Express Scripts

Last updated
Express Scripts Holding Company
Company type Subsidiary
Industry
Founded1986;38 years ago (1986), in St. Louis County, Missouri
HeadquartersSt. Louis County, Missouri, U.S.
Key people
 Adam Kautzner (President, Express Scripts)
ProductsPrescription benefit management, specialty prescription management
RevenueDecrease2.svg US$ 100.065 billion 2017 [1]
Increase2.svg US$ 5.494 billion (2017) [1]
Increase2.svg US$ 4.532 billion (2017) [1]
Total assets Increase2.svg US$ 54.256 billion (2017) [1]
Total equity Increase2.svg US$ 18.125 billion (2017) [1]
Number of employees
26,600 (2017) [1]
Parent Cigna
Subsidiaries
Website express-scripts.com
Footnotes /references
[2] [3]

Express Scripts Holding Company is a pharmacy benefit management (PBM) organization. In 2017 it was the 22nd-largest company in the United States by total revenue as well as the largest pharmacy benefit management (PBM) organization in the United States. [2] Express Scripts had 2016 revenues of $100.752 billion. [2] Since December 20, 2018, the company has been a direct subsidiary of Bloomfield, Connecticut-based Cigna.

Contents

The term "Scripts" in the company title refers to the widely used clipped version of prescription.

Headquartered in Greater St. Louis within unincorporated North St. Louis County, Missouri, Express Scripts provides integrated pharmacy benefit management services including network-pharmacy claims processing; home delivery pharmacy services; specialty pharmacy benefit management, through its subsidiary Accredo; benefit-design consultation; drug-utilization review; formulary management; and medical and drug data analysis services to manage drug plans for health plans, self-insured employers and government agencies (both as administrator of employee benefits and public assistance programs). One of its largest clients is the United States Department of Defense's Tricare program. [4]

Express Scripts also offers pharmacy benefit management services for workers' compensation insurance programs. The program is accredited by URAC, the nation's largest accrediting body for pharmacy benefit management companies.

The company processes pharmaceutical claims for members through a network of retail pharmacies. Its own automated pharmacies dispense medications for chronic long-term diseases, such as diabetes or heart disease, directly to members by home delivery. [5] : 4 

On March 7, 2018, it was announced that Cigna would buy Express Scripts in a $67 billion deal. [6] [7]

The deal closed on December 20, 2018 at $54 billion, allowing Cigna to start offering new Express Scripts products to its corporate health insurance customers in 2019. [8]

History

Founding

Express Scripts began in 1986 in St. Louis County, Missouri as a result of a joint venture between a retail chain of more than 79 pharmacies (Medicare Glaser Inc.) and Sanus Corp. Health Systems.

Sanus traces its history to Bradford Systems and Administrative Services which was founded in Boston in 1968. Bradford had a contract for computer processing of Medicare and Medicaid payments. It was acquired in 1981 by McDonnell Douglas through its McDonnell Automation Company (McAuto) subsidiary for $11.5 million. [9]

In 1983, two of McDonnell Douglas' former principals Joseph T. Lynaugh (a former director of NYC Health + Hospitals in New York City), the McAuto's project manager of the Bradford takeover, [10] and Howard L. Waltman, a long time Bradford's employee, [11] formed the Sanus Corporation with substantial investments and ownership from McDonnell Douglas, including a McDonnell Douglas whole ownership of the St. Louis office. General American Life Insurance Company invested in Sanus's future, the largest part of the funding based in New York. Sanus was a health maintenance organization and it merged with the General America Life Insurance preferred provider organization. [12] Sanus rapidly grew and by 1986 it had 200,000 clients and $100 million in revenue, operating in the St. Louis, Dallas, Fort Worth, Houston, and Washington, D.C. markets. It created a subsidiary called GenCare to fill prescriptions.

