. Over the last three years, our aggregate revenue from small to mid-size clients increased an average of approximately 39% per year, excluding the impact of acquisitions, to approximately $1.6 billion in 2002. 另外，我们通过分支机构满足中小客户的特殊需求。此前3年，来自于中小客户的营收每年按39%增长（不包含并购效益），2002年总值达16亿。
From 1998 to 2002, our net revenues increased on average approximately 26.4% per year. In 2002, we filled or processed approximately 548 million prescriptions, had net revenues of approximately $33 billion and net income of more than $360 million, and had earnings before interest income/expense, taxes, depreciation and amortization, or EBITDA, of approximately $886 million. Our net income is driven by our ability to earn rebates and negotiate favorable discounts on prescription drugs from pharmaceutical manufacturers, obtain competitive discounts from retail pharmacies, negotiate competitive client pricing, including rebate sharing terms, shift dispensing volumes from retail to home delivery and provide services in a cost-efficient manner.
1998至2002，净营业额按年均26.4%增长。2002年，我们处理了5.48亿个处方，营业额330亿，净营收3.6亿以上，未扣除利息、销售费用、税收、折旧及递延费用的收入8.86亿。我们的净收入是基于从生产商赢得返点和争得优惠（进货）
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折扣，从零售药店获得有利的销售折扣，与客户谈成有利的价格包括返点、共享条款、从零售到邮购的分销转移、以及按成本-效益方式提供服务。
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