Fact-checked by Grok 2 weeks ago

Express Scripts

Express Scripts is a pharmacy benefit manager (PBM) that administers prescription drug benefits for health plans, employers, unions, and government programs in the United States, processing claims, negotiating drug prices with manufacturers, and operating mail-order and specialty pharmacies to enhance medication access and affordability.^[1]^[2] Founded in 1986 and originally headquartered at 1 Express Way in St. Louis, Missouri, the company grew through acquisitions into one of the largest PBMs, handling tens of millions of members before its $67 billion acquisition by Cigna Corporation in December 2018, after which it integrated into Cigna's Evernorth division while retaining its brand for PBM services.^[3]^[4]^[5] Express Scripts' core operations include developing formularies to guide drug coverage, leveraging its pharmacy network for retail fills, and providing home delivery for maintenance medications, which collectively aim to reduce overall pharmaceutical spending through volume-based rebates and generic promotion—saving clients an estimated $38 billion annually in self-reported figures prior to the merger.^[6]^[7] The firm has achieved scale with pre-acquisition revenues exceeding $100 billion and a workforce of about 26,600 employees, enabling it to influence drug utilization patterns and negotiate directly with pharmaceutical suppliers.^[8]^[3] Notable for its data-driven approaches to adherence and cost containment, Express Scripts has nonetheless encountered significant controversies over PBM industry practices, including opaque rebate retention, spread pricing between reimbursements and pharmacy payments, and potential incentives that prioritize high-cost drugs, prompting federal investigations and legislative scrutiny into whether such mechanisms truly lower net costs or exacerbate affordability issues for patients.^[9]^[10] These debates highlight causal tensions in the supply chain, where PBMs' intermediary role facilitates discounts from manufacturers but has been empirically linked in some analyses to sustained list price inflation and pharmacy margin squeezes.^[9]

History

Founding and Early Development (1986–1988)

Express Scripts was established in 1986 in St. Louis, Missouri, as a joint venture between Medicare-Glaser Inc., a retail pharmacy chain operating more than 79 locations, and Sanus Corp. Health Systems, a health maintenance organization seeking to control prescription costs for its members.^[11]^[12] The venture leveraged Medicare-Glaser's pharmacy expertise and Sanus's insured base to pioneer mail-order fulfillment, addressing rising healthcare expenses amid the expansion of managed care in the 1980s.^[13] This model emphasized centralized processing to streamline claims, reduce administrative burdens, and enable bulk purchasing for efficiency. Initial operations commenced with manual prescription filling and rudimentary automation, such as basic conveyor systems for packaging.^[14] The company's first mail-order deliveries occurred on February 3, 1987, consisting of 11 prescriptions shipped to Sanus beneficiaries, establishing Express Scripts as an early innovator in home delivery pharmacy services.^[14] Sanus remained the primary customer, accounting for the bulk of early volume, while the firm handled claims adjudication and benefit coordination to optimize drug utilization and costs. By 1988, Express Scripts had secured investment from New York Life Insurance Company, which provided funding to scale infrastructure and expand beyond its foundational client.^[15] This capital infusion supported initial marketing efforts to other health plans and refined operational processes, laying groundwork for growth in pharmacy benefit management amid increasing demand for cost-containment in employer-sponsored insurance.^[16] The period marked a focus on proving the viability of third-party mail-order models, with revenues beginning from low millions as membership grew modestly from Sanus's network.

Expansion Through Acquisitions (1989–2011)

Following its acquisition by New York Life Insurance Company in 1989, which provided financial backing for growth, Express Scripts went public in 1992, raising capital to pursue expansion in the pharmacy benefit management (PBM) sector.^[11] This period marked a shift toward aggressive acquisition strategy, starting with smaller entries into new markets and accelerating with larger deals that consolidated market share and enhanced service capabilities. By the early 1990s, the company had secured major clients such as FHP International Corp. and Lockheed Corp., but organic growth was supplemented by targeted buys to build infrastructure for mail-order pharmacy, workers' compensation services, and international operations.^[11] In 1995, Express Scripts acquired Eclipse Claims Services, a Canadian PBM, enabling entry into the international market and adding clients including Aetna and Prudential divisions.^[13] The pace intensified in 1998 with the $445 million purchase of ValueRx, the PBM unit of Columbia/HCA Healthcare Corp., which positioned Express Scripts as the largest independent U.S.-based PBM at the time by expanding its network claims processing and formulary management scale.^[17] This was followed in April 1999 by the $700 million acquisition of Diversified Pharmaceutical Services from SmithKline Beecham Corp., further solidifying its ranking as the third-largest U.S. PBM and boosting annual drug spend management to nearly $10 billion through integrated data analytics and rebate negotiation enhancements.^[11]^[13] The 2000s saw continued consolidation amid rising healthcare costs and PBM demand. In February 2002, Express Scripts agreed to acquire National Prescription Administrators, the largest private PBM, for $515 million in stock, adding over 4 million covered lives and strengthening third-party administration capabilities.^[18] In December 2003, it purchased CuraScript Pharmacy for $335 million in cash, entering the specialty pharmacy segment for high-cost drugs like oncology and hemophilia treatments, which diversified revenue beyond traditional generics and retail networks.^[19] The 2005 $1.3 billion acquisition of Priority Healthcare expanded distribution for specialty and home infusion services, while the 2007 purchase of ConnectYourCare introduced consumer-directed health plans with personalized benefit designs.^[20] By 2009, the $4.675 billion deal for WellPoint's NextRx subsidiaries closed, integrating mail-order and specialty operations to handle an additional $11 billion in annual prescriptions and enhancing vertical integration in rebate capture.^[11] These acquisitions collectively drove revenue from under $1 billion in the mid-1990s to over $20 billion by 2010, primarily through synergies in claims processing efficiency, formulary control, and client retention rates exceeding 90 percent in core segments, though integration challenges occasionally arose from disparate IT systems in acquired entities.^[13]^[21] The strategy reflected causal dynamics in the PBM industry, where scale enabled better pharmaceutical manufacturer negotiations for rebates—often 20-30 percent of list prices—while empirical data from post-merger outcomes showed sustained cost savings for clients via generic substitution rates above 70 percent.^[22] No major antitrust blocks occurred during this era, as Federal Trade Commission reviews focused on potential rebate pass-through rather than outright market foreclosure.^[23]

Merger with Medco Health Solutions (2012)

In July 2011, Express Scripts announced a definitive merger agreement to acquire Medco Health Solutions in a cash-and-stock transaction valued at approximately $29.1 billion, including the assumption of debt.^[24] The deal proposed combining the two largest pharmacy benefit managers (PBMs) in the United States, creating a new entity under Express Scripts Holding Company that would manage pharmacy benefits for over 100 million covered lives and generate projected annual revenues exceeding $90 billion. Medco shareholders were to receive $28.81 per share in cash or Express Scripts stock, representing a 19% premium over Medco's closing price prior to the announcement. The merger faced significant antitrust scrutiny from the Federal Trade Commission (FTC), which issued a second request for information in August 2011, extending the review process.^[25] Concerns were raised by independent pharmacists, consumer groups, and members of Congress, including hearings by the House Judiciary Subcommittee on Antitrust, Competition Policy, and Consumer Rights in September and December 2011, highlighting potential reductions in competition that could harm rural pharmacies and increase pricing power over drug manufacturers and retailers.^[26] Opponents argued the combined entity would control about 75-80% of the U.S. PBM market, potentially enabling practices like steering patients to affiliated mail-order and specialty pharmacies at the expense of local providers, though proponents countered that the merger would enhance bargaining leverage to lower drug costs amid rising healthcare expenses.^[27] Shareholders of both companies approved the transaction in December 2011, with Medco shareholders reaffirming support after an initial vote. On April 2, 2012, the FTC approved the merger by a 3-1 vote after an eight-month investigation, determining it would not substantially lessen competition, as the PBM industry remained dynamic with opportunities for new entrants and the deal promised $1 billion in annual cost savings passed to clients through rebates and formulary efficiencies.^[25] The merger closed the same day, with George Paz serving as CEO of the combined company headquartered in St. Louis, Missouri.^[28] Post-merger integration focused on unifying operations to improve clinical outcomes and affordability, including expanded use of evidence-based formularies and home delivery services, though subsequent analyses noted concentrated market power that influenced rebate negotiations with pharmaceutical firms.^[29] The transaction marked a pivotal consolidation in the PBM sector, reducing the number of major players and prompting ongoing debates about regulatory oversight of vertical integration in healthcare supply chains.^[30]

Acquisition by Cigna and Integration (2018)

On March 8, 2018, Cigna Corporation announced its agreement to acquire Express Scripts Holding Company in a cash-and-stock transaction valued at approximately $67 billion, including the assumption of $15 billion in debt.^[31] The deal offered Express Scripts shareholders $48.75 in cash plus 0.2434 shares of Cigna common stock per share, representing a 31% premium over Express Scripts' closing price of $73.42 on March 7, 2018.^[31] Post-merger ownership was structured such that Cigna shareholders would hold about 64% of the combined entity, with Express Scripts shareholders retaining 36%; the combined company retained the Cigna name and headquarters in Bloomfield, Connecticut, while Express Scripts maintained its operations and base in St. Louis, Missouri.^[31]^[32] The acquisition received shareholder approvals from both companies in August 2018 and cleared U.S. Department of Justice antitrust review as a vertical merger without requiring divestitures.^[33]^[34] The transaction closed on December 20, 2018, earlier than the anticipated year-end deadline, enabling immediate operational alignment.^[4] David M. Cordani continued as president and CEO of the enlarged Cigna, overseeing the integration of Express Scripts' pharmacy benefit management capabilities with Cigna's health insurance and services portfolio to pursue cost reductions through enhanced data analytics, value-based care models, and supply chain efficiencies.^[4]^[32] Initial integration efforts focused on segment reorganization, with Express Scripts' operations reclassified under a new Health Services segment effective in the fourth quarter of 2018, incorporating pharmacy revenues from the post-closing period.^[35] The combined entity projected synergies including double-digit earnings per share accretion and targeted adjusted income from operations of $20–$21 per share by 2021, driven by improved affordability and predictability in drug pricing and benefit management.^[31]^[4] Concurrently, Cigna announced a $200 million community investment commitment and launched the Healthier Kids for Our Future initiative, a $25 million, five-year program starting in 2019 to combat childhood hunger, signaling early post-acquisition priorities in social determinants of health.^[4]

Operations Under The Cigna Group (2019–Present)

