Businessweek

Express Scripts Holding Company operates as a pharmacy benefit management (PBM) company in North America. The company offers a range of services to its clients, which include managed care organizations, health insurers, third-party administrators, employers, union-sponsored benefit plans, workers’ compensation plans and government health programs. Segments The company operates through two segments, PBM and Other Business Operations. PBM This segment offers various services, including domestic and Canadian retail network pharmacy management; home delivery pharmacy services; benefit design consultation; drug utilization review; drug formulary management, compliance and therapy management programs; a flexible array of Medicare Part D and Medicaid products to support clients’ benefits; specialty pharmacy, including the distribution of fertility pharmaceuticals requiring special handling or packaging; bio-pharma services, including reimbursement and customized logistics solutions; administration of a group purchasing organization; consumer health and drug information; and improved health outcomes through personalized medicine and application of pharmacogenomics. Other Business Operations This segment primarily consists of various services, including distribution of pharmaceuticals and medical supplies to providers and clinics; and scientific evidence to guide the safe, effective and affordable use of medicines. Products and Services PBM Services The company’s PBM services involve the management of outpatient prescription drug utilization to foster pharmaceutical care. Its direct relationship with patients also enables it to utilize the principles of Health Decision Science, its proprietary approach that combines the behavioral sciences, clinical specialization and actionable data to help patients make decisions about their health and the cost of their care. Retail Network Pharmacy Administration: The company contracts with retail pharmacies to provide prescription drugs to members of the pharmacy benefit plans it manages. The company also manages networks of pharmacies that are customized for or under direct contract with specific clients. In addition, it has contracted Medicare Part D provider networks to comply with Centers for Medicare & Medicaid Services (CMS) access requirements for the Medicare Part D Prescription Drug Program. All retail pharmacies in the company’s pharmacy networks communicate with it online and in real time to process prescription drug claims. The electronic processing of the claim includes confirming the member’s eligibility for benefits under the applicable health benefit plan and any conditions or limitations on coverage; performing a concurrent drug utilization review and alerting the pharmacist to possible drug interactions and reactions or other indications of inappropriate prescription drug usage; updating the member’s prescription drug claim record; if the claim is accepted, confirming to the pharmacy that it would receive payment for the drug dispensed according to its provider agreement with it; and informing the pharmacy of the co-payment amount to be collected from the member based upon the client’s plan design and the remaining payable amount due to the pharmacy. Home Delivery Services: As of December 31, 2012, the company dispensed prescription drugs from its five high-volume automated dispensing home delivery pharmacies and one non-automated dispensing home delivery pharmacy. In addition to the order processing that occurs at these home delivery pharmacies, the company operates various non-dispensing order processing facilities and patient contact centers. The company also maintains one non-dispensing home delivery fulfillment pharmacy for business continuity purposes. Through its home delivery pharmacies, the company is involved with the prescriber and patient and, as a result, research shows it are generally able to achieve a higher level of generic substitutions, therapeutic interventions and better adherence than can be achieved through the retail pharmacy networks. Benefit Design Consultation: The company offers consultation and financial m