Paul Sanchez
Express Scripts is a pharmacy benefit management (PBM) organization that provides prescription drug coverage to its customers. It was founded in 1986 as a subsidiary of Sanus Corporation, a health maintenance organization, and Medicare-Glaser, a pharmacy. Express Scripts has since been acquired by Cigna, a health insurance company, and offers Medicare Part D prescription drug plans, also known as Part C or Medicare Advantage, which provide coverage for prescription drugs. These plans are available in all U.S. states, Puerto Rico, and Washington, D.C., with varying costs depending on location and the specific plan chosen. Express Scripts' preferred pharmacy network includes retailers such as Walgreens, Walmart, and Kroger, and members can choose between home delivery and retail pharmacies to receive their prescriptions.
| Characteristics | Values |
|---|---|
| Type of Organization | Pharmacy benefit management (PBM) organization |
| Services | Integrated pharmacy benefit management services, including network-pharmacy claims processing, home delivery pharmacy services, specialty pharmacy benefit management, benefit design consultation, drug utilization review, formulary |
| Coverage | Prescription medicines and supplies related to prescriptions |
| Costs | Out-of-pocket expenses, including annual deductible, copays, or coinsurance. Other factors include the tier of the drug and whether it is a generic or brand-name medication. |
| Plan Options | Saver, Assurance, and Extra |
| Number of Employees | 30,000 worldwide |
| Savings | Approximately $38 billion annually for its clients |
Explore related products
![Drug coverage under national health insurance : Proceedings of the national conference, October 5-7, 1977 Editors : Milton Silverman and Mia Lydecker. 1978 [Leather Bound]](https://m.media-amazon.com/images/I/61IX47b4r9L._AC_UY218_.jpg)
What You'll Learn
Express Scripts' history and ownership
Express Scripts is a pharmacy benefit management company that operates in the United States and Canada. It is headquartered in St. Louis, Missouri, where it was founded in 1986 as a joint venture between a retail chain of over 79 pharmacies (Medicare Glaser Inc.) and Sanus Corp. Health Systems. Sanus, which was formed by two former principals of McDonnell Douglas, had acquired Bradford Systems and Administrative Services in 1981. Bradford had a contract for computer processing of Medicare and Medicaid payments.
Medicare Glaser sold its Express Scripts partnership interest back to Sanus before it was acquired by SupeRx in 1989. SupeRx declared bankruptcy in 1991, and all stores closed after Walgreens acquired the pharmacy records. Sanus remained the dominant early insurance customer, but Express Scripts began marketing to other providers. With increased investment by New York Life Insurance Company, Sanus changed its name to NYL Cares and was sold to Aetna in 1998.
Express Scripts became a publicly traded company in 1992 and has since expanded its services and acquired several companies, including ConnectYourCare in 2007, WellPoint's NextRx subsidiaries in 2009, and Medco Health Solutions in 2012. The company provides a range of services, including network-pharmacy claims processing, home delivery pharmacy services, benefit design consultation, drug utilization review, and medical and drug data analysis. It serves thousands of clients, including health plans, employers, labour unions, and government agencies, and is one of the largest pharmacy benefit managers in the United States.
As of 2025, Express Scripts Holding Co. has approximately 563.6 million outstanding shares, with the majority owned by other corporate entities and institutional investors. The company employs over 26,000 people worldwide and has received substantial tax breaks for its operations in St. Louis.
Your Money: Uninsured and at Risk
You may want to see also
Explore related products
The pharmacy benefit management services it provides
Express Scripts is a pharmacy benefit management (PBM) organization that manages the pharmacy portion of health plan coverage. It ensures that the use of medicine is safer and more affordable. Express Scripts provides integrated pharmacy benefit management services, including:
Network-pharmacy claims processing
Express Scripts offers a wide network of pharmacies for its customers to choose from. It also provides home delivery services for prescription drugs.
Specialty pharmacy benefit management
Through its subsidiary Accredo, Express Scripts offers specialized pharmacy benefit management services for complex or chronic conditions. This includes access to pharmacists who specialize in specific conditions.
Benefit-design consultation
The company provides benefit-design consultation services to help plan sponsors care for their people and create new value. This includes negotiating deeper discounts, rebates, and formulary tiers to make medication more affordable for its clients.
Drug-utilization review
Express Scripts conducts a drug-utilization review to ensure that the prescribed medications are safe, cost-effective, and of high clinical quality.
Formulary management
The company manages the formulary, which is a list of covered drugs for each plan. It works with drug manufacturers to secure affordable medication alternatives that provide greater clinical value.
Member experience and engagement
Express Scripts focuses on providing a simple and seamless pharmacy benefit experience for its members. It engages members with the right information at the right time to help them take advantage of their prescription benefits.
Overall cost savings
Through its various initiatives, Express Scripts helps clients save billions of dollars in incremental value. This includes avoiding costs through its Advanced Utilization Management program, which ensures the safest and most cost-effective medications are prescribed.
Term Insurance: Taxable Money?
You may want to see also
Explore related products
Express Scripts' prescription drug plans
Express Scripts is a pharmacy benefit management (PBM) organization that provides prescription drug plans. It is a subsidiary of Cigna, a global health company. Express Scripts offers Medicare Part D plans, which provide prescription drug coverage. This means that individuals enrolled in Original Medicare (Part A and Part B) can opt for a Part D drug prescription plan, which covers the costs of prescription medicines and supplies.