Following the acquisition's completion on December 20, 2018, Express Scripts integrated its operations into Cigna Corporation starting in 2019, combining mail-order and specialty pharmacy functions to streamline services and capture synergies in pharmacy benefit management (PBM). This merger amplified Cigna's health services revenue, with third-quarter 2019 sales reaching $24.88 billion, driven by Express Scripts' contributions to rebate negotiations, formulary design, and network management for over 100 million covered lives.^[36]^[37] Integration efforts emphasized cost containment, including expanded home delivery options integrated into Cigna's broader network, which supported clinical adherence and reduced out-of-pocket expenses for members.^[38] In September 2020, Cigna rebranded its health services division—including Express Scripts—as Evernorth Health Services, positioning Express Scripts as the core PBM engine within a platform that also encompasses specialty pharmacy (via Accredo), care delivery, and analytics tools.^[39]^[2] Under this structure, Express Scripts managed pharmacy benefits by prioritizing generics, negotiating manufacturer rebates, and enforcing formulary exclusions to lower net drug costs, with operations supported by 24/7 member access via app and phone.^[40] In February 2023, Cigna reorganized as The Cigna Group, with Evernorth operating as a distinct division focused on unregulated services like PBM, generating revenue growth through scaled operations while maintaining Express Scripts' headquarters in Franklin Lakes, New Jersey.^[41]^[42] A pivotal early partnership came in December 2019, when Express Scripts collaborated with Prime Therapeutics on a three-year agreement, under which Express Scripts handled retail network management, manufacturer contracting, and rebate aggregation for Prime's clients, effectively expanding its influence to an additional 27 million lives without full ownership overlap.^[43] This arrangement enhanced bargaining power for drug pricing but drew later antitrust scrutiny in states like Michigan, where it was alleged to suppress independent pharmacy reimbursements.^[44] Subsequent initiatives included the 2023 Rural Health Access program, which boosted reimbursements and added services like vaccinations at independent pharmacies to improve access in underserved areas, and a 2024 tie-up with CPESN USA to integrate community pharmacists into value-based care models.^[45]^[46] From 2020 to 2025, Express Scripts emphasized digital and transparency tools, such as the Real-Time Prescription Benefit tool for point-of-sale savings and annual formulary updates like the 2025 National Preferred Formulary, which excluded higher-cost drugs in favor of clinically equivalent, lower-priced alternatives to drive savings.^[47]^[48] In response to regulatory pressures on PBM practices, Evernorth introduced ClearNetwork in 2025, a simplified pricing model passing 100% of rebates and fees directly to clients without spreads, aiming to enhance predictability amid biosimilar expansions projected to impact $100 billion in specialty spend over five years.^[49] These efforts sustained operational focus on affordability, with Express Scripts handling home delivery for maintenance medications and specialty infusions while adapting to federal reforms on drug pricing transparency.^[50]^[51]

Business Model and Services

Core Pharmacy Benefit Management Functions

Express Scripts performs core pharmacy benefit management functions, including real-time claims adjudication, pharmacy network administration, and clinical utilization management, to administer prescription drug benefits for health plans, employers, and government programs.^[2]^[52] These operations enable electronic processing of claims at the point of pharmacy dispensing, verifying patient eligibility, coverage, formulary status (as determined separately), copayment requirements, and prior authorizations before approving or denying reimbursement to pharmacies.^[53]^[54] In handling claims for over 110 million members—representing about one in three Americans—Express Scripts achieves high efficiency, processing 99.1% of specialty drug claims for commercial and health plan payers.^[2] Pharmacy network management constitutes a foundational service, involving the negotiation and maintenance of contracts with retail, independent, and chain pharmacies to ensure broad geographic access and competitive dispensing fees.^[55]^[53] Express Scripts administers networks serving approximately 60 health plans, 2,300 employers, and 42 government entities, facilitating member choice while enforcing standards for quality, compliance, and reimbursement rates.^[2] This includes performance-based contracting to incentivize adherence to clinical guidelines and cost controls, supported by a workforce of 18,000 employees nationwide.^[2] Clinical utilization management tools, such as prior authorization requirements, step therapy protocols, and quantity limits, are applied to promote evidence-based prescribing and prevent overuse or misuse of medications.^[56]^[55] Express Scripts employs over 1,000 specialized pharmacists, physicians, and nurses, along with 3,500 patient service advocates, to review complex cases and ensure therapeutic appropriateness, particularly for high-cost or high-risk drugs.^[2] Their advanced utilization management initiatives have generated annual savings of $4.6 billion for clients by averting unnecessary expenditures, equivalent to 10-13% of pharmacy spend, through interventions like preferred alternative recommendations.^[2] Record-keeping and reporting form an essential backend function, aggregating claims data for analytics, compliance auditing, and trend analysis to inform plan sponsors on utilization patterns and outcomes.^[52] These systems support regulatory reporting and enable interventions to optimize drug therapy adherence and safety.^[54]

Negotiation, Rebates, and Formulary Management

Express Scripts negotiates with pharmaceutical manufacturers to secure rebates and discounts on prescription drugs, primarily in exchange for preferred placement on its formularies or higher utilization volumes. These negotiations leverage the company's market share, representing approximately 25% of the U.S. prescription drug market, to extract concessions that reduce net drug costs for clients. Rebates are calculated based on actual drug utilization by plan members and are paid quarterly by manufacturers to Express Scripts, which then distributes the majority to health plan sponsors.^[57]^[9] In its rebate model, Express Scripts passes through over 95% of collected rebates to clients, retaining the remainder as compensation for negotiation and administrative services, a practice it has maintained since at least 2022. Clients can select from various economic arrangements, including full rebate pass-through options with transparent pricing, where plan sponsors pay exactly what Express Scripts reimburses pharmacies plus a fixed fee. However, federal investigations, including a 2024 FTC lawsuit, allege that this rebate system incentivizes PBMs to favor high-rebate drugs over lower-cost alternatives, artificially inflating list prices—particularly for insulins—and distorting competition by prioritizing manufacturer payments over patient affordability. Express Scripts has contested these claims, arguing that rebates promote competition and lower net costs, while offering 100% auditable models to address transparency concerns.^[58]^[59]^[60] Formulary management at Express Scripts involves developing tiered lists of covered drugs, where decisions prioritize clinical appropriateness, safety, and efficacy over cost, according to the company's stated principles. The process includes pharmacist and physician reviews of clinical data, with exclusions applied to drugs deemed less effective or redundant; for instance, the 2025 formulary excluded high-cost biologics like Humira biosimilars in favor of lower-list-price alternatives from select manufacturers. Preferred tiers typically require higher manufacturer rebates, linking formulary position to negotiation outcomes, though Express Scripts maintains that rebate guarantees do not override evidence-based assessments. Critics, including state attorneys general in a 2025 lawsuit, contend this creates conflicts where formulary exclusions coerce larger rebates, potentially limiting access to clinically equivalent options and contributing to higher out-of-pocket costs for patients.^[61]^[62]^[63]

Specialty Pharmacy and Mail-Order Services

Express Scripts delivers specialty pharmacy services primarily through Accredo, its dedicated specialty pharmacy under the Evernorth umbrella, focusing on high-cost, complex medications for chronic and rare conditions including cancer, hepatitis C, HIV/AIDS, multiple sclerosis, rheumatoid arthritis, and bleeding disorders.^[64]^[65] Accredo provides integrated support such as personalized patient counseling by therapy-specific pharmacists, adherence monitoring via refill reminders and scheduled deliveries, financial assistance navigation, and 24/7 access to clinical experts, all coordinated with prescribers to optimize therapy outcomes.^[64]^[66] These services operate as a home delivery model, ensuring medications are dispensed with cold-chain logistics where required and without additional fees beyond standard cost-sharing for eligible members.^[66] Specialty drugs represent a significant portion of pharmacy expenditures; for instance, prescriptions for such medications, used by under 2% of patients, comprised 51% of overall pharmacy costs as of 2022, driven by launches of biologics and gene therapies with list prices often exceeding $100,000 annually per patient.^[67] Express Scripts manages these through formulary placement, prior authorization protocols, and rebate negotiations with manufacturers, aiming to balance access with cost containment, though utilization growth in categories like oncology and immunology has contributed to year-over-year spending increases of 10-15% in commercial plans.^[68] Complementing specialty offerings, Express Scripts' mail-order service, branded as Express Scripts Pharmacy, enables home delivery of maintenance and chronic medications, typically in 90-day supplies to enhance convenience and adherence while reducing retail copays by up to 30% compared to 30-day fills at network pharmacies.^[69]^[70] Members can initiate orders online, via mobile app, phone, or e-prescription, with free standard shipping (10-14 days) or expedited options, automatic refill scheduling, and real-time tracking; this service processed millions of prescriptions annually, particularly for cardiovascular, diabetes, and respiratory therapies, yielding estimated savings of $1-2 per day per member through bulk dispensing efficiencies.^[69]^[71] For specialty items, mail-order integrates seamlessly with Accredo's model, supporting limited-distribution drugs that require manufacturer-restricted handling.^[66]

Digital and Analytics Tools

Express Scripts offers members a suite of digital tools accessible via its online portal and mobile application, enabling prescription refills, order tracking, payment management, and automated reminders for medication adherence.^[72] These platforms support home delivery integration, reducing pharmacy visits and providing real-time updates on shipments and claims status.^[72] In December 2019, Express Scripts introduced the Digital Health Formulary, a curated selection of digital therapeutics and remote monitoring services designed to assist payers in covering evidence-based tools for chronic condition management and wellness.^[73] Launching in January 2020 with an initial roster of 15 solutions, including mobile apps for personalized health tracking and clinically validated programs, the formulary emphasizes safety, usability, and relevance, vetted for effectiveness and data security.^[74]^[75] This initiative facilitates on-the-go health management, such as symptom monitoring and behavioral interventions, integrated with pharmacy benefits to enhance patient outcomes without requiring additional infrastructure from employers.^[76] On the analytics front, Express Scripts deploys proprietary platforms like Pulse, a PHI-compliant system built with R, Shiny applications, and machine learning to analyze drug trend data, customer feedback via natural language processing, and predictive forecasting, contributing to a 10-point improvement in Net Promoter Scores and cost reductions through targeted interventions.^[77] Complementing this, partnerships with SAS enable predictive modeling for medication adherence, scoring patients based on integrated prescription, medical, and lab data via tools like ScreenRx to proactively address non-adherence risks.^[78]^[79] Through Evernorth's Intelligence+ suite, Express Scripts applies advanced data science and machine learning to pharmacy benefit management, uncovering utilization patterns, predicting clinical gaps, and generating financial risk assessments for clients.^[80] Specialized tools include myDataSense, launched by subsidiary myMatrixx in November 2018, which aggregates pharmacy events, prescriber data, and drug references into visual dashboards for workers' compensation analytics, aiding in utilization review and cost control.^[81] These capabilities support broader initiatives like the Evernorth Research Institute's data-driven studies on health equity and affordability, leveraging Express Scripts' claims data for evidence-based formulary decisions.^[80]

