Express Scripts

Express Scripts is a United States pharmacy benefit management (PBM) organization that administers prescription-drug benefits for health plans, employers, government programs, and other institutional clients. The company began in 1986 in the St. Louis County, Missouri area as a joint venture between Sanus Corporation, a health-care organization, and Medicare-Glaser pharmacies. Its name uses “scripts” as an informal shortening of “prescriptions.” The original business combined retail-pharmacy fulfillment with claims administration and, at an early stage, helped develop mail-order prescription services for members outside its initial Missouri and Illinois markets. Express Scripts expanded from a regional prescription administrator into a national PBM through organic growth and acquisitions. It became publicly traded in 1992, added workers’ compensation prescription services and reinsurance during the 1990s, and broadened its client base beyond its original insurance relationships. Important acquisitions included ValueRx in 1998, Diversified Pharmaceutical Services in 1999, National Prescription Administrators in 2002, NextRx from WellPoint in 2009, and Medco Health Solutions in 2012. The Medco transaction substantially increased Express Scripts’ scale and made it the largest U.S. PBM by prescription volume at the time. The company’s services have included retail-pharmacy network claims processing, formulary and benefit design, drug-utilization review, rebate and procurement administration, specialty-pharmacy management, home delivery, clinical programs, and analysis of medical and prescription data. Accredo, its specialty-pharmacy subsidiary, has served patients using complex or high-cost medicines. Express Scripts has also administered prescription benefits for workers’ compensation programs and managed pharmacy services for the U.S. Department of Defense’s TRICARE program. The company’s annual Drug Trend Report, begun in 1993, analyzes prescription utilization and spending patterns, while its health-decision-science work has sought to combine clinical expertise, behavioral research, and claims data. Express Scripts faced strategic and legal pressure as PBMs became more central to the U.S. drug-pricing system. Anthem, one of its largest customers, declined to renew its contract for 2019 and alleged that Express Scripts had overcharged it by billions of dollars; the dispute contributed to a substantial decline in Express Scripts’ share price and led Anthem to develop its own PBM, IngenioRx. Express Scripts also faced allegations from regulators, state officials, customers, and other stakeholders concerning rebate retention, pricing disclosures, and the competitive effects of PBM consolidation. These issues became part of broader national debates over drug affordability and the role of PBMs. On March 7, 2018, Cigna announced an agreement to acquire Express Scripts. The transaction was initially described as a $67 billion deal and closed on December 20, 2018, with reported transaction value of approximately $54 billion under the final structure. Express Scripts became a direct subsidiary of Cigna, while its capabilities were integrated into Cigna’s broader health-services strategy. In late 2020, Cigna reorganized Express Scripts and related businesses under Evernorth, its health-services platform. Express Scripts continues to operate as a recognizable pharmacy-benefit and pharmacy-services brand, although it is no longer an independently listed public company.

Express Scripts originated in St. Louis County in 1986 through a joint venture between Sanus Corporation and Medicare-Glaser pharmacies. Sanus had developed from earlier health-plan and benefits-administration businesses, while Medicare-Glaser supplied a retail-pharmacy base. The venture combined prescription fulfillment with claims administration and used mail delivery to serve members outside its initial store markets. Howard L. Waltman became the early chief executive after the company’s formation. New York Life acquired Express Scripts in 1989, and the business became publicly traded in 1992. During the 1990s it signed health-plan and employer customers, added workers’ compensation prescription services, established Express Scripts Canada, and began publishing the Drug Trend Report. Acquisitions then became a central growth mechanism. ValueRx was acquired in 1998, followed by Diversified Pharmaceutical Services in 1999. Express Scripts also experimented with online pharmacy commerce through a relationship with PlanetRx, but wrote off that investment after the start-up encountered financial problems. In 2001, Express Scripts joined Merck-Medco and Advance PCS in creating RxHub, an electronic prescription-benefit information venture. Express Scripts acquired National Prescription Administrators in 2002 and won a TRICARE home-delivery contract in 2003. It later expanded its relationship with the Department of Defense to manage broader TRICARE prescription services. In 2007, it acquired ConnectYourCare, a consumer-directed health-account administrator, although that business was later divested in 2012. Express Scripts attempted to acquire Caremark in 2006, but CVS ultimately won that contest and combined with Caremark. In 2009, Express Scripts bought WellPoint’s NextRx subsidiaries for approximately $4.675 billion. The acquisition strengthened its position among national health-plan customers. In 2012, after regulatory review, Express Scripts completed the approximately $29.1 billion acquisition of Medco Health Solutions. The combination made Express Scripts the largest pharmacy benefit manager in the United States by prescription volume and substantially expanded its mail-order, specialty-pharmacy, analytics, and clinical-management operations. The company continued diversifying during the 2010s. It launched Inside Rx in 2017 to provide medication discounts, acquired workers’ compensation specialist myMatrixx, and announced the purchase of eviCore. It also divested United BioSource Corp., a pharmaceutical-support business. At the same time, PBM practices became a focus of public and governmental scrutiny. Critics questioned the treatment of manufacturer rebates, the transparency of pricing and spread arrangements, and whether consolidation among insurers, PBMs, pharmacies, and drug suppliers reduced competition. Earlier litigation by New York officials and disputes with major customers reflected these concerns. Anthem’s decision in 2017 not to renew its Express Scripts contract for 2019 was a major strategic setback. Anthem alleged that Express Scripts had overcharged it by approximately $3 billion and said it would create its own PBM, IngenioRx, with CVS Health. The dispute affected investor confidence and became part of a broader contest among insurers and PBMs over control of prescription economics. Cigna announced its acquisition of Express Scripts in March 2018. The deal, initially reported at $67 billion, closed on December 20, 2018, with the final transaction described at approximately $54 billion. Express Scripts ceased to be an independent public company and became a direct Cigna subsidiary. Cigna subsequently integrated the PBM with other health-services businesses. In late 2020, Express Scripts and related operations were reorganized under Evernorth, while the Express Scripts name continued to identify important pharmacy-benefit and pharmacy-service offerings. The organization remains headquartered in the St. Louis area and serves U.S. plan sponsors, government programs, pharmacies, and patients.