In late 1986, Sanus announced a deal with St. Louis based pharmacy Medicare-Glaser for fulfilling prescriptions. The deal was a 50-50 split ownership between Sanus and Medicare-Glaser, with the new name of Express Scripts (scripts being medical industry jargon for prescriptions). Initial plans called for Missouri and Illinois clients to get their prescriptions at the Medicare-Glaser brick and mortar pharmacies while those in other cities could get their prescriptions via mail order—an innovation at the time. [13] The initial report of the creation said that Charles H. Ridings, formerly in charge of McDonnell Douglas mergers and acquisitions, was named the first chief executive, although he was quickly replaced by Waltman. [14]

Sanus remained the dominant early insurance customer but Express Scripts began marketing to other providers. With increased investment by New York Life, Sansus change its name to NYL Cares and in 1998 was sold to Aetna for $1.05 billion. [15]

Glaser Drug Company sold its Express Scripts partnership interest back to Sanus before it was acquired by chain SupeRx in 1989 for $18.2 million. SupeRX declared bankruptcy and all stores closed in 1991 after Walgreens acquired the pharmacy records. SupeRX's loan to buy Glaser Drug Co. had been financed by Lincoln Savings and Loan Association. Morris Glaser had founded the company on October 1, 1924. In 1959, Glaser opened discount pharmacies, which would be called Medicare Pharmacy. The discount pharmacies were designed to resemble a doctor waiting room and were only about 800 to 1,000 square feet which focused just on the prescriptions. The two companies although sharing the same name operated separately, peaking at 100 stores. [16]

General America, which had been a private St. Louis-based insurance since 1933, was acquired by MetLife for $1.2 billion in 1999. General America had run into financial problems and had said it could not pay back $6.8 billion in short term bonds to investors. [17] [18]

1989-1999

Express Scripts was purchased by New York Life Insurance Company in 1989 and became a publicly traded company in 1992. [19] In 1993, Express Scripts signed on both FHP International and Maxicare Health Care and corporate clients Lockheed, Service Merchandise, and Ingersoll-Rand. [19] [20] In 1994, the company expanded its services by adding workers’ compensation prescription services and reinsurance. [20] In 1994, the company announced a two-for-one stock split, and in 1996 established Express Scripts Canada. [19] The same year, the company began the annual Drug Trend Report and launched the Outcomes Symposium Conference. [19]

In April 1998, Express Scripts acquired ValueRx, the PBM business of Columbia/HCA Healthcare Corp. [20] The following year, in April 1999, the company purchased Diversified Pharmaceutical Services from SmithKline Beecham Corp for $700 million. [20] That same year, the company purchased stock in PlanetRx.com. [20] This partnership offered members options for purchasing prescriptions and over-the-counter health products online. [20]

2000-2010

In 2000, the company had to write off its $165 million relationship with PlanetRx.com when the startup experienced financial difficulties. [20] In 2001, Express Scripts partnered with Merck-Medco and Advance PSC to form RxHub LLC. [20]

In 2002, Express Scripts, Inc. (ESI) acquired National Prescription Administrators, Inc. (NPA). [21]

In late December 2006, Express Scripts made a proposal to purchase Caremark. Express Scripts lost the race to acquire Caremark to CVS Corporation, which became CVS/Caremark Corporation on March 22, 2007. [22]

In October 2007, Express Scripts acquired ConnectYourCare, and now handles FSA, HRA and HSA accounts for companies such as Suntrust, Zions Bancorporation and Allegis. [23] However, Express Scripts divested ConnectYourCare in August 2012. [23] [24]

On April 13, 2009, it was announced that Indianapolis-based WellPoint (now Anthem) had agreed to sell its NextRx subsidiaries for $4.675 billion to Express Scripts. [25] Express Scripts closed the transaction in December 2009. [26]

2010-present

In April 2012, Express Scripts completed a $29.1 billion acquisition of Medco Health Solutions. [27] The Federal Trade Commission gave formal approval on April 2, 2012 after an anti-trust investigation. [27] The acquisition positioned Express Scripts Holding Co. as the largest pharmacy benefit manager, filling 1.4 billion annual prescriptions. [27]