Corporate Structure

Headquarters and Organizational Integration

Express Scripts maintains its corporate headquarters at 1 Express Way, St. Louis, Missouri 63121, located in unincorporated North St. Louis County.^[82]^[83] This 315,000-square-foot facility serves as the primary operational hub for the company's pharmacy benefit management activities, including administrative functions and key decision-making.^[84] The campus has been central to Express Scripts since its consolidation in the region, supporting a workforce focused on claims processing, formulary development, and client services.^[85] Following its acquisition by Cigna Corporation—completed on December 20, 2018, in a $67 billion transaction—Express Scripts retained its St. Louis headquarters, distinct from Cigna's primary location at 900 Cottage Grove Road, Bloomfield, Connecticut.^[32]^[86]^[87] This geographic separation preserved operational continuity for Express Scripts' specialized PBM functions while enabling synergies with Cigna's broader health insurance portfolio.^[4] The deal emphasized vertical integration, allowing coordinated management of medical and pharmacy benefits without immediate relocation of core operations.^[88] Organizationally, Express Scripts operates as a key component of Evernorth Health Services, a division of The Cigna Group (formerly Cigna Corporation, rebranded in 2021).^[42]^[89] Evernorth encompasses Express Scripts' PBM services alongside specialty pharmacy (e.g., Accredo), care management (e.g., eviCore), and behavioral health solutions, facilitating data-driven integration across the health services ecosystem.^[90] This structure supports The Cigna Group's model of combining insurance (via Cigna Healthcare) with ancillary services, aiming to align incentives for cost containment and patient outcomes through shared analytics and rebate negotiations.^[91] Express Scripts reports into Evernorth leadership, with its executive team contributing to group-wide strategy while maintaining autonomy in day-to-day PBM execution.^[40]

Leadership and Key Executives

Adam Kautzner, PharmD, has served as President of Express Scripts since January 18, 2023, leading pharmacy benefit management operations, formulary strategies, and integration with Evernorth Health Services under The Cigna Group.^[92] In this role, Kautzner oversees supply chain management, specialty pharmacy services, and efforts to manage drug costs amid regulatory scrutiny on PBM practices; prior to his appointment, he held senior positions including Senior Vice President of Supply Chain at Express Scripts, where he focused on pharmaceutical contracting and vendor negotiations.^[93] On October 8, 2025, Kautzner was appointed chair of the board for the Pharmaceutical Care Management Association (PCMA), the leading PBM lobbying group, highlighting his influence in advocating for industry positions on rebate retention and transparency reforms.^[94] Prior leadership includes Tim Wentworth, who was CEO of Express Scripts from September 2016 until his retirement at the end of 2021, during which he managed the post-acquisition transition into Cigna's structure and expanded digital tools for claims processing.^[95] Wentworth's tenure emphasized cost containment through rebate negotiations, reporting $100 billion in annual pharmacy savings for clients by 2020.^[96] Following the 2018 Cigna acquisition, Express Scripts executives like Eric Palmer (Evernorth CEO from 2022) and Steven Miller (former chief clinical officer) contributed to integrated care models, though Palmer departed the company in March 2025 amid broader Cigna management reshuffles driven by rising healthcare costs.^[97]^[98] Key supporting executives include Katie Walsh, Senior Vice President and Chief Operating Officer, responsible for operational efficiency and mail-order fulfillment scaling to over 100 million annual prescriptions.^[95] Christine Gilroy, MD, MSPH, FACP, appointed Chief Medical Officer in November 2021, directs clinical guidelines and evidence-based formulary decisions to address rising specialty drug expenditures.^[99] Nikki White serves as Vice President and General Manager of the Health Plan Division, focusing on employer-sponsored benefit customizations.^[100] These roles report ultimately to Cigna Group CEO David Cordani, reflecting Express Scripts' subordination to corporate oversight since 2018, with decisions on rebates and pricing aligned to Evernorth's $140 billion in annual pharmacy spend management as of 2024.^[101]^[51]

Financial Performance

Pre-Merger Financial Milestones

Express Scripts, Inc. was incorporated in September 1986 as a provider of pharmacy claims processing services and went public on the NASDAQ on January 19, 1992, at an initial share price of $13, with shares reaching a high of $35.25 early in 1993 amid rapid post-IPO growth driven by expanding mail-order and claims management operations.^[102]^[16] A transformative milestone came with the April 2, 2012, completion of its $29.1 billion merger with Medco Health Solutions, Inc., in a cash-and-stock transaction valued at $71.36 per Medco share; this deal, approved by the Federal Trade Commission, combined the two largest pharmacy benefit managers, nearly doubling Express Scripts' scale, enhancing negotiating power with drug manufacturers, and propelling combined annual revenues toward $100 billion in subsequent years through synergies in formulary management and specialty drug handling.^[103]^[104] Revenue growth accelerated post-merger, with 2010 figures (pre-merger) at approximately $45 billion, up from $24.7 billion in 2009, reflecting gains from client contracts and operational efficiencies; by 2016, annual revenues had climbed to $100.752 billion, supported by increased claims volume exceeding 1 billion annually and expansion in specialty pharmacy services.^[105] The company demonstrated sustained profitability, with adjusted earnings per diluted share rising 28% year-over-year to $2.43 in the third quarter of 2017, underscoring cost containment strategies and rebate optimization amid rising drug prices; full-year 2017 net revenues approximated $100 billion, positioning Express Scripts as a dominant player ahead of its 2018 acquisition by Cigna.^[106]

Post-Acquisition Economics Within Cigna

The acquisition of Express Scripts by Cigna, completed on December 20, 2018, for approximately $67 billion, integrated the pharmacy benefit manager into Cigna's operations under the Evernorth Health Services segment, fundamentally reshaping the company's economic profile by adding high-volume pharmacy revenues and scale advantages. This vertical integration enabled Cigna to capture greater value from drug pricing negotiations, rebates, and distribution, with Express Scripts contributing the bulk of post-acquisition pharmacy-related income. In 2019, the first full year of integration, Cigna's total revenues surged to $153.6 billion from $49 billion in 2018, driven predominantly by Express Scripts' $100 billion-plus in prior-year pharmacy services revenue now consolidated within Cigna. Adjusted revenues for 2019 reached $140.2 billion, reflecting initial synergies in administrative efficiencies and cross-selling opportunities between insurance and pharmacy benefits.^[107]^[108] Express Scripts' economics bolstered Cigna's profitability through rebate retention and cost containment, with the company projecting over $600 million in annual retained synergies from reduced overhead and enhanced formulary leverage. By 2023, Evernorth Health Services, led by Express Scripts, generated $153.5 billion in revenue—comprising about 78% of Cigna's total $195.3 billion—up 9% from the prior year, fueled by a 40% increase in retail network claims volume to over 1.3 billion prescriptions annually. This segment's growth outpaced Cigna's overall 8% revenue rise, demonstrating Express Scripts' role in driving accretive earnings via expanded mail-order fulfillment and specialty drug management, which accounted for higher-margin services. Adjusted income from operations for Cigna as a whole climbed to levels supporting $7.9 billion in 2024 guidance, with pharmacy benefits yielding over 95% rebate pass-through to clients under certain contracts, though net retention supported internal margins.^[109]^[110]^[111] Into 2024, pharmacy revenues exceeded $185 billion, contributing to Cigna's total of $247.1 billion—a 27% year-over-year increase—while shareholders' net income reached $3.4 billion. Express Scripts' platform sustained this trajectory amid rising drug costs, with Express Scripts' claims processing efficiency enabling Cigna to weather GLP-1 demand spikes and regulatory scrutiny without proportional margin erosion in core PBM functions. However, Evernorth's operating profit margins trended downward from 4.62% in 2020 to lower levels by 2024, attributable to investments in digital tools and competitive pricing pressures, though absolute adjusted earnings per share rose to $26.32 for the year. Overall, the acquisition delivered sustained economic value, positioning Express Scripts as a high-revenue engine that offset slower medical segment growth and enhanced Cigna's leverage in a concentrated PBM market.^[112]^[113]^[114]

Research and Publications

Drug Trend Reports

Express Scripts publishes annual Drug Trend Reports that quantify changes in prescription drug spending across its client base, primarily commercial and Medicare plans, using data from adjudicated claims for tens of millions of covered members. The core metric, "drug trend," represents the year-over-year percentage change in per-member-per-year (PMPY) pharmacy expenditures, adjusted for factors including utilization rates, unit costs, therapeutic mix shifts, new drug launches, and generic or biosimilar competition, often incorporating net rebates negotiated by the PBM. These reports, derived from Express Scripts' proprietary dataset, emphasize how formulary management, step therapy, and prior authorizations influence trends, typically reporting lower growth rates for clients employing their strategies compared to broader market estimates.^[2]^[115] Specialty medications have dominated findings since the mid-2010s, surpassing 50% of total pharmacy spend in commercial plans by 2021 and projected to grow 10-15% annually through therapies for oncology, immunology, and rare diseases. For example, the 2016 report documented specialty trend growth at 13.3%, the lowest since tracking began, crediting PBM interventions amid rising prices for brands like those for multiple sclerosis. In 2019, overall trend stabilized at 2.3%, buoyed by generic entries offsetting specialty launches, though inflammatory condition drugs drove nearly half of spending increases. Biosimilars, such as adalimumab alternatives entering in 2023, are forecasted to curb immunology costs, while HIV and cancer generics provide partial relief against incidence-driven utilization rises.^[116]^[117]^[118] Recent reports spotlight glucagon-like peptide-1 (GLP-1) agonists, such as semaglutide, as primary escalators of traditional drug spend, with 2024 trend reaching 8.9% overall—comprising 6.1% from utilization and inflation—fueled by off-label weight loss demand. The companion 2025 Pharmacy in Focus analysis projects 73.1% GLP-1 utilization growth for obesity by year-end, contributing 46.8% to spend acceleration, yet notes >50% discontinuation within 12 months among weight loss users, alongside surging youth uptake (84.6% increase from 2023-2024). Express Scripts advocates clinical safeguards like evidence-based criteria and lowest-net-cost formulary positioning to temper these dynamics, asserting such measures sustained net trends below gross estimates in prior years.^[119]^[120]

Health Decision Science Initiatives

Express Scripts' Health Decision Science integrates behavioral sciences, clinical specialization, and actionable data to inform better choices in pharmacy benefits management, focusing on drug selection, pharmacy networks, and overall health behaviors. This framework emerged prominently after the 2012 merger with Medco Health Solutions, enabling targeted interventions to boost adherence, optimize costs, and enhance outcomes.^[121] One key initiative involved a 2013 collaboration with Walgreens, applying Health Decision Science to deliver personalized coaching and data-driven recommendations for patients with chronic conditions, aiming to reduce non-adherence rates that contribute to higher long-term expenses. The program emphasized behavioral nudges alongside clinical guidance to encourage consistent medication use.^[122] The science has also supported research on specialty medications, where analyses identified strategies like home delivery and manufacturer discounts to curb per-member cost growth from 17.0% in 2012 to projected lower trends through evidence-based protocols. Similarly, studies of Health Insurance Marketplace enrollees used these principles to highlight adherence gaps and promote lower-cost alternatives without compromising efficacy.^[123]^[124] In broader applications, Health Decision Science guides formulary designs and patient routing to clinically superior, cost-effective options, as evidenced in company roadmaps emphasizing empirical data over traditional fee-for-service models to address rising drug expenditures. These efforts, while self-reported by Express Scripts, align with observable reductions in trend rates in their annual drug reports.^[125]