1. 2020Evernorth reorganization

   Cigna reorganizes Express Scripts and related health-services businesses under Evernorth.

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2. 2018Cigna acquisition closes

   Cigna completes its acquisition, making Express Scripts a direct subsidiary.

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3. 2012Medco merger

   Express Scripts completes its approximately $29.1 billion acquisition of Medco Health Solutions after regulatory approval.

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4. 2009NextRx acquisition

   Express Scripts completes its acquisition of WellPoint’s NextRx subsidiaries.

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5. 2002National Prescription Administrators acquisition

   Express Scripts expands its PBM platform by acquiring NPA.

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6. 1999Diversified Pharmaceutical Services acquisition

   The company purchases Diversified Pharmaceutical Services from SmithKline Beecham.

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7. 1998ValueRx acquisition

   Express Scripts acquires the PBM business of ValueRx.

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8. 1992Public listing

   Express Scripts becomes a publicly traded company.

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9. 1989Acquired by New York Life

   New York Life Insurance Company purchases Express Scripts.

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10. 1986Express Scripts is founded

    Sanus Corporation and Medicare-Glaser establish Express Scripts in the St. Louis County area as a prescription-benefit and pharmacy-fulfillment joint venture.

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A large-scale pharmacy-benefit and prescription-services provider focused on managing drug utilization, access, network administration, and costs for health plans, employers, government programs, and patients.

• Express Scripts PharmacyHome-delivery pharmacy

  The company’s home-delivery pharmacy service dispenses maintenance medicines, particularly prescriptions used for chronic conditions such as diabetes and cardiovascular disease. It is designed to coordinate fulfillment with a member’s pharmacy benefit, including refill management, claims adjudication, and delivery to the patient.

• AccredoSpecialty pharmacy

  Accredo is Express Scripts’ specialty-pharmacy business. It supports patients using complex, high-cost, or temperature-sensitive medicines and may provide condition-focused clinical support, adherence services, fulfillment, and coordination with health plans and prescribers.

• Pharmacy benefit managementHealthcare administration1986

  Express Scripts administers prescription benefits through retail-pharmacy networks, claims processing, formulary management, utilization review, drug procurement and rebate administration, benefit-design support, and reporting for employers, insurers, and government programs.

• Inside RxMedication discount service2017

  Inside Rx is a discount-medicine service launched in 2017 and intended in part for people without adequate insurance coverage. It provides access to negotiated prescription prices through participating pharmacies and is distinct from traditional insured benefit administration.

• Drug Trend ReportResearch and analytics1993

  Published annually since 1993 and later provided in web-based form, the Drug Trend Report analyzes prescription utilization, therapy categories, cost drivers, and changes in drug-benefit spending for industry and plan-sponsor audiences.

• 2020Reorganize under EvernorthStrategy

  Cigna reorganized its health-services activities to present pharmacy, specialty, care, and analytics capabilities through a unified platform.

