Express Scripts

Express Scripts Holding Company
Company type	Subsidiary
Industry	Pharmacy benefit management
Founded	1986 in St. Louis County, Missouri, United States
Founder	Joint venture of Medicare Glaser Inc. and Sanus Corp. Health Systems
Headquarters	Bloomfield, United States
Area served	United States
Key people	Eric Palmer (CEO of Evernorth, parent organization)
Products	Pharmacy benefit management solutions, network pharmacy claims adjudication, home delivery pharmacy operations, specialty pharmacy oversight, benefit design consulting, drug utilization evaluations, formulary oversight, data analytics services
Number of employees	26,600 (2017)
Parent	Cigna

Express Scripts Holding Company stands as a prominent pharmacy benefit management (PBM) firm, recognized as the largest PBM by revenue within the United States. In 2017, it ranked 22nd among American corporations, generating $100.065 billion in revenue. The company's headquarters are located in unincorporated North St. Louis County, Missouri. Express Scripts delivers comprehensive pharmacy benefit management solutions, including network pharmacy claims adjudication, home delivery pharmacy operations, and specialty pharmacy oversight through its subsidiary Accredo. Additionally, it offers benefit design consulting, drug utilization evaluations, formulary oversight, and data analytics services to health plans, self-funded employers, and government programs such as the United States Department of Defense's Tricare.

Beyond these services, Express Scripts administers pharmacy benefit management for workers' compensation insurance schemes and holds accreditation from URAC, a respected industry standards organization. The company operates automated pharmacies that supply medications for chronic illnesses directly to members, strengthening its position in specialty prescription management.

On March 7, 2018, it was announced that Cigna would acquire Express Scripts in a transaction valued at $67 billion; the deal finalized on December 20, 2018, at $54 billion. This acquisition broadened Cigna’s portfolio and market reach by incorporating Express Scripts’ extensive PBM capabilities into its health insurance offerings. Currently, Express Scripts functions as a Cigna subsidiary with headquarters in Bloomfield, Connecticut.

Notable subsidiaries of Express Scripts include Accredo, Curascript, eviCore, Inside Rx, and UBC. As of 2017, the company employed around 26,600 individuals and maintains a significant role in healthcare and pharmaceutical sectors through its integrated approach to managing drug benefits for a diverse clientele.

Founding

Express Scripts was established in 1986 within St. Louis County, Missouri, as a joint venture equally owned by Medicare Glaser Inc., a retail pharmacy chain operating over 79 locations, and Sanus Corp. Health Systems.

Sanus traced its roots back to Bradford Systems and Administrative Services, founded in Boston in 1968 to manage computer processing for Medicare and Medicaid claims. McDonnell Douglas acquired Sanus in 1981 for $11.5 million. In 1983, Joseph T. Lynaugh—formerly director of NYC Health + Hospitals—and Howard L. Waltman—a longtime Bradford employee—formed Sanus. Major investors included McDonnell Douglas and General American Life Insurance Company. Sanus functioned as a health maintenance organization and merged with General America Life Insurance's preferred provider organization. By 1986, through its GenCare prescription unit, Sanus served approximately 200,000 clients generating $100 million in revenue across regions including St. Louis, Dallas, Fort Worth, Houston, and Washington, D.C.

In late 1986, Sanus teamed up with Medicare-Glaser to launch Express Scripts as an equal partnership focused on prescription fulfillment services. The company combined traditional retail pharmacy operations in Missouri and Illinois with innovative mail-order prescription delivery for other markets. Charles H. Ridings initially held the CEO position but was soon succeeded by Waltman.

Sanus remained the principal insurance client of Express Scripts while expanding its customer base further. Following increased investment from New York Life, Sanus rebranded as NYL Cares before being acquired by Aetna in 1998 for $1.05 billion.

Medicare-Glaser divested its interest back to Sanus prior to being acquired by SupeRx in 1989 for $18.2 million. SupeRx filed for bankruptcy in 1991 after Walgreens took over its pharmacy records operations. Founded by Morris Glaser in 1924, Medicare Glaser operated discount pharmacies designed to resemble doctor waiting rooms with a focus exclusively on prescriptions; at its peak, the chain had about 100 stores.

General America Life Insurance Company, a private insurer based in St. Louis since 1933, encountered financial challenges and was acquired by MetLife in 1999 for $1.2 billion after difficulties repaying $6.8 billion in short-term bonds.