In 2017, Express Scripts launched Inside Rx, a partially owned subsidiary that provides discounts on medications for the uninsured and underinsured. [28] In July 2017, Express Scripts purchased myMatrixx, a workers' compensation pharmacy benefits company based in Tampa, for $250 million. [29]

In October 2017, Express Scripts lost its biggest client, Anthem, which said it would not renew the PBM contract in 2019 and would instead use CVS Health. Anthem alleged in court filings that Express had overcharged it by $3 billion. [30] Anthem said that it would launch its own competing PBM service, IngenioRx. The battle between the two companies in 2017 caused Express Scripts stock to drop by nearly a third. [31] Express Scripts announced its acquisition of eviCore in October 2017. The $3.6 billion deal closed that December. [32] [33] [34] In November 2017, Express Scripts announced it was divesting United BioSource Corp. (UBC), its pharmaceutical support business. UBC was sold to Avista Capital Partners. [35] [36] [37]

In March 2018, Cigna, which earlier was blocked by courts from being acquired by Anthem, announced a $67 billion deal to acquire Express Scripts. The Express Scripts acquisition would be the last major deal involving the country's largest PBMs. In 2017, CVS Health announced a merger with Aetna, completing in November 2018. [38] The takeover of PBMs have drawn regulator resistance because of fears they foster an anti-competitive environment. Insurance companies have charged that the PBM model has contributed to high drug prices because PBMs take a commission on each transaction. [39] [40]

Express Scripts has 30,000 employees worldwide. [26] [41] The company volunteers with local Blessings in a Backpack organizations. [42]

In December 2018, it was reported that Walmart and Express Scripts extended their network agreement to give Express Scripts' clients access to Walmart's prescription services. [43]

In December 2019, Express Scripts entered into a three-year partnership with Prime Therapeutics. [44]

In late 2020, Express Scripts and several subsidiaries were rebranded and reorganized into a distinct health services organization, Evernorth. [45] Evernorth CEO Tim Wentworth retired at the end of 2021 and Cigna veteran executive Eric Palmer became Evernorth CEO starting in 2022. [46]

Finances

For the fiscal year 2017, Express Scripts reported earnings of US$4.517 billion, with an annual revenue of US$100.065 billion, a decline of 0.2% over the previous fiscal cycle. Express Scripts shares traded at over $64 per share, and its market capitalization was valued at over US$53.6 billion in October 2018. [47]

YearRevenue
in mil. USD$		Net income
in mil. USD$		Total Assets
in mil. USD$		Price per Share
in USD$		Employees
200516,1884005,49413.65
200621,5634745,10819.49
200721,8245685,25625.40
200821,9417765,50932.77
200924,72282811,93133.61
201044,9731,18110,55848.71
201146,1281,27615,60750.92
201293,7141,31358,11155.87
2013104,0991,84553,54861.6729,975
2014100,8872,00853,74873.6629,500
2015101,7522,47653,24386.0125,900
2016100,2883,40451,74572.9825,600
2017100,0654,51754,25664.4126,600

World headquarters

1 of 6 Express Scripts Headquarters buildings in April 2013 Express Scripts (8681557549).jpg
1 of 6 Express Scripts Headquarters buildings in April 2013

Express Scripts is headquartered within Greater St. Louis in North St. Louis County, Missouri.

In 2007, the company became the first and only Fortune 500 company to open a headquarters on a college campus when it opened its headquarters at 1 Express Way on the north edge of the University of Missouri–St. Louis north of University Place Drive and south of Interstate 70. A second headquarters building adjoining the original one opened in 2008. Three additional structures have been added to the NorthPark development on the north side of I-70 including an Office and Data Center, Tech and Innovation Center, and Operations Center. The area north of I-70 is separate from the university. [48] In 2018 the majority of the 5,000 St. Louis Express Scripts employees work in the complex. [48]

Aerial view of 1 Express Way in St. Louis County, MO 1 Express Way.jpg
Aerial view of 1 Express Way in St. Louis County, MO

George Paz, CEO of Express Scripts at the time of the move, was an UMSL graduate. [49] Express Scripts, which rather owns both its headquarters and nearby office buildings, received substantial tax breaks. [50] Since the move the company has been an active partner with the university including contributing money to renovate the computer sciences building (Express Scripts Hall), [51] raising funds for building projects, sponsoring a pre-collegiate bridge program for high school students and sponsoring a small business incubator.