Economic and Healthcare Impact

Evidence of Cost Reductions and Efficiency Gains

Express Scripts implements cost reductions through manufacturer rebate negotiations, generic and biosimilar substitution incentives, and utilization management tools like step therapy, which encourage the use of lower-cost, clinically effective alternatives before higher-priced options.^[126] These mechanisms have lowered net drug expenditures for payers by leveraging scale to secure discounts and promote cost-effective prescribing.^[127] In 2022, 73% of Express Scripts members incurred less than $100 in annual out-of-pocket costs for medicines, with an average of $14.49 for a 30-day supply, maintaining flat cost-sharing over five years despite drug price inflation exceeding 10 times that rate.^[128] The Diabetes Patient Assurance Program generated $18 million in insulin savings for members that year, accumulating over $45 million since 2020, while boosting adherence by 30% and halving diabetes-related cost shares.^[128] Value-based pricing initiatives further demonstrate efficiency, such as point-of-sale rebates yielding $319 average savings per Praluent prescription, alongside improved adherence.^[129] Commercial client drug spending rose only 1.5% in 2017, a slowdown attributed to rebate capture and generic utilization amid list price hikes.^[130] Home delivery pharmacy services enhance operational efficiency by streamlining fulfillment and reducing waste, contributing to lower administrative burdens and higher medication adherence rates that indirectly curb long-term healthcare costs.^[131] PBM rebate negotiations, including those by Express Scripts, reduce payers' net acquisition costs, though empirical pass-through to end-users depends on plan design.^[132]

Criticisms of Pricing Practices and Market Concentration

Express Scripts, as one of the largest pharmacy benefit managers (PBMs), has faced scrutiny for contributing to high levels of market concentration in the U.S. PBM industry, where the three dominant players—CVS Caremark, OptumRx, and Express Scripts—collectively process approximately 80% of prescriptions.^[133] Nationally, Express Scripts holds about 17-23% market share, ranking second behind CVS Caremark.^[134] In specific markets like Michigan's Medicaid and commercial sectors, its dominance reaches 89%, enabling practices such as steering patients to affiliated mail-order pharmacies and suppressing independent pharmacy reimbursements.^[44] This concentration, critics contend, reduces competition, limits consumer choice, and allows PBMs to extract higher fees from payers while underpaying pharmacies, potentially leading to pharmacy closures and reduced service access.^[135] Pricing practices have drawn particular criticism for opacity and incentives that favor higher drug list prices over net cost reductions. The Federal Trade Commission (FTC) sued Express Scripts and other major PBMs in September 2024, alleging a rebate system that prioritizes drugs with inflated list prices to secure larger manufacturer rebates, artificially inflating insulin costs by up to 1,000% since 1996 despite minimal underlying increases.^[60] This structure, per the FTC, discourages formulary placement of lower-list-price alternatives, passing higher out-of-pocket costs to patients while PBMs retain undisclosed portions of rebates as profit.^[60] Independent analyses and lawsuits echo these concerns, claiming PBMs like Express Scripts engage in "spread pricing"—charging payers more than they reimburse pharmacies—and withhold rebate pass-throughs, contributing to overall drug spending growth exceeding 10% annually in some years.^[136] Legal actions underscore these issues. In April 2025, Michigan filed an antitrust lawsuit against Express Scripts, accusing it of colluding with competitors to fix pharmacy reimbursement rates at suppressed levels (e.g., at least 20% below competitive benchmarks) and leveraging market power to favor affiliates, resulting in higher costs for state health plans.^[134]^[135] A January 2024 class-action suit alleged Express Scripts conspired with other PBMs to artificially depress generic drug reimbursements, harming pharmacies and consumers.^[137] Similarly, Vermont's Attorney General sued Express Scripts' parent Evernorth in July 2024 for practices driving up prescription costs through non-transparent rebate retention and network restrictions.^[138] Express Scripts has countered such claims, suing the FTC in September 2024 to retract a report it deems misleading and asserting that PBM negotiations yield net savings for payers, though empirical evidence on full rebate pass-through remains contested due to proprietary data.^[139] Pharmacists and patient advocates report tangible harms, including reduced medication access from restrictive networks and prior authorizations that delay care, exacerbating out-of-pocket burdens amid list price hikes.^[140] While PBMs defend their role in negotiating $200 billion+ in annual rebates, critics argue the concentrated model's lack of transparency obscures whether these translate to consumer benefits or merely redistribute costs, with independent pharmacies citing reimbursement shortfalls as a key driver of 10-15% annual closures since 2010.^[141] These practices, if sustained, risk entrenching inefficiencies where high concentration enables rent-seeking over genuine cost control.

Empirical Data on Net Effects for Consumers and Payers

Empirical analyses indicate that pharmacy benefit managers (PBMs), including Express Scripts, have generated substantial net savings for payers such as insurers and employers through rebate negotiations and formulary management, though these benefits are often retained primarily by payers rather than passed directly to consumers. A study examining PBM interventions found they reduced overall prescription drug spending by approximately 28% relative to a scenario without such management, primarily by lowering prices and influencing utilization without significantly restricting patient access to medications.^[142] For Express Scripts specifically, independent analysis of its formulary strategies estimated cumulative savings of about $26 billion for clients over six years ending in 2023, driven by preferential placement of lower-cost alternatives and rebate capture from manufacturers.^[143] Commercial plan sponsors using Express Scripts reported weighted average drug spending growth of just 2.3% in 2019, attributed to increased volume of prescriptions rather than unit price inflation, reflecting effective cost containment amid rising utilization.^[144] For consumers, net effects are more variable, with evidence of declining out-of-pocket (OOP) costs for generics but persistent challenges for branded and specialty drugs due to coinsurance tied to list prices rather than net costs after rebates. Insured consumers' direct OOP payments for generic drugs fell by about 50% between 2007 and 2016, coinciding with total generic prices dropping 80%, largely from PBM-driven generic substitution and tiered copays.^[145] However, practices like copay clawbacks—where PBMs or pharmacies recoup portions of copays—resulted in consumers overpaying relative to actual drug costs in 28% of generic transactions during this period, averaging $7.32 per instance.^[145] Express Scripts data from 2022 showed 73% of members spending less than $100 OOP annually on medicines, rising to 81% under $250 in 2023, though these figures reflect self-reported aggregates and may not account for forgone care due to cost barriers.^[128]^[146] In rebate distribution, such as in Texas health plans in 2023, PBMs passed $2.07 billion to issuers but only $15 million directly to enrollees out of $2.2 billion total rebates, limiting consumer-level relief.^[9] Countervailing evidence highlights practices that erode net benefits, particularly through spread pricing where PBMs charge payers more than they reimburse pharmacies, capturing margins that offset claimed savings. Express Scripts retained $23.3 million in such spreads from Washington, D.C., Medicaid between 2016 and 2019, per a U.S. Department of Health and Human Services Inspector General audit, contributing to higher program costs without proportional payer reductions.^[9] Similarly, it overcharged a federal employee health plan by $45 million from 2016 to 2021 by withholding rebates and imposing undisclosed fees, illustrating how opaque contracting can diminish net payer savings.^[9] Overall, while payers experience verifiable reductions in net drug expenditures—estimated at up to 40% lower total spending even after PBM fees—consumers often bear disproportionate OOP burdens from list-price basing and limited rebate passthrough, with empirical gaps in access data complicating full causal attribution.^[142]^[9]

Legal and Regulatory Challenges

Fraud and Overcharging Allegations

In September 2024, the U.S. Federal Trade Commission filed an administrative complaint against Express Scripts, along with CVS Caremark and OptumRx, alleging that these pharmacy benefit managers (PBMs) artificially inflated insulin prices through practices such as spread pricing—where PBMs charge health plans more than they reimburse pharmacies—and retaining rebates via clawbacks rather than passing savings to patients.^[60] The complaint claims these entities, controlling about 80% of U.S. prescriptions, used exclusionary formularies to favor high-list-price insulins with larger manufacturer rebates, contributing to list price surges like Humalog's increase from $21 per vial in 1999 to $274 in 2017 (over 1,200%) and Novolog U-100's doubling from $122.59 in 2012 to $289.36 in 2018.^[60] By 2019, one in four insulin patients reportedly could not afford their medication due to these dynamics, with patients in deductible phases bearing full unreduced list prices.^[60] In April 2025, Michigan Attorney General Dana Nessel sued Express Scripts and Prime Therapeutics for anticompetitive practices, alleging a 2019 agreement suppressed reimbursement rates to independent pharmacies, enabling excessive PBM profits and contributing to pharmacy closures that created "pharmacy deserts" in 50% of Detroit neighborhoods and rural northern Michigan.^[147] The suit claims these actions violated the Sherman Antitrust Act and Michigan laws by restricting medication access and raising costs for consumers and pharmacies, seeking termination of the agreement.^[147] Similarly, a January 2024 federal antitrust class action in the Western District of Washington accused Express Scripts of colluding with rivals Prime, Benecard, and Magellan to fix reimbursement rates and fees, leveraging market power to impose unfavorable terms on community pharmacies and seeking recovery of hundreds of millions in alleged overcharges.^[148] Vermont Attorney General Charity Clark's July 2024 lawsuit against Evernorth (Express Scripts' parent entity) and CVS alleged illegal market manipulation in Vermont's commercial prescription market, where the firms control about 95% share, by prioritizing high-cost drugs on formularies to capture manufacturer rebates and fees while excluding lower-cost alternatives, thereby driving up overall drug costs and limiting patient access.^[138] The complaint further claims Express Scripts steered patients to its affiliated pharmacies, harming local providers and lacking transparency in pricing decisions that favor PBM profits over health outcomes, with remedies including greater pricing transparency and accountability for unfair practices.^[138] Class action lawsuits have targeted excessive fees charged by Express Scripts and its specialty pharmacy Accredo to employer health plans, alleging fiduciary breaches by plan sponsors like Johnson & Johnson and Wells Fargo for permitting markups of 5,000% to 10,000% on drugs relative to acquisition costs.^[149] For instance, teriflunomide (a generic multiple sclerosis drug) was reportedly charged over $10,000 for a 90-day supply versus $28 available online, contributing to higher plan and beneficiary costs without commensurate value.^[149] In October 2024, Michigan AG Nessel additionally sued Express Scripts and OptumRx for their role in the opioid crisis, alleging collusion with manufacturers for formulary placement kickbacks, failure to enforce dispensing standards, and promotion of opioid use that breached contracts and created a public nuisance under state law, facilitating over-dispensing in a market where these PBMs hold over 80% share.^[150] These cases remain ongoing, with Express Scripts contesting many claims, including a September 2024 lawsuit against the FTC demanding retraction of a related PBM report deemed false and harmful.^[139]

Data Privacy and Information Breaches

In October 2008, Express Scripts received an extortion letter containing personal information on 75 individuals, including names, dates of birth, social security numbers, and limited prescription details, with threats to release data on millions of patients unless an unspecified ransom was paid.^[151]^[152] The company notified the FBI, conducted an internal investigation with forensics experts, and alerted the affected individuals; subsequent review led to notifications for approximately 700,000 customers whose personal and medical information may have been compromised, though the exact breach vector remained undetermined.^[153]^[154] A cyberattack on Medical Review Institute of America, a subcontractor to Express Scripts, compromised protected health information of unspecified numbers of current and former plan participants in late 2021, prompting Express Scripts to notify plan sponsors on December 15, 2021.^[155] The vendor agreed to handle individual notifications and offer credit monitoring, while plan sponsors assessed compliance with HIPAA breach notification requirements and potential indemnification under business associate agreements.^[155] Between April 30 and May 3, 2022, unauthorized actors accessed certain Express Scripts mobile application accounts via credential stuffing attacks using valid usernames and passwords, exposing names, medication details, prescription numbers, dosages, prescribing physicians' names, and pharmacy names for 19,796 individuals as reported to the U.S. Department of Health and Human Services Office for Civil Rights.^[156] Express Scripts detected the activity on May 1, locked affected accounts, reset passwords, and advised users to update credentials on linked accounts to mitigate risks.^[156] Express Scripts maintains HIPAA-compliant privacy practices, including business associate agreements with vendors and notifications of uses or disclosures of protected health information, but has faced allegations of misuse.^[157] In 2018, a class-action lawsuit claimed the company violated HIPAA by charging excessive fees for patient records beyond reasonable cost-based limits, though the case's outcome emphasized strict HIPAA fee constraints without confirming broader violations.^[158] A 2019 suit by independent pharmacies alleged improper sharing of submitted patient data in violation of HIPAA privacy rules, but the U.S. Court of Appeals for the Eighth Circuit dismissed it in 2020, ruling that HIPAA does not grant pharmacies control over data uses after submission to pharmacy benefit managers.^[159] No enforcement actions or fines for systemic HIPAA violations by Express Scripts have been documented in federal records.

