Express Scripts

Express Scripts is a prominent pharmacy benefit management (PBM) organization in the United States, playing a critical role in the healthcare system by managing prescription drug benefits on behalf of health insurers, Medicare Part D plans, large employers, and other clients. Founded in 1986, Express Scripts has grown to become one of the largest PBMs in the country, aiming to make the use of prescription drugs safer and more affordable through the use of innovative technology and data analytics.

History

Express Scripts was established in 1986 in St. Louis, Missouri. Over the years, it expanded through a series of acquisitions, including the purchase of Medco Health Solutions in 2012, which significantly increased its market share and influence in the pharmacy benefit management sector. This acquisition was a pivotal moment in the company's history, making it one of the leading PBMs in the United States.

Services

Express Scripts provides a wide range of services aimed at improving health outcomes and reducing healthcare costs. These services include network-pharmacy claims processing, home delivery pharmacy services, specialty pharmacy services, and formulary management. The company also offers programs and services that help manage drug costs for chronic and complex conditions, such as diabetes and cancer, through its specialty pharmacy, Accredo.

Formulary Management

One of the key strategies used by Express Scripts to control prescription drug costs is formulary management. A formulary is a list of prescription drugs, both generic and brand name, that are preferred by a health plan. Express Scripts uses evidence-based protocols to determine which drugs are included on its formulary, with the aim of encouraging the use of cost-effective and clinically effective medications.

Specialty Pharmacy

Accredo, Express Scripts' specialty pharmacy, provides targeted therapy management programs for patients with complex chronic conditions. Specialty pharmacies are critical in the distribution of high-cost injectable, infused, oral, or inhaled medications that are often required to treat rare and chronic diseases.

Impact on Healthcare

Express Scripts plays a significant role in the healthcare system by negotiating drug prices with pharmaceutical manufacturers, thereby lowering the cost of prescription drugs for its clients and their members. Additionally, the company's focus on data analytics and innovative technology helps improve medication adherence and patient outcomes, contributing to the overall efficiency of the healthcare system.

Controversies

Like many large PBMs, Express Scripts has faced criticism and legal challenges related to its business practices. Critics argue that the lack of transparency in PBM operations can lead to conflicts of interest and higher drug prices. However, Express Scripts maintains that its practices are aimed at reducing healthcare costs and improving patient care.

Acquisition by Cigna

In 2018, Express Scripts was acquired by Cigna, a global health service company, in a deal valued at approximately $67 billion. This acquisition integrated Express Scripts' pharmacy benefit management services with Cigna's healthcare insurance business, creating a comprehensive healthcare service platform aimed at delivering better outcomes at lower costs.

Conclusion

Express Scripts has played a pivotal role in shaping the pharmacy benefit management industry in the United States. Through its comprehensive range of services, the company strives to improve access to affordable prescription medications while enhancing the quality of care for millions of Americans. Despite facing challenges and controversies, Express Scripts continues to innovate and adapt in an ever-evolving healthcare landscape.