Express Scripts throughout its entire history has been in St. Louis County, Missouri rather than the City of St. Louis. It was originally headquartered in Maryland Heights, Missouri, and its current headquarters is about 4 miles west of the St. Louis city limits and its two building headquarters campus is actually spread across three jurisdictions. The entrance to the main building is located in Cool Valley, Missouri. [52] The southeast portion of the campus is in Bellerive, Missouri [53] and the southwest corner of the two-building complex is in unincorporated St. Louis County. [54] The three buildings north of I-70 are in Berkeley, Missouri. [55]

Chief executives

Drug Trend Report

Published annually since 1993, the Express Scripts Drug Trend Report provides detailed analysis of prescription drug costs and utilization. [20] [57] Now a web-based version, the Drug Trend Report is developed and published by the Express Scripts Research & New Solutions Lab with contributors from researchers, clinicians and others. [58] This type of research is designed to understand consumer behavior relative to healthcare benefits. [59] [60]

Health decision science

Health science is the study of how people make decisions, and how to help them make better ones[ citation needed ]. Upon the merger of Express Scripts and Medco Health Solutions, the company came up with its own approach to understand its members health concerns, which it has dubbed Health Decision Science. This involves looking at three scientific disciplines: behavioral science or “consumerology”, clinical specialization, and actionable data. [61] [62] [63] Because of its position between pharmacies and health care plans, Express Scripts sees 1.4 billion prescriptions a year, and it uses this information as part of its research data to create better options for clients and patients. [64] [65] [66] [67] [68]

Controversy

Fraud allegations

On August 4, 2004, New York State Attorney General Eliot Spitzer filed a lawsuit against Express Scripts alleging that the company had kept tens of millions of dollars in drug rebates owed to the state. The suit was filed in the New York Supreme Court in Albany County. [69] The lawsuit further claimed that Express Scripts had overstated the cost benefits of switching to certain preferred medications. In 2008 the company settled the lawsuit, agreeing to pay $9.3 million to Pennsylvania and 28 other states to resolve claims of deceptive business practices. As part of the settlement, the company also agreed to change its business practices and pay up to $200,000 in reimbursement to patients. [70]

Information breach

In October 2008, the St. Louis headquarters received an anonymous letter that contained sensitive information about 75 members. [71] The extortionist stated that they would release more of similar records if the company failed to pay an unspecified amount of money. A consumer class action lawsuit against Express Scripts was brought on by John Amburgy, a Missouri man, who accused the company of negligence in protecting customer records. The case was dismissed when Amburgy failed to show how he was directly affected by the breach. [72]

Rockford lawsuit

The city of Rockford, Illinois is now[ when? ] suing Mallinckrodt Pharmaceuticals and Express Scripts for their failure to reduce the prescription drug Acthar's price. The suit alleges that Express Scripts had a contract to be the exclusive distributor of Acthar, and therefore benefited from its higher price. The company said in an email to 60 Minutes that there was no conflict of interest. [73]

Reimbursements

Express Scripts is known to reimburse pharmacies below cost for medications and push patients to only use their mail order service. They then will spread price the medication and charge the plan sponsor a much higher price for the medication than they will reimburse pharmacies for. [74]

Related Research Articles

Prescription drug list prices in the United States continually are among the highest in the world. The high cost of prescription drugs became a major topic of discussion in the 21st century, leading up to the American health care reform debate of 2009, and received renewed attention in 2015. One major reason for high prescription drug prices in the United States relative to other countries is the inability of government-granted monopolies in the American health care sector to use their bargaining power to negotiate lower prices, and the American payer ends up subsidizing the world's R&D spending on drugs.