The Express Scripts prescription drug plan allows individuals to choose their preferred pharmacy from a network of nearly 64,000 pharmacies. This includes the option of home delivery or retail pharmacies. The specific pharmacies included in the network vary depending on location, but individuals can use the Express Scripts website or mobile app to find a list of currently in-network pharmacies and order refills.
Express Scripts offers three Medicare Part D prescription drug plan options: Saver, Assurance, and Extra. The costs of these plans, including premiums and copayments, depend on the individual plan and the person's location. The basic Part D premium for 2025 is $36.78, and additional costs can include out-of-pocket expenses such as the annual deductible, copays, or coinsurance.
The prescription drug coverage provided by Express Scripts includes a formulary of thousands of medications, with low to no cost for the individual. This formulary lists all the drugs covered by the plan, including generic and brand-name options. The cost of medications can vary depending on whether they are generic or brand-name, and the tier in which the drug is categorized.
Express Scripts also provides tools to help individuals manage their prescriptions online, such as the "Find a Pharmacy" tool, which assists in locating nearby pharmacies that are covered by their prescription plan. Additionally, individuals can set up an account through their employer to pay for certain out-of-pocket medical costs with tax-free dollars, including insurance copays and deductibles.
Understanding the DHS License: A Necessary Credential for Insurance Adjusters
You may want to see also
Explore related products
Costs and eligibility for prescription drug plans
Express Scripts is a pharmacy benefit management (PBM) organisation. It provides integrated pharmacy benefit management services, including network-pharmacy claims processing, home delivery pharmacy services, and specialty pharmacy benefit management.
Express Scripts (Cigna) offers three Medicare Part D prescription drug plans: Saver, Assurance, and Extra. The costs and eligibility for these plans vary depending on the individual plan and the person's location.
The basic Part D premium for 2025 is $36.78. Additional costs include out-of-pocket expenses such as the annual deductible, copays, or coinsurance. The amount of out-of-pocket expenses depends on the tier of the drug and whether it is a generic or brand-name medication.
For example, after paying the deductible, an individual will pay a maximum of 25% of the cost of either generic or brand-name drugs, up to a total of $2,000. After reaching this limit, the individual will automatically get "catastrophic coverage" and will not have to pay out-of-pocket for covered Part D drugs for the rest of the calendar year.
There are also State Pharmaceutical Assistance Programs (SPAPs) and Pharmaceutical Assistance Programs (PAPs) that can help with the costs of prescription drug plans. These programs are designed to help individuals with limited incomes and resources pay for their medications.
Additionally, there is a Part D Low-Income Subsidy (LIS) program that provides assistance with plan premiums and cost-sharing for individuals with low incomes and modest assets. As of 2024, anyone who qualifies for the LIS program receives full benefits and pays only modest copayments for prescription drugs.
It is important to note that enrollment in a Part D plan is optional, but there may be penalties for late enrollment.
Get Maximum Compensation: Tips for Talking to Insurance Adjusters
You may want to see also
Explore related products
How to manage your prescriptions online
Express Scripts is a pharmacy benefit management (PBM) organization that provides integrated pharmacy benefit management services. It is a commercial prescription drug insurance that offers three Medicare Part D prescription drug plans: Saver, Assurance, and Extra.
Register or log in to your account
To get started, you will need to create an account on the Express Scripts website or log in if you already have one. Once you are logged in, you will be able to access your prescriptions and manage them online.
View your prescriptions
After logging in, you can view your existing prescriptions in the "My Medications" section. This will show you all the medications that are eligible for home delivery. If you have refills available, you can add them to your cart and place your order.
Contact your doctor
Express Scripts will contact your doctor on your behalf to take care of the prescription refill process. It is recommended that you inform your doctor beforehand so that they can be prepared with your information.
Confidential and safe delivery
Express Scripts ensures that your medications are delivered to your door with confidential, tamper-evident, and weather-resistant packaging. If your medication requires specific temperature control, they use special packaging and coolant packs, adjusting for the weather forecast and climate.
24/7 pharmacist support
You can reach a live person, either a patient care advocate or a pharmacist, 24 hours a day, 7 days a week. This allows you to have unrushed conversations about your prescriptions from the privacy of your own home.
Use the mobile app
For added convenience, you can download the Express Scripts mobile app on Android or Apple devices. The app allows you to view and manage your prescriptions on the go, making it easy to refill, renew, and track your prescriptions ordered through TRICARE Pharmacy Home Delivery.
Underwriting Profits: How Insurance Underwriters Make Money
You may want to see also
Frequently asked questions
Express Scripts is a pharmacy benefit management (PBM) organization. It provides prescription drug coverage for thousands of clients.
Express Scripts offers three Medicare Part D prescription drug plans: Saver, Assurance, and Extra. These plans are available in all U.S. states, Puerto Rico, and Washington, D.C. The specific plans available to you depend on your location.
You can use the Find a Pharmacy tool to search for nearby pharmacies in your prescription plan's network. Log in and go to Find a Pharmacy under Prescriptions in the main menu. You can search by ZIP code or city and state.