  What changed. Express Scripts and related subsidiaries were placed within the Evernorth organization while retaining the Express Scripts brand for pharmacy services.

  Aftermath. The company continued operating as a major pharmacy-benefit business without an independent public listing.

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• 2018Join CignaM&A

  Cigna pursued vertical integration of health insurance and pharmacy-benefit capabilities.

  What changed. Cigna acquired Express Scripts in a transaction announced at $67 billion and completed on December 20, 2018.

  Aftermath. Express Scripts became a direct Cigna subsidiary and was subsequently organized within Evernorth.

  Announced transaction value. US$67 billion (2018 announcement)

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• 2017Acquire eviCoreM&A

  Express Scripts sought to expand beyond prescription-benefit administration into broader medical-benefit management.

  What changed. The company announced and completed the acquisition of eviCore for a reported $3.6 billion.

  Aftermath. The deal broadened Express Scripts’ health-services capabilities before its later combination with Cigna.

  Transaction value. Approximately US$3.6 billion (2017)

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• 2012Acquire Medco Health SolutionsM&A

  Express Scripts sought greater scale across mail-order pharmacy, specialty pharmacy, claims administration, and clinical programs.

  What changed. It completed the approximately $29.1 billion acquisition after Federal Trade Commission review and approval.

  Aftermath. The combined organization became the largest U.S. PBM by prescription volume and expanded its national operating platform.

  Transaction value. Approximately US$29.1 billion (2012)

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• 2017Anthem pricing disputeControversy

  Anthem alleged in court filings that Express Scripts had overcharged it by approximately $3 billion. The disagreement accompanied Anthem’s decision to terminate the PBM relationship and develop IngenioRx with CVS Health.

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• 2004New York rebate and savings allegationsControversy

  New York Attorney General Eliot Spitzer filed a lawsuit alleging that Express Scripts retained tens of millions of dollars in rebates owed to the state and overstated the financial benefits of switching members to selected medicines. The matter was reported as settled in 2008.

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• 2020Express Scripts businesses reorganized under Evernorth

  Cigna reorganized Express Scripts and related health-services operations under the Evernorth platform.

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• 2019Express Scripts partners with Prime Therapeutics

  The companies entered a three-year partnership covering selected pharmacy-benefit capabilities.

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• 2018Cigna announces acquisition of Express Scripts

  Cigna announced a deal initially valued at $67 billion to acquire Express Scripts.

  M&A
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• 2018Cigna completes Express Scripts acquisition

  Express Scripts became a direct subsidiary of Cigna after the transaction closed on December 20.

  M&A
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• 2018Express Scripts and Walmart extend pharmacy network agreement

  The companies extended their network arrangement, preserving Walmart pharmacy access for Express Scripts members.

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• 2017Express Scripts launches Inside Rx

  Inside Rx was introduced as a discount-medicine service aimed partly at uninsured and underinsured consumers.

  Product launch
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• 2017Express Scripts acquires myMatrixx

  The company acquired the workers’ compensation pharmacy-benefits provider for a reported $250 million.

  M&A
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• 2017Express Scripts acquires eviCore

  The company announced and completed a reported $3.6 billion acquisition of eviCore, expanding into medical-benefit management.

  M&A
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• 2012Express Scripts completes Medco acquisition

  The approximately $29.1 billion acquisition received Federal Trade Commission approval and created the largest U.S. PBM by prescription volume.

  M&ARegulation
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• 2009Express Scripts acquires NextRx

  Express Scripts completed its purchase of WellPoint’s NextRx subsidiaries, strengthening its national PBM position.

  M&A
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• 2003Express Scripts wins TRICARE home-delivery contract

  The company began managing pharmacy home-delivery services for the U.S. Department of Defense’s TRICARE program.

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• 2000Express Scripts writes off its PlanetRx relationship

  Financial difficulties at the online pharmacy start-up led Express Scripts to write off its investment and relationship.

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• 1999Express Scripts acquires Diversified Pharmaceutical Services

  The transaction further increased the company’s scale in pharmacy benefit management.

  M&A
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• 1998Express Scripts acquires ValueRx

  The acquisition expanded Express Scripts’ pharmacy-benefit administration capabilities.

  M&A
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• 1993Express Scripts launches its annual Drug Trend Report

  The report began providing recurring analysis of prescription-drug utilization and cost trends.

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• 1992Express Scripts becomes a publicly traded company

  The company completed its transition to public ownership and expanded its national PBM strategy.

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1. Express Scripts
2. Express Scripts official website