<span class="mw-page-title-main">CVS Pharmacy</span> American pharmacy chain

CVS Pharmacy, Inc. is an American retail corporation. A subsidiary of CVS Health, it is headquartered in Woonsocket, Rhode Island. Originally named the Consumer Value Stores, it was founded in Lowell, Massachusetts in 1963.

Walgreen Company is an American company that operates the second-largest pharmacy store chain in the United States, behind CVS Health. It specializes in filling prescriptions, health and wellness products, health information, and photo services. It was founded in Chicago in 1901, and is headquartered in the Chicago suburb of Deerfield, Illinois. On December 31, 2014, Walgreens and Switzerland-based Alliance Boots merged to form a new holding company, Walgreens Boots Alliance. Walgreens became a subsidiary of the new company, which retained its Deerfield headquarters and trades on the Nasdaq under the symbol WBA.

<span class="mw-page-title-main">Cigna</span> American health services organization

The Cigna Group is an American multinational managed healthcare and insurance company based in Bloomfield, Connecticut. Its insurance subsidiaries are major providers of medical, dental, disability, life and accident insurance and related products and services, the majority of which are offered through employers and other groups. Cigna is incorporated in Delaware.

Medco Health Solutions, Inc. was an American Pharmacy Benefits Management (PBM) company. Medco provided pharmacy services to private and public employers, health plans, labor unions, government agencies, and individuals served by Medicare Part D Prescription Drug Plans.

An online pharmacy, internet pharmacy, or mail-order pharmacy is a pharmacy that operates over the Internet and sends orders to customers through mail, shipping companies, or online pharmacy web portal.

In the United States, a pharmacy benefit manager (PBM) is a third-party administrator of prescription drug programs for commercial health plans, self-insured employer plans, Medicare Part D plans, the Federal Employees Health Benefits Program, and state government employee plans. PBMs operate inside of integrated healthcare systems, as part of retail pharmacies, and as part of insurance companies.

CVS Health Corporation is an American healthcare company that owns CVS Pharmacy, a retail pharmacy chain; CVS Caremark, a pharmacy benefits manager; and Aetna, a health insurance provider, among many other brands. The company is the world's second largest healthcare company, behind UnitedHealth Group. In 2023, the company was ranked 64th in the Forbes Global 2000.

<span class="mw-page-title-main">First Databank</span>

First Databank (FDB) is a major provider of drug and medical device databases that help inform healthcare professionals to make decisions. FDB partners with information system developers to deliver useful medication- and medical device-related information to clinicians, business associates, and patients. FDB is part of Hearst and the Hearst Health network.

Electronic prescription is the computer-based electronic generation, transmission, and filling of a medical prescription, taking the place of paper and faxed prescriptions. E-prescribing allows a physician, physician assistant, pharmacist, or nurse practitioner to use digital prescription software to electronically transmit a new prescription or renewal authorization to a community or mail-order pharmacy. It outlines the ability to send error-free, accurate, and understandable prescriptions electronically from the healthcare provider to the pharmacy. E-prescribing is meant to reduce the risks associated with traditional prescription script writing. It is also one of the major reasons for the push for electronic medical records. By sharing medical prescription information, e-prescribing seeks to connect the patient's team of healthcare providers to facilitate knowledgeable decision making.

Catamaran Corporation is the former name of a company that now operates within UnitedHealth Group's OptumRX division. It sells pharmacy benefit management and medical record keeping services to businesses in the United States and to a broad client portfolio, including health plans and employers. Working independently of the government and insurance companies allowed it to operate as a third party verifier; the RxCLAIM online claim processing system allowed for prescription drug claims to be processed online if the customer lived in and filled their prescription in the United States. SXC had three separate but interrelated business segments which dealt with prescription drug programs. For 2013, 23% of company revenue came from Cigna Corporation.