Antitrust and Contract Disputes

In April 2025, the Michigan Attorney General filed an antitrust lawsuit against Express Scripts Inc. (ESI) and Prime Therapeutics in federal court, alleging that a December 2019 agreement between the two PBMs suppressed reimbursement rates for independent pharmacies to levels below dispensing costs, in violation of the Sherman Antitrust Act, Michigan Antitrust Reform Act, and state public nuisance laws.^[147] The suit claims ESI, controlling approximately 89% of the PBM market in Michigan, allowed Prime access to its buying power and network in exchange for administrative fees and adoption of ESI's lower rates, contributing to independent pharmacy closures and "pharmacy deserts" in areas like half of Detroit's neighborhoods.^[44] ^[147] Remedies sought include termination of the agreement and injunctive relief to restore competition.^[147] In September 2024, the Federal Trade Commission (FTC) sued ESI, along with CVS Caremark and OptumRx—the "Big Three" PBMs handling about 80% of U.S. prescriptions—for artificially inflating insulin prices through a rebate system that favors high list-price drugs from manufacturers.^[60] The FTC alleges ESI and affiliates prioritized rebates tied to elevated list prices (e.g., Humalog rising over 1,200% from $21 in 1996 to $274 in 2017), excluding lower-list-price competitors and generating hundreds of millions in revenue without corresponding services, which shifted costs to patients and reduced access for vulnerable groups.^[60] The complaint invokes Section 5 of the FTC Act for unfair methods of competition.^[60] Additional antitrust challenges include a July 2024 federal lawsuit by AIDS Healthcare Foundation (AHF) against ESI and subsidiary Accredo Health Group in the U.S. District Court for the Eastern District of Missouri, asserting ESI's monopoly power in Louisiana—covering over 70% of health plan enrollees—imposes anticompetitive restraints on specialty pharmacies, costing AHF revenues and limiting access to HIV and hepatitis C treatments.^[160] In February 2025, pharmacies secured a preliminary federal court order in Washington state denying ESI's motion to dismiss or transfer a class action alleging conspiracy with smaller PBMs like Prime, Benecard, and Magellan to leverage ESI's market power for imposing low reimbursements and high fees, advancing claims of antitrust price-fixing.^[161] Contract disputes have centered on provider network terminations. In 2025, ESI terminated its agreement with Pennsylvania-based Martella's Pharmacies chain despite an ongoing class-action lawsuit filed in August, citing undisclosed disciplinary histories of pharmacists; Martella's attorneys described the move as an "egregious act" violating patient access commitments, prompting plans for a federal temporary restraining order.^[162] Separately, compounding pharmacy HM Compounding Services LLC sued ESI for wrongful termination of provider agreements, alleging breaches based on misrepresented recredentialing details.^[163] These cases highlight tensions over reimbursement transparency and network exclusion practices amid broader PBM scrutiny.^[164]

Regulatory Scrutiny and Company Defenses

The Federal Trade Commission (FTC) initiated significant regulatory action against Express Scripts and two other major pharmacy benefit managers (PBMs)—CVS Caremark and OptumRx—on September 20, 2024, filing an administrative complaint alleging that their rebate practices artificially inflated insulin prices by prioritizing high-list-price insulins from manufacturers like Eli Lilly, Novo Nordisk, and Sanofi to maximize rebates, which in turn raised net costs for payers and limited patient access to lower-priced options.^[60] The complaint, supported by internal documents and data analysis, claimed these PBMs controlled over 75% of the U.S. insulin market and engaged in exclusionary tactics, such as delisting competitors, that stifled biosimilar and alternative insulin development.^[60] State-level scrutiny intensified in 2025, exemplified by Michigan Attorney General Dana Nessel's antitrust lawsuit filed on April 28, 2025, against Express Scripts and Prime Therapeutics, accusing them of a 2019 agreement whereby Prime adopted Express Scripts' reimbursement formulas, which allegedly suppressed independent pharmacy reimbursements below costs, reduced competition, and drove pharmacy closures across Michigan and nationally.^[63] Tennessee's Department of Commerce and Insurance concluded a 2023 audit of Express Scripts with a consent order on September 12, 2025, requiring enhanced transparency in pricing and pharmacy reimbursements amid findings of non-compliance with state PBM laws.^[165] Additionally, the Canadian Competition Bureau obtained a court order on April 11, 2025, to advance an investigation into Express Scripts Canada's pharmacy sector practices for potential anti-competitive conduct.^[10] Express Scripts has mounted legal defenses, including a September 17, 2024, federal lawsuit against the FTC seeking to vacate and retract its June 2024 interim PBM report, which the company described as containing "false and misleading" assertions about rebate pass-through and cost impacts, arguing the report relied on selective data and ignored evidence of net savings delivered to clients.^[139] In its October 9, 2024, answer to the FTC's insulin complaint, Express Scripts asserted affirmative defenses, including lack of antitrust injury, failure to state a claim under Section 5 of the FTC Act, and preemption by Medicare laws, while contending that rebate negotiations demonstrably lower overall drug spend for health plans without consumer harm.^[166] Company executives, including those from parent Cigna, have publicly maintained that PBM operations, including Express Scripts', generate billions in annual savings through formulary management and rebates, positioning the firm to adapt to prospective reforms without operational disruption.^[50]