1989-1999

In 1989, Express Scripts became a subsidiary of New York Life Insurance Company and went public three years later in 1992. By 1993, the firm had secured significant contracts with major corporations such as Lockheed, Service Merchandise, and Ingersoll Rand. The following year, Express Scripts broadened its services to include workers’ compensation prescription management and reinsurance. In 1994, the company also declared a two-for-one stock split. Expansion continued with the launch of Express Scripts Canada in 1996, alongside the introduction of the annual Drug Trend Report and the Outcomes Symposium Conference, both of which enhanced its industry presence.

In April 1998, Express Scripts acquired ValueRx, the pharmacy benefit management division of Columbia/HCA Healthcare Corp. The company further expanded in 1999 by purchasing Diversified Pharmaceutical Services from SmithKline Beecham Corp for $700 million and investing in PlanetRx.com, a platform offering members online access to prescription and health products.

2000-2010

Due to financial difficulties faced by PlanetRx.com, Express Scripts wrote off its $165 million investment in 2000. The following year, it collaborated with Merck-Medco and Advance PSC to establish RxHub LLC, boosting its digital infrastructure.

In 2002, Express Scripts strengthened its market position through the acquisition of National Prescription Administrators, Inc. (NPA). Toward the end of 2006, it made a $26 billion offer to acquire Caremark but was outbid by CVS Corporation, which subsequently formed CVS/Caremark Corporation in 2007.

October 2007 marked Express Scripts’ purchase of ConnectYourCare to administer FSA, HRA, and HSA accounts for clients including Suntrust and Zions Bancorporation; however, this unit was sold off in August 2012.

A notable acquisition took place in 2009 when Express Scripts bought WellPoint’s NextRx subsidiaries for $4.675 billion, finalizing the transaction by December. This acquisition expanded its international footprint and solidified its status as a top pharmacy benefit manager.

2010-present

Express Scripts finalized a $29.1 billion acquisition of Medco Health Solutions in April 2012 after receiving approval from the Federal Trade Commission following an antitrust evaluation. This deal established Express Scripts as the largest pharmacy benefit manager (PBM), processing approximately 1.4 billion prescriptions annually.

In 2017, the company launched Inside Rx, a subsidiary aimed at providing discounted medications to uninsured and underinsured patients. That July, Express Scripts acquired myMatrixx, a Tampa-based workers' compensation PBM, for $250 million.

However, October 2017 saw Express Scripts lose its largest client, Anthem (company), which transitioned to CVS Health amid allegations of $3 billion in overcharges. Anthem also announced plans to develop its own PBM called IngenioRx. This loss caused Express Scripts’ stock value to decline by nearly one-third. In the same month, Express Scripts revealed a $3.6 billion acquisition of eviCore, a medical benefits management company; this deal closed in December. Additionally, in November 2017, it divested United BioSource Corp., its pharmaceutical support division, selling it to Avista Capital Partners.

In March 2018, Cigna declared plans to acquire Express Scripts for $67 billion, marking a significant consolidation within the PBM sector following CVS Health's merger with Aetna earlier that year. These mergers attracted regulatory scrutiny due to concerns over potential anti-competitive behavior and pricing models associated with PBMs.

Currently employing approximately 30,000 people worldwide, Express Scripts participates in community outreach efforts such as collaborations with local Blessings in a Backpack initiatives.

In December 2018, Walmart renewed its prescription services contract with Express Scripts to enhance benefits for its customers. By December 2019, Express Scripts entered into a three-year partnership with Prime Therapeutics aimed at optimizing drug cost management.

Toward the end of 2020, Express Scripts and its subsidiaries were rebranded under Evernorth, a new health services organization. Tim Wentworth stepped down as Evernorth CEO at the close of 2021 and was succeeded by Eric Palmer—a seasoned executive from Cigna—in 2022.

Financial Overview

During the 2017 fiscal period, Express Scripts announced net earnings of US$4.517 billion on total revenues amounting to US$100.065 billion, reflecting a marginal decrease of 0.2% compared to the prior year. By October 2018, the company's stock price exceeded $64 per share, with a market valuation surpassing US$53.6 billion.