Linda Cahn is the founder and president of a nationwide consulting firm, Pharmacy Benefit Consultants. The firm assists corporations, unions, government entities and insurance companies in improving their prescription coverage benefits and decreasing their prescription coverage costs.

Specialty drugs or specialty pharmaceuticals are a recent designation of pharmaceuticals classified as high-cost, high complexity and/or high touch. Specialty drugs are often biologics—"drugs derived from living cells" that are injectable or infused. They are used to treat complex or rare chronic conditions such as cancer, rheumatoid arthritis, hemophilia, H.I.V. psoriasis, inflammatory bowel disease and hepatitis C. In 1990 there were 10 specialty drugs on the market, around five years later nearly 30, by 2008 200, and by 2015 300.

Philidor Rx Services is a Pennsylvania-licensed specialty online pharmacy, which mainly sold Valeant Pharmaceuticals International Inc drugs directly to patients and handled insurance claims on the customers' behalf.

Specialty pharmacy refers to distribution channels designed to handle specialty drugs — pharmaceutical therapies that are either high cost, high complexity and/or high touch. High touch refers to higher degree of complexity in terms of distribution, administration, or patient management which drives up the cost of the drugs. In the early years specialty pharmacy providers attached "high-touch services to their overall price tags" arguing that patients who receive specialty pharmaceuticals "need high levels of ancillary and follow-up care to ensure that the drug spend is not wasted on them." An example of a specialty drug that would only be available through specialty pharmacy is interferon beta-1a (Avonex), a treatment for MS that requires a refrigerated chain of distribution and costs $17,000 a year. Some specialty pharmacies deal in pharmaceuticals that treat complex or rare chronic conditions such as cancer, rheumatoid arthritis, hemophilia, H.I.V. psoriasis, inflammatory bowel disease (IBD) or Hepatitis C. "Specialty pharmacies are seen as a reliable distribution channel for expensive drugs, offering patients convenience and lower costs while maximizing insurance reimbursements from those companies that cover the drug. Patients typically pay the same co-payments whether or not their insurers cover the drug." As the market demanded specialization in drug distribution and clinical management of complex therapies, specialized pharma (SP) evolved.„ Specialty pharmacies may handle therapies that are biologics, and are injectable or infused. By 2008 the pharmacy benefit management dominated the specialty pharmacies market having acquired smaller specialty pharmacies. PBMs administer specialty pharmacies in their network and can "negotiate better prices and frequently offer a complete menu of specialty pharmaceuticals and related services to serve as an attractive 'one-stop shop' for health plans and employers."

Diplomat Pharmacy, Inc. is the largest independent provider of specialty pharmacy services in the United States. The company partners with manufacturers, payers, providers, hospitals, and more. Headquartered in Flint, Michigan, Diplomat has facilities across the United States and dispenses drugs in all 50 states. Diplomat offers specialized medication and medication management programs for patients with complex and chronic conditions such as cancer, hepatitis, multiple sclerosis, HIV and others.

GoodRx Holdings, Inc. is an American healthcare company that operates a telemedicine platform and free-to-use website and mobile app that track prescription drug prices in the United States and provide drug coupons for discounts on medications. GoodRx checks drug prices at more than seventy-five thousand pharmacies in the United States. The platform allows individuals to consult with a doctor online and obtain a prescription for certain types of medications at a cost of US$20, regardless of insurance status. Medical testing services, which vary in price, are also offered through the platform.

Timothy C. Wentworth is an American businessman and CEO of pharmacy operator Walgreens Boots Alliance. He is a former CEO of Evernorth, Cigna's health services platform and a former CEO of Express Scripts, the United States' largest pharmacy benefit manager.

<span class="mw-page-title-main">PillPack</span> American online pharmacy

PillPack, Inc. is an American online pharmacy which is a subsidiary of Amazon. It is based in Manchester, New Hampshire, United States. The company was founded in 2013.

Amazon Pharmacy is an American online pharmacy which is a subsidiary of Amazon. The business was launched on November 17, 2020, initially offering pharmacy service only in the United States.

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