References

[1]
What is a pharmacy benefit manager or PBM? - Express Scripts
A pharmacy benefit manager (PBM) manages the pharmacy portion of your health plan to help medication safer and more affordable.
[2]
Express Scripts Pharmacy Benefit Services | Evernorth
Learn how Express Scripts Pharmacy Benefit Services can benefit you by driving down drug spend, improving member access to medications, and achieving lower ...
[3]
Express Scripts | ESRX Stock Price, Company Overview & News
Founded: 1986 ; Headquarters: St Louis, Missouri ; Country/Territory: United States ; Chairman, President & CEO: George Paz ; Employees: 26,600 ...
[4]
Cigna Completes Combination with Express Scripts, Establishing a ...
Dec 1, 2018 · Cigna Corporation (NYSE: CI), a leading global health service company, has successfully completed its combination with Express Scripts Holding Company.
[5]
Cigna closes $67B Express Scripts acquisition, promising ...
Dec 20, 2018 · Cigna officially absorbed one of the largest pharmacy benefit managers in the country on Thursday, closing its $67 billion purchase of Express Scripts.
[6]
Express Scripts® Pharmacy Benefit Services Member Experience
Our pharmacy care teams proactively help members get and stay on the medications they need at no additional cost. When members are adherent to their medications ...<|separator|>
[7]
Express Scripts Facts - Evernorth Health Services
Each year, Express Scripts saves approximately $38 billion1 for the thousands of clients we serve—who choose Express Scripts for our proven track record of ...
[8]
Express Scripts Holding - Fortune
Ticker:ESRX · Company type: · Revenues ($M):$100,065 · Profits ($M):$4,517 · Market value ($M):$38,791 · Number of employees:26,600.
[9]
[PDF] The Role of Pharmacy Benefit Managers in Prescription Drug Markets
Jul 9, 2024 · Express Scripts not only has the name of a prescription a patient uses but also identifies the costs, which they determine, to the patient. This ...
[10]
Competition Bureau advances an investigation into Express Scripts ...
Apr 11, 2025 · The Competition Bureau has obtained a court order to advance an investigation into Express Scripts Canada, a company that provides prescription drug claim ...
[11]
Express Scripts - Companies History
Mar 12, 2024 · Express Scripts began in 1986 in St. Louis, Missouri as a result of a joint venture between a retail chain of more than 79 pharmacies (Medicare ...
[12]
Express Scripts history Health - St. Louis Post-Dispatch
1986 - Express Scripts begins as result of a joint venture between Medicare Glaser Inc. and Sanus Corp. Health Systems. It is based in St. Louis.
[13]
Express Scripts Inc. - Company Profile, Information, Business ...
Express Scripts was born out of the boom in health management organizations of the late 1970s and early 1980s. In 1983, two employees of McDonnell Douglas, then ...
[14]
Celebrating 35 years of home delivery for Express Scripts® Pharmacy
all 11 of them — arrive in the mail on February 3, 1987. History has been made. Today you know this pharmacy as ...
[15]
Express Scripts Holding History: Founding, Timeline, and Milestones
1986. Express Scripts happened when Medicare Glaser and Sanus Corp entered into a joint venture back in 1986. · 1988. New York Life was also an early investor in ...
[16]
Express Scripts Inc | Encyclopedia.com
1986: Express Scripts Inc.(ESI) is formed as a joint venture between GenCare Health Systems and Medicare-Glaser. 1989: Medicare-Glaser sells its 50 percent ...
[17]
Express Scripts Buys Largest Private PBM for $515 Million
Feb 15, 2002 · In 1998, it paid $445 million, or 0.34x revenue, to acquire ValueRx from HCA (NYSE: HCA, then Columbia/HCA). In 1999, it paid $700 million, or ...
[18]
https://www.wsj.com/articles/SB101303375258048120
[19]
COMPANY NEWS; EXPRESS SCRIPTS TO ACQUIRE SPECIALTY ...
Dec 23, 2003 · Express Scripts Inc., the mail-order pharmacy company, agreed to pay $335 million in cash for the closely held CuraScript Pharmacy Inc. to ...
[20]
Billion-dollar deal ties Express Scripts with A-B for largest company
Jul 31, 2005 · Express Scripts Inc.'s $1.3 billion purchase of Priority Healthcare Corp. will give the pharmacy benefit manager a strong position in the ...
[21]
[PDF] Express Scripts 2006 Annual Report - AnnualReports.com
We have a successful history of acquiring and integrating companies, including five significant acquisitions since 1998. We announced a proposal to acquire all ...
[22]
[PDF] express scripts - SEC.gov
Apr 29, 2005 · We've expanded our capabilities and scope through several strategic acquisitions. These have yielded significant benefits, including ...
[23]
EXPRESS SCRIPTS SET TO GROW WITH BUY OF SMITHKLINE PBM
Feb 14, 1999. ST. LOUIS-Express Scripts Inc.'s planned purchase of rival Diversified Pharmaceutical Services Inc. could result in a stronger independent ...
[24]
exv99w1 - SEC.gov
Express Scripts and Medco Health Solutions Sign Definitive Merger Agreement; Medco Shareholders to Receive $29.1 Billion · Combined company will lead the effort ...Missing: details | Show results with:details
[25]
FTC Closes Eight-Month Investigation of Express Scripts, Inc.'s ...
Apr 2, 2012 · Under an agreement dated July 20, 2011, Express Scripts intends to acquire Medco for approximately $29 billion. After the proposed deal was ...
[26]
[PDF] the proposed merger between express scripts and medco hearing
Sep 20, 2011 · raised antitrust concerns with the regulators. The FTC's so-called second request demonstrates that the merger will receive close scrutiny ...
[27]
ESRX-MHS: Analysis of the FTC Decision - Drug Channels
Apr 2, 2012 · By a 3-1 vote, the Federal Trade Commission (FTC) approved Express Scripts' (NASDAQ: ESRX) acquisition of Medco Health Solutions (NYSE: MHS).
[28]
Express Scripts and Medco Health Solutions Complete Merger
Apr 2, 2012 · ST. LOUIS, April 2, 2012 /PRNewswire/ -- Express Scripts (NASDAQ: ESRX) completed its previously announced $29.1 billion acquisition of Medco ...
[29]
F.T.C. Approves Merger of Express Scripts and Medco
Apr 2, 2012 · Regulators said that though the deal between Express Scripts and Medco Health Solutions ... regulators had approved their $29 billion merger.
[30]
Express Scripts, Medco Win Approval for $29 Billion Deal - Bloomberg
Apr 2, 2012 · The Federal Trade Commission approved the purchase by a 3-1 vote today. Clearance was unconditional, with the commissioners saying their eight- ...Missing: date value
[31]
[PDF] CIGNA TO ACQUIRE EXPRESS SCRIPTS FOR $67 BILLION
Mar 8, 2018 · • Delivers first year double digit ... “Cigna's acquisition of Express Scripts brings together two complementary customer-centric services.
[32]
Cigna closes $67B deal to buy Express Scripts. Here's our take.
Dec 21, 2018 · Cigna on Thursday officially closed on its $67 billion acquisition of pharmacy benefit manager Express Scripts, completing the merger of two ...<|separator|>
[33]
Express Scripts Stockholders Approve Acquisition by Cigna
Aug 24, 2018 · Express Scripts expects the transaction to close by December 31, 2018. "By approving our proposed combination, Cigna and Express Scripts ...
[34]
DOJ approves Cigna, Express Scripts merger | AHA News
Sep 17, 2018 · Cigna Corp. and Express Scripts today announced that the Department of Justice's Antitrust Division has cleared their pending merger.Missing: acquisition | Show results with:acquisition
[35]
[PDF] CIGNA CORPORATION
Feb 27, 2019 · On December 20, 2018, Cigna completed the acquisition of Express Scripts. As a result, effective in the fourth quarter of 2018 our segments ...
[36]
Cigna raises 2019 forecast as Express Scripts buyout pays off
Oct 31, 2019 · In the reported quarter, Cigna's $52 billion acquisition of Express Scripts helped amplify health services sales to $24.88 billion from $1.11 ...
[37]
How Cigna's Growing Pharmacy Platform Expands Its Channel Power
May 12, 2021 · Following Cigna's 2018 acquisition of Express Scripts, the companies combined their mail and specialty pharmacy operations. According to Drug ...
[38]
[PDF] The Power of We.
We've also added Express Scripts' home delivery pharmacy to our Cigna network, which ensures our clients' employees get the clinical support they need – when ...
[39]
Cigna rebrands health services division, including Express Scripts ...
Sep 16, 2020 · Cigna is rebranding its growing health services business, including pharmacy benefit manager Express Scripts, as Evernorth, ...<|separator|>
[40]
Who We Are - Express Scripts
Express Scripts helps you get the right medication at the lowest price and is Evernorth's pharmacy benefit service, dedicated to helping you save on ...
[41]
Cigna Evolves Brands to Reflect Growing Portfolio - PR Newswire
Feb 13, 2023 · The Cigna Group includes products and services marketed under Cigna Healthcare, Evernorth Health Services or its subsidiaries. The Cigna Group ...
[42]
Evernorth Health Services | The Cigna Group
Evernorth Health Services offers comprehensive solutions in pharmacy, care, and benefits. Discover Express Scripts®, Accredo®, eviCore®, MDLIVE®, and more.
[43]
Express Scripts and Prime Therapeutics Collaborate to Deliver More ...
Dec 19, 2019 · Under this collaboration, Express Scripts will provide services to Prime related to retail pharmacy network and pharmaceutical manufacturer ...
[44]
Express Scripts controls 89% of PBM market in Michigan: lawsuit
May 2, 2025 · The latest lawsuit points to the same agreement from 2019, where Prime reportedly adopted Express Scripts' lower reimbursement rates. In return, ...Missing: venture | Show results with:venture
[45]
Express Scripts® Launches New Initiative to Expand Rural Health ...
Apr 20, 2023 · The initiative includes increased reimbursement rates for pharmacies and expanded healthcare services such as vaccinations and health screenings ...<|control11|><|separator|>
[46]
Cigna's (CI) Express Scripts Collaborates With CPESN USA - Nasdaq
May 27, 2024 · This collaboration is closely related to Express Script's IndependentRx initiative, which aims to solidify pharmacists' role in care delivery.
[47]
Press Releases | Cigna Healthcare Newsroom
... Cigna and Express Scripts Boost Access to Real-Time Prescription Savings Opportunities. Real-Time Prescription Benefit tool, now available for Cigna health ...Missing: developments | Show results with:developments
[48]
[PDF] 2025 Express Scripts National Preferred Formulary Exclusions
Oct 1, 2025 · The 2025 Express Scripts exclusions include medications like FIRVANQ, VANCOMYCIN, and METRONIDAZOLE. Ask your doctor for preferred alternatives.Missing: key 2019-2025
[49]
Press Releases | The Cigna Group Newsroom
Express Scripts Introduces New Option to Give Clients Maximum Simplicity in Drug Pricing. Express Scripts ClearNetwork offers employers and health plans a ...Missing: initiatives | Show results with:initiatives
[50]
Cigna exec says Express Scripts poised to weather eventual PBM ...
Sep 10, 2025 · Cigna exec says Express Scripts poised to weather eventual PBM reform. Reforms to the pharmacy benefit management industry continue to be a key ...Missing: developments | Show results with:developments
[51]
Cigna pledges changes to pharmacy, medical benefits following ...
Jan 30, 2025 · Cigna expects $100 billion of specialty drug spend in the U.S. will be subject to biosimilar and generic competition in the next five years.Missing: 2019-2025 | Show results with:2019-2025
[52]
The ABCs of PBMs - NCBI Bookshelf
In addition to offering their core services—claims processing, record keeping, and reporting programs—PBMs offer their customers a wide range of services, ...
[53]
PBM Basics - Pharmacists Society of the State of New York
Currently the three largest PBMs - CVS Caremark, Express Scripts and OptumRx (a division of United Healthcare) hold nearly 80% of the prescription benefits ...
[54]
Insurance Topics | Pharmacy Benefit Managers - NAIC
Jun 2, 2025 · PBMs act as middlemen between insurance plans, drug manufacturers, and pharmacies, working to control drug spending, process prescription claims,
[55]
Pharmacy Benefit Managers: History, Business Practices ...
Nov 3, 2023 · The PBM provides 5 key functions: formulary design, utilization management, price negotiation, pharmacy network formation, and mail order ...
[56]
PBM Regulations on Drug Spending | Commonwealth Fund
Mar 17, 2025 · Pharmacy benefit managers, or PBMs, are companies that work with health insurers, large employers, and other payers to manage their prescription drug benefits.Missing: core | Show results with:core
