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Express Scripts Inc.

Express Scripts Inc.

13900 Riverport Drive
Maryland Heights, Missouri 63043
U.S.A.
Telephone: (314) 770-1666
Fax: (314) 702-7037
Web site: http://www.express-scripts.com

Public Company
Incorporated:
1986
Employees: 5,259
Sales: $6.7 billion (2000)
Stock Exchanges: NASDAQ
Ticker Symbol: ESRX
NAIC: 45411 Electronic Shopping and Mail-Order Houses; 51421 Data Processing Services

Express Scripts Inc. (ESI) operates as a leading independent pharmacy benefits manager (PBM) in the United States. Headquartered outside of St. Louis, and with facilities in seven states and Canada, ESI provides a full range of PBM services and distributes outpatient pharmaceuticals through retail drug card programs, mail pharmacy services, formulary, and various other clinical management programs. Its clients include health maintenance organizations (HMOs), health insurers, third-party administrators, employers, union-sponsored benefits plans, and government health programs. The companys subsidiary, Practice Patterns Science (PPS), formed in 1994, provides variation analysis and disease management support services. Health Management Services, an ESI division created in 1997, offers demand and disease management support services.

With the rising dominance of managed health care and increasing pressure to contain health care costs, ESI grew rapidly in the 1990s and into the new millennium. The companys sales reached $6.8 billion in 2000 and it secured earnings growth for the 36th consecutive quarter. In 2001, ESIs PBM services covered more than 55,000 pharmacies in the United Statesthis figure included 99 percent of all U.S.-based retail pharmacies and five mail pharmacy service centers. The firms member base grew to include 43.5 million customers.

ESIs position as a leading independent among the countrys top PBMs has proved to be a strong selling point with its customers. In 2000, Fortune magazine ranked ESI as one of the fastest-growing companies in the U.S., and the firm was also named part of the Fortune 500 List and the Forbes Platinum List.

Origins in the 1980s

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 one of Missouris largest employers, left that company to start up their own HMO, called Sanus Corp. Health Systems. Backed by major investors McDonnell Douglas and General American Life Insurance Co., the private Sanus grew quickly, expanding into the Dallas, Fort Worth, Houston, and Washington, D.C., markets, as well as in St. Louis, signing up 90,000 members and reaching revenues of $30 million by 1985. One year later, Sanuss membership had swelled to 200,000, and revenues topped $100 million. As Sanus grew, it expanded its range of services as well. Considered innovative at the time, Sanus operated not only an HMO but also a preferred-provider plan, or PPO, and a standard health insurance plan. The expansion of Sanuss services led the company to establish GenCare Health Systems as an umbrella operation for the Sanus plans. By then, Barrett A. Toan had joined the company to serve as executive director.

Toan, who held a bachelors degree from Kenyon College and a masters degree from the University of Pennsylvanias Wharton School of Finance and Commerce, came to the private sector after years in public service. Early in his career, after a period of working as a high school teacher, Toan served as the assistant director with the office of state planning and development in Pennsylvania, and later as a budget analyst and deputy director for the Illinois Bureau of Budget. In the late 1970s, he was appointed commissioner of the division of social services for the state of Arkansas under Bill Clinton, then in his first term as governor. In 1981, Toan moved to Missouri, where he was named director of that states department of social service.

As director of social service, Toan was placed in charge of Missouris Medicaid system, which had seen a 40 percent rise in costs in the previous year alone. Toan convinced the state legislature to enact major changes in Medicaid, especially in that systems pricing structure. Where previously doctors and hospitals had been allowed to bill Medicaid for services after they were performed, which led to the charging of inflated fees, Toan argued for set fees to be negotiated in advance of treatment. These price caps forced providers to control their own costs, a trend that would lead to the rise of the HMO as the dominant form of health care provision by the mid-1990s.

Toan left public service in 1985, joining GenCare as its executive director, and GenCare, with additional investments from New York Life, expanded into the New York, New Jersey, and Maryland markets. Despite the greater efficiency of managed care over traditional health insurance plans, GenCare found itself paying high prices for its members prescriptions. Hiring a claims examiner to process prescriptions, however, would not have provided the company greater efficiency. Instead, Toan negotiated with St. Louis-based Medicare-Glaser to process and fill GenCare and Sanus members prescriptions. Data on prescription orders were then provided to GenCare, eliminating the need for GenCare to enter the data on its own. Medicare-Glaser was, at the time, one of the 25 largest pharmacy chains in the United States, operating nearly 90 pharmacies and full-line drug stores, as well as optical and home health centers, principally in Missouri, but also in Illinois and Connecticut.

Toan quickly recognized that this arrangement had applications beyond the GenCare-Sanus network. In late 1986, GenCare and Medicare-Glaser formed ESI as a joint venture providing mail-order prescription drug and claims processing. Under the agreement, Sanus members in Missouri and Illinois continued to receive their prescription benefit through the Medicare-Glaser pharmacy chain. The remainder of Sanuss 200,000 member network became ESIs initial customers; however, the company quickly began marketing its services to health care providers across the country. Early ESI clients included the cities of Baltimore, Memphis, and San Antonio. Toan became head of ESI, while continuing to lead GenCare.

By 1987, New York Life had begun to increase its investment in Sanus Health Systems, investing more than $50 million in the company and increasing its investment to as much as $75 million in the following year. New York Life was also an early investor in ESI. In 1988, Medicare-Glaser began to stumble as Walgreens moved to expand aggressively in the former companys core St. Louis market. By early 1989, with losses mounting, Medicare-Glaser announced it was merging with SupeRx of Arizona, Georgia and Alabama Corp., moving its headquarters to Arizona. At the time of the merger, Medicare-Glaser agreed to sell its 50 percent interest in ESI to Sanus, giving New York Life, which had already gained controlling interest in Sanus, full ownership of both GenCare and ESI. Medicare-Glaser subsequently filed for bankruptcy and closed or sold off all of its stores.

New York Life quickly sold GenCare back to General American, retaining the Sanus HMO and ESI. Toan, however, continued to serve as the head of both GenCare and ESI, both of which were based in St. Louis. Toan remained with GenCare through 1991, when he took the