Year	Revenue in mil. USD$	Net income in mil. USD$	Total Assets in mil. USD$	Share Price in USD$	Workforce
2005	16,188	400	5,494	13.65
2006	21,563	474	5,108	19.49
2007	21,824	568	5,256	25.40
2008	21,941	776	5,509	32.77
2009	24,722	828	11,931	33.61
2010	44,973	1,181	10,558	48.71
2011	46,128	1,276	15,607	50.92
2012	93,714	1,313	58,111	55.87
2013	104,099	1,845	53,548	61.67	29,975
2014	100,887	2,008	53,748	73.66	29,500
2015	101,752	2,476	53,243	86.01	25,900
2016	100,288	3,404	51,745	72.98	25,600
2017	100,065	4,517	54,256	64.41	26,600

Corporate Headquarters

Express Scripts is based in North St. Louis County within the Greater St. Louis area of Missouri.

In 2007, it became the first Fortune 500 firm to locate its headquarters on a university campus at the University of Missouri–St. Louis (UMSL). The campus comprises several facilities including the original building at 1 Express Way and later expansions such as an Office and Data Center along with a Tech and Innovation Center. By 2018, approximately 5,000 employees were stationed at this site.

This relocation was spearheaded by then-CEO George Paz, an alumnus of UMSL. The company retains ownership of its headquarters properties and has received significant tax benefits while actively collaborating with UMSL through investments in infrastructure like Express Scripts Hall and support for academic initiatives and entrepreneurial incubators.

The campus covers three different jurisdictions within St. Louis County: the main entrance is located in Cool Valley; parts extend into Bellerive and unincorporated zones; buildings situated north of Interstate 70 fall within Berkeley's boundaries. Throughout its existence, Express Scripts has chosen to remain headquartered in St. Louis County rather than moving into the City of St. Louis.

Executive Leadership

Howard L. Waltman (1986–1992)
Barrett A. Toan (1992–2005)
George Paz (2005–2016)
Tim Wentworth (2016–2021)
Adam Kautzner (2021–Present)

Annual Drug Trend Report

Since 1993, Express Scripts has released its yearly Drug Trend Report which delivers comprehensive evaluations of prescription medication expenses and usage patterns. Created by the Express Scripts Research & New Solutions Lab with contributions from academic researchers and healthcare professionals, this online publication offers valuable perspectives on consumer interactions with healthcare benefits and aids in making informed pharmaceutical management decisions.

Health Decision Science

Following its merger with Medco Health Solutions, Express Scripts introduced a Health Decision Science framework aimed at gaining deeper insights into patient health priorities. This methodology combines behavioral science ("consumerology"), clinical knowledge, and practical data analytics. Utilizing its unique capacity to oversee 1.4 billion prescriptions annually worldwide, Express Scripts applies this intelligence to design enhanced healthcare solutions for clients and patients that improve medication adherence while optimizing cost-effectiveness across its global services.

Fraud Allegations

On August 4, 2004, Eliot Spitzer, then New York State Attorney General, initiated legal action against Express Scripts, accusing the firm of withholding tens of millions in drug rebates owed to the state. The complaint further asserted that Express Scripts exaggerated the cost savings associated with transitioning to preferred medications. In 2008, the company agreed to a settlement, disbursing $9.3 million to Pennsylvania and 28 additional states to resolve accusations of deceptive business practices. This agreement also required Express Scripts to modify its business operations and compensate patients up to $200,000.

Data Breach Incident

In October 2008, an anonymous extortion note was received at Express Scripts' headquarters in St. Louis, threatening to disclose confidential information involving 75 members unless a ransom was paid. A class action lawsuit representing consumers was subsequently filed but was dismissed after the plaintiff could not establish direct harm resulting from the breach.

Lawsuit in Rockford

As of January 2020, legal proceedings in Rockford, Illinois target Mallinckrodt Pharmaceuticals and Express Scripts for allegedly failing to lower the prescription cost of Acthar. The lawsuit claims that Express Scripts, serving as the exclusive distributor, profited from maintaining the medication’s elevated price. The company refuted any conflict of interest in a statement provided to CBS News.

Pharmacy Reimbursement Practices

Express Scripts has been scrutinized for reimbursing pharmacies at rates below their acquisition costs while steering patients toward its mail-order service. Subsequently, the company charges plan sponsors prices significantly exceeding those reimbursements, influencing its pricing approach and relationships within the market.

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