[57]
Exploring Drug Rebates - Realities and Benefits | Evernorth
Sep 5, 2023 · Express Scripts' clients receive 95% of the drug rebates that we obtain by negotiating with pharmaceutical companies. Express Scripts gets paid ...
[58]
[PDF] HOW WE SHARE IN THE VALUE WE CREATE WITH CLIENTS
PBMs negotiate discounts, inclusive of rebates, with drug manufacturers. Clients choose their preferred rebate arrangement with Express Scripts. Rebate ...
[59]
Surprising Data on Employer-PBM Rebate Pass-Through ...
Aug 15, 2023 · Adam Kautzner, president of Express Scripts, testified that the company “passed through over 95% of rebates it collected for its clients in 2022 ...
[60]
FTC Sues Prescription Drug Middlemen for Artificially Inflating ...
Sep 20, 2024 · The FTC alleges that the three PBMs created a perverse drug rebate system that prioritizes high rebates from drug manufacturers, leading to artificially ...
[61]
[PDF] White Paper: Formulary Development at Express Scripts
The Express. Scripts' formulary development process is based on the following principles: 1. Clinical appropriateness of the drug, not cost, is Express ...
[62]
The Big Three PBMs' 2025 Formulary Exclusions: Humira, Stelara ...
Jan 22, 2025 · Express Scripts has stated that its formulary will include Stelara plus a low-list-price private label biosimilar from Quallent.
[63]
[PDF] Express Scripts Complaint - National Association of Attorneys General
Apr 28, 2025 · December 2018, Express Scripts has been owned by The Cigna Group, a health insurance company. 26. Defendant Evernorth Health, Inc ...
[64]
Patients Home | Accredo Specialty Pharmacy
Accredo is a specialty pharmacy that serves patients with complex and chronic health conditions, including cancer, hepatitis C, HIV, bleeding disorders and ...Contact UsWelcome to AccredoLog inSpecialty MedicationsPrescribers
[65]
Specialty pharmacy - Express Scripts
If you're taking a specialty medicine, you can find services through our specialty pharmacy Accredo. If you can't find the answer to your question. Contact ...
[66]
Specialty Pharmacy Services - Express Scripts
Express Scripts Pharmacy is a home delivery pharmacy that provides pharmacy services when you fill eligible medications at TRICARE Home Delivery.
[67]
Specialty Drug Trends, Costs, and Utilization in the US | Evernorth
Apr 20, 2022 · Even though less than 2% of the population uses specialty drugs, those prescriptions account for a staggering 51% of total pharmacy spending1.
[68]
PBMs and Drug Spending in 2020: Data from CVS Health (sort of ...
Jul 14, 2021 · For Express Scripts' commercial clients, the 4.9% increase in specialty drug utilization accounted for more than half of the 9.2% increase in ...
[69]
Home Delivery | Express Scripts® Pharmacy
Manage prescriptions online and get medications delivered right to your door. Enjoy free standard shipping and automatic refills. Talk to specially trained ...Missing: specialty | Show results with:specialty
[70]
Home delivery - Express Scripts
Skip the trip to the pharmacy. You could save time and money by getting a 3-month supply of your medication delivered right to your door.
[71]
Express Scripts® Mail Service - Wellcare
Express Scripts mail service provides home delivery of chronic drug prescriptions, up to 100-day supply, free shipping, and 10-14 day delivery. Sign up online, ...
[72]
Express Scripts Members: Manage Your Prescriptions Online
Millions trust Express Scripts for safety, care and convenience. Express Scripts makes the use of prescription drugs safer and more affordable.Log in · Contact us · Our Partners · Register
[73]
Express Scripts selects first crop of tech tools to include on new ...
Dec 12, 2019 · Express Scripts has selected the first 15 technology tools to include in its new digital health formulary, which launches next month.Missing: analytics | Show results with:analytics
[74]
Express Scripts a Pioneer: Launches Curated List of Digital ...
Dec 12, 2019 · The digital formulary will help payers make informed decisions on which digital health tools to provide to members. Being introduced in 2020, ...
[75]
Digital Health Formulary - Express Scripts
The digital health formulary provides personalized, safe, and easy-to-use tools for managing health on-the-go, including mobile apps and up-to-date advice. ...
[76]
Express Scripts Improves Patient Access to Digital Health Solutions
Dec 12, 2019 · Starting in January 2020, the Express Scripts Digital Health Formulary initially includes 15 solutions including remote monitoring services and ...<|separator|>
[77]
Express Scripts - Posit
The result was Pulse, Express Scripts' PHI-compliant, analytics platform for accessing, understanding and communicating insights from data. Pulse is an ...
[78]
Express Scripts Tackles Medication Adherence With SAS Analytics
Express Scripts Tackles Medication Adherence With SAS Analytics. SAS' new Center for Health Analytics will expand statistical applications.
[79]
How Express Scripts Uses Analytics To Improve Patient Outcomes
Jul 29, 2013 · Also, we have developed a tool called ScreenRx, which allows us to take medical data, prescription data, and lab data, and analyze it with about ...
[80]
Healthcare Data and Analytics Solutions - Evernorth Health Services
Discover how Intelligence+ provides advanced healthcare analytics, predictive models, and custom research to solve complex healthcare challenges.Data And Advanced Analytics · The Lab By Evernorth · Evernorth Research Institute
[81]
Express Scripts' myMatrixx Launches myDataSense Analytics Tool
Nov 6, 2018 · The myDataSense tool transforms data from a variety of sources, including pharmacy events, prescribers and drug references, into a highly visual ...
[82]
Contact us | Express Scripts
Express Scripts is available 24/7. For general pharmacy help, call (800) 282-2881. Medicare members call (866) 529-4917. Website support is (800) 711-5672. ...Express Scripts Pharmacy · Medicare Members · Accredo Specialty Pharmacy
[83]
Express Scripts Inc - Company Profile and News - Bloomberg Markets
SUB-INDUSTRY. Health Care Facilities & Svcs ; INCORPORATED. 03/27/1992 ; ADDRESS. 1 Express Way Saint Louis, MO 63121 United States ; WEBSITE. www.express-scripts.
[84]
EXPRESS SCRIPTS HEADQUARTERS - PARIC, LLC
St. Louis, MO 315,000 Sq. Ft. ... This building on the Express Scripts campus included a 315,000 sq.ft. build-to-suit headquarters for the St. Louis-based, ...
[85]
Where is Express Scripts's Headquarters? Main Office Location and ...
Feb 14, 2025 · The primary headquarters of Express Scripts is located at 1 Express Way in St. Louis, Missouri. This facility serves as the company's main ...
[86]
Cigna to acquire Express Scripts for $54B in health care shakeup
Mar 8, 2018 · Cigna will remain headquartered in Bloomfield, Conn., and Express Scripts will remain headquartered in St. Louis, Mo. The companies said they ...
[87]
https://www.thecignagroup.com/about-us/contact-us
[88]
Cigna-Express Scripts: Vertical Integration and PBMs' Medical ...
May 2, 2018 · Though Cigna was an unexpected acquirer, the deal confirms the importance of pharmacy and medical benefit integration.Missing: changes | Show results with:changes<|separator|>
[89]
Cigna rebrands health services division, including Express Scripts ...
Sep 16, 2020 · Evernorth will peddle health services geared toward other payers, employers and government businesses, including those without Cigna medical insurance.Missing: structure | Show results with:structure
[90]
Evernorth Health Services | Redefining Health Care
Bringing together the right people with the right capabilities · Express Scripts Pharmacy Benefit Services · Express Scripts Pharmacy · Accredo Specialty Pharmacy.Express Scripts Pharmacy · Our services · Contact Us · Evernorth Provider
[91]
Vertical Integration Continues with CIGNA/Express Scripts ... - Mercer
Mar 8, 2018 · The proposed CIGNA/ESI deal underscores that the market has swung “back to the future,” where medical and pharmacy benefits are managed by one entity.
[92]
Evernorth Names Adam Kautzner President, Express Scripts
Jan 18, 2023 · Kautzner brings decades of experience to the role and most recently served as Senior Vice President of Supply Chain, leading pharmaceutical and ...
[93]
Adam Kautzner | President of Express Scripts and Evernorth Care ...
Adam Kautzner is President of Express Scripts and Evernorth Care Management, leading benefit solutions and driving all aspects of Express Scripts.Missing: key | Show results with:key
[94]
Influential PBM lobby appoints top Express Scripts executive as ...
Oct 8, 2025 · The top lobby for pharmacy benefit managers has named Adam Kautzner, the head of major PBM Express Scripts, as chair of its board. As board ...Missing: leadership key
[95]
Express Scripts CEO and Key Executive Team - Craft.co
Express Scripts's President is Adam Kautzner. Other executives include Katie Walsh, Senior Vice President and Chief Operating Officer.
[96]
Leadership - Evernorth Health Services
Dave Anderson. Vice President, Strategy. View Dave's Profile ; Lou Aversano. Chief Brand and Marketing Officer. View Lou's Profile ; Adam Kautzner, Pharm.D.Adam Kautzner, Pharm.D. · Dave Anderson · Lou Aversano · Eva BordenMissing: key | Show results with:key
[97]
Cigna Shakes Up Management Ranks Amid Rising Costs - Forbes
Mar 13, 2025 · The Cigna Group shook up its management team amid rising healthcare costs and pressure from employer clients to hold the line on spending.
[98]
Cigna names Brian Evanko president, Eric Palmer to leave company
Mar 13, 2025 · Cigna is reshuffling its top leadership by promoting Brian Evanko to president and chief operating officer and elevating Ann Dennison to executive vice ...
[99]
Evernorth Names New Chief Medical Officer for Express Scripts
Nov 22, 2021 · Evernorth today named Christine Gilroy, MD, MSPH, FACP as chief medical officer of Express Scripts, the leading pharmacy benefit manager serving more than one ...
[100]
Executive Spotlight: Nikki White - The Cigna Group
Nikki White is the new Vice President and General Manager of the Health Plan Division at Express Scripts.
[101]
Executives and Management Team - The Cigna Group
David Cordani. Chairman and Chief Executive Officer · David J. Brailer, MD, PhD · Ann Dennison. Executive Vice President and Chief Financial Officer · Christopher ...
[102]
Express Scripts - Financial Details - Crunchbase
Express Scripts Logo Express Scripts. Section: Financials. Actions ... IPO Date Jan 19, 1992. Express Scripts is registered under the ticker NASDAQ ...
[103]
Express Scripts and Medco Health Solutions Sign Definitive Merger ...
Express Scripts and Medco Health Solutions Sign Definitive Merger Agreement; Medco Shareholders to Receive $29.1 Billion. Combined company will lead the effort ...Missing: IPO | Show results with:IPO
[104]
ESRX - 12.31.2013 - 10K - SEC.gov
Dec 31, 2013 · On April 2, 2012, ESI consummated the Merger with Medco and both ESI and Medco became wholly-owned subsidiaries of Express Scripts. The ...
[105]
Barrett Toan, Medicare Glaser and the origins of Express Scripts
Mar 9, 2018 · Express Scripts was founded in 1986 and became a publicly traded company in 1992. The company, being acquired by health insurer Cigna for $67 ...
[106]
Express Scripts Announces 2018 Third Quarter Results - PR Newswire
Oct 31, 2018 · Consolidated 2018 third quarter adjusted earnings per diluted share were $2.43, which represents growth of 28% over consolidated 2017 third ...
[107]
[PDF] Press Release
Total revenues were $153.6 billion. Adjusted revenues1 were $140.2 billion in 2019. • Shareholders' net income for 2019 was $5.1 billion, or $13.44 per ...<|separator|>
[108]
Cigna Delivers Strong 2018 Results as it Completes Express Scripts ...
Feb 1, 2019 · “Cigna completed an exceptionally strong 2018, with revenue ... completion of the Express Scripts combination on December 20, 2018.
[109]
[PDF] CIGNA TO ACQUIRE EXPRESS SCRIPTS
Mar 8, 2018 · Combination with Express Scripts accelerates Cigna's Enterprise Strategy. Page 8. 8. Acquisition of Express Scripts Makes Health Care Simpler.Missing: 2019 | Show results with:2019<|control11|><|separator|>
[110]
Cigna's 2023 Revenue Grew 8% to $195.3 Billion
Feb 2, 2024 · The Cigna Group's 2023 revenue grew to $195.3 billion, up 8% compared with 2022's revenue of $180.6 billion.
[111]
The Top Pharmacy Benefit Managers of 2024 - Drug Channels
Mar 31, 2025 · DCI estimates that Express Scripts' annual retail pharmacy network claims volume grew by 531 million (+40%), from more than 1.3 billion in 2023 ...
[112]
https://www.statista.com/statistics/985078/types-of-revenues-of-cigna/
[113]
The Cigna Group Reports Fourth Quarter and Full Year 2024 ...
Jan 30, 2025 · Total revenues for 2024 increased 27% to $247.1 billion; Shareholders' net income for 2024 was $3.4 billion, or $12.12 per share ...Missing: 2019-2024 | Show results with:2019-2024
[114]
https://www.stock-analysis-on.net/NYSE/Company/Cigna-Group/Ratios/Reportable-Segments
[115]
PBMs and Drug Spending in 2019: CVS Health and Express Scripts ...
Jun 16, 2020 · Spending rose by less than 3% in 2019, continuing a multiyear trend of slow growth. At some plan sponsors, total drug spending even declined.
[116]
2021 and Onward | Drug Trend Report | Evernorth
For the first time ever, specialty drug spend surpassed 50% of overall pharmacy spend among commercial plans. We expect this trend to continue as specialty ...
[117]
[PDF] 2016 Drug Trend Report - Center for Value-Based Insurance Design
Feb 2, 2017 · Express Scripts solutions helped to keep the increase in specialty drug spending to 13.3% in 2016 – the lowest trend since we first included ...
[118]
Express Scripts reveals drug classes that are driving spending growth
Feb 18, 2020 · Overall, Express Scripts' drug trend—or the year-over-year percent change in per-member annual spending—increased by 2.3% in 2019. The PBM ...<|separator|>
[119]
Drug Channels News Roundup, April 2025: Amazon Rx Update ...
Apr 28, 2025 · For 2024, drug trend—the total change in spending for Express Scripts' plan sponsor clients—was +8.9%. This growth was comprised of 6.1% ...
[120]
2025 Pharmacy in Focus Report: GLP-1 Drugs | Evernorth
GLP-1s is an expanding drug class with increased demand with increased demand that is driving historic shift in drug trends.
[121]
Form 10-K - SEC.gov
On July 20, 2011, Express Scripts, Inc. (“ESI”) entered into a definitive merger agreement (the “Merger Agreement”) with Medco Health Solutions, Inc ...Missing: 1989 | Show results with:1989
[122]
Express Scripts and Walgreens Offer New Solution to Improve ...
Aug 1, 2013 · Express Scripts uniquely combines three capabilities – behavioral sciences, clinical specialization and actionable data – to create Health ...
[123]
Express Scripts Study Reveals Keys to Controlling Specialty Drug ...
behavioral sciences, clinical specialization and actionable data — to create Health ...
[124]
New Express Scripts Analysis Reveals Trends Among Health ...
behavioral sciences, clinical specialization and actionable data — to create Health Decision Science ...
[125]
Express Scripts Provides Roadmap to Improve Health Care, Reduce ...
Combining innovations from CuraScript and Accredo, Express Scripts draws upon Health Decision Science – which integrates behavioral science, clinical ...Missing: Initiatives | Show results with:Initiatives
[126]
[PDF] DRUG TREND REPORT - Express Scripts Canada
The trends in medication use described in the report require effective drug plan management tools. These include opportunities for prior authorization, step ...
[127]
New Study Shows PBMs Lower Drug Prices
Jul 30, 2024 · The negotiating power of PBMs helps to secure 40 to 50 percent savings on prescription drugs and related medical costs for their customers. This ...<|control11|><|separator|>
[128]
By the numbers: How Express Scripts saved members money in 2022
Nov 7, 2023 · About three in four Express Scripts members – 73% – spent less than $100 out of pocket for their medicines in 2022.Missing: methodology | Show results with:methodology
[129]
Express Scripts: Value-based programs increasing adherence ...
Mar 28, 2019 · A new analysis from Express Scripts reveals that value-based programs are keeping costs down while also improving care and outcomes for patients.
[130]
New Express Scripts Data: The Drug Spending Slowdown Is Real
Feb 13, 2018 · The latest data confirm the slowdown in drug spending. For 2017, drug spending increased by only 1.5% for Express Scripts' commercial plan sponsors.
[131]
Express Scripts Canada Introduces New Business Model
Nov 15, 2011 · Express Scripts Canada is the only pharmacy benefits management company in Canada to offer a full range of integrated PBM products and services.
[132]
[PDF] Pharmacy Benefit Managers: The Powerful Middlemen Inflating ...
Cigna (Express Scripts). The fourth largest health insurer nationally, Cigna acquired Express. Scripts in 2018.112 Cigna's insurance segment, Cigna ...
[133]
In PBM market, competition is hard to come by
CVS Health is the largest PBM (21.3% market share), followed by OptumRx (20.8%), Express Scripts (17.1%), and Prime Therapeutics (10.3%). This indicates that ...
[134]
[PDF] Express Scripts Complaint - State of Michigan
Apr 28, 2025 · Claims adjudication is the process by which PBMs determine (1) whether an individual has prescription-drug benefits, (2) whether the drug in.<|separator|>
[135]
A Blueprint for Action: Michigan's Lawsuit Against Express Scripts ...
May 2, 2025 · In Michigan's Medicaid and commercial markets, the complaint alleges that Express Scripts now controls an astounding 89% of the PBM services ...
[136]
Beyond transparent pricing: decoding the strategies of major PBMs
Aug 7, 2024 · Claims to be 100% auditable; plan sponsors might not see all revenue streams from drugmakers, affecting transparency. Express Scripts ...
[137]
NCPA Applauds Class Action Lawsuit Alleging Collusion Between ...
Jan 10, 2024 · The National Community Pharmacists Association today cheered a class action lawsuit against Express Scripts, alleging that the massive pharmacy benefit manager
[138]
Attorney General Clark Sues Pharmacy Benefit Managers for ...
Jul 17, 2024 · Attorney General Charity Clark today filed a lawsuit against pharmacy benefit managers Evernorth (owner of Express Scripts) and CVS as well as nearly two dozen ...
[139]
Express Scripts Sues FTC Over PBM Report - AJMC
Sep 17, 2024 · The interim report 2 criticized PBMs for driving up drug costs and harming independent pharmacies, despite their original goal of reducing ...
[140]
Pharmacists, patients say Express Scripts limits access to meds
May 17, 2024 · They claim the company's negotiating tactics result in decreased availability of medicines and higher prices for consumers. Express Scripts is a ...
[141]
Michigan v. Express Scripts, Inc. et al.
It further alleges that ESI, through its dominant market share in PBM services, has leveraged its market power to steer pharmacy business to its affiliated mail ...Missing: concentration | Show results with:concentration
[142]
Demand Inertia and the Hidden Impact of Pharmacy Benefit Managers
Mar 18, 2024 · PBMs reduce overall spending by 28%, without greatly limiting patient access. Without demand inertia, the presence of PBMs would cause prices to fall ...
[143]
Independent analysis demonstrates value of pharmacy benefit ...
Jun 6, 2025 · Working in partnership with health plans and plan sponsors, PBMs generate cost savings by negotiating with manufacturers and pharmacy networks.
[144]
Latest Express Scripts Data: Slow Drug Spending Growth—And Big ...
Feb 24, 2020 · The majority of spending growth was due the growth in the number of people being treated and the number of prescriptions being dispensed—not to ...Missing: consumer studies
[145]
U.S. Consumers Overpay for Generic Drugs - May 31, 2022
May 31, 2022 · Researchers found that direct out-of-pocket payments by insured consumers to pharmacies for generic prescription drugs declined by about 50% ...
[146]
Express Scripts by Evernorth Members Paid Less for Their Share of ...
Jun 19, 2024 · For the entirety of 2023, four in five Express Scripts members – 81% – spent less than $250 out of pocket for their medicines, or about $20 per ...Missing: criticisms | Show results with:criticisms
[147]
AG Nessel Files Lawsuit Against Two Pharmacy Benefit Managers ...
Apr 29, 2025 · The lawsuit seeks to terminate the agreement between Express Scripts and Prime Therapeutics, among other remedies. ###. MI Newswire Attorney ...
[148]
Berger Montague Files Antitrust Lawsuit Against PBM Express Scripts
Jan 10, 2024 · The lawsuit alleges that Express Scripts colluded with rival PBMs Prime, Benecard, and Magellan to fix pharmaceutical reimbursement rates and fees.Missing: settlements | Show results with:settlements
[149]
Emerging Class Action Litigation Trend Over Excessive PBM Fees
Aug 27, 2024 · In some instances, the lawsuits allege that Express Scripts charged between a 5,000% to 10,000% markup for certain drugs when compared to the ...
[150]
AG Nessel Sues Pharmacy Benefit Managers for Role in Opioid Crisis
Oct 24, 2024 · Michigan Attorney General Dana Nessel filed a lawsuit against pharmacy benefit managers OptumRX and ExpressScripts for their role in the Opioid Epidemic in ...<|control11|><|separator|>
[151]
Express Scripts reports extortion over data breach - Reuters
Nov 7, 2008 · NEW YORK (Reuters) - Express Scripts Inc said on Thursday it received an extortion letter threatening to expose millions of patient records and ...
[152]
Express Scripts discloses extortion threat, possible data breach
Express Scripts late last week disclosed it received an extortion threat in October pertaining to patient records the pharmacy benefits management company holds ...
[153]
Breach At Pharmaceutical Benefits Company May Have Affected ...
Express Scripts says it is "in the process of notifying" the other members whose identities may have been compromised. In a news report, a spokeswoman said some ...
[154]
[PDF] Express Scripts Cyber Risk Report Proposal
In 2008, the Express Scripts Holding Company ("Company") disclosed a data breach affecting personal and medical information of over 700,000 customers. The ...
[155]
HIPAA Breach by Express Scripts Vendor Triggers Plan Sponsor ...
This cyberattack apparently resulted in a HIPAA breach of current or former participants' protected health information (PHI) under the plans.
[156]
5 HIPAA-Regulated Entities Announced Hacking Incidents that ...
Jun 22, 2022 · The pharmacy benefit management organization, Express Scripts, has announced that the accounts of certain customers have been accessed by an ...
[157]
Notice of Privacy Practices - Express Scripts
We are required by state and federal law to protect the privacy of your PHI and to provide you with this Notice about how we safeguard and use it, and notify ...
[158]
Class-action suit claims Express Scripts charges 'exorbitant and ...
Sep 27, 2018 · Under HIPAA, covered entities may charges “reasonable, cost-based fees for the cost of copying and postage.” The law allows covered entities to ...
[159]
Express Scripts HIPAA-Based Lawsuit Dismissed by Court of Appeals
Sep 17, 2020 · A lawsuit filed against Express Scripts over alleged misuse of patient data has been dismissed by the 8th U.S. Circuit Court of Appeals.
[160]
AHF Files Antitrust Action Against Express Scripts PBM
Jul 29, 2024 · Federal lawsuit asserts PBM's monopoly power in Louisiana costs AHF substantial revenues and harms its ability to provide lifesaving care.Missing: concentration | Show results with:concentration<|separator|>
[161]
Pharmacies win preliminary order against Express Scripts in federal ...
Feb 18, 2025 · A federal court in Washington state has granted several pharmacies a win in their lawsuit against Express Scripts Inc. for its conspiracy with Prime, Benecard, ...
[162]
'An egregious act:' Express Scripts terminates contract with Martella's, despite lawsuit
### Summary of Contract Dispute Between Express Scripts and Martella's Pharmacies
[163]
Express Scripts, Inc. - Husch Blackwell
Plaintiff HM Compounding Services LLC sued Express Scripts alleging that ESI wrongfully terminated provider agreements.
[164]
Pharmacy Fights Back Against PBM Termination Notice
Express Scripts purportedly terminated HMC from its network based on misrepresentations on a recredentialing application. Specifically, Express Scripts claimed ...
[165]
Consent Orders Target Caremark and Express Scripts - Frier Levitt
Oct 16, 2025 · Tennessee's actions arrive amid mounting federal scrutiny. The Federal Trade Commission's (FTC) ongoing investigation into PBM business ...
[166]
[PDF] Answer and Defenses of Respondents Express Scripts, Inc ...
Oct 9, 2024 · Negotiating with drug manufacturers to lower net costs for plan sponsors— whether through rebates or otherwise—promotes competition and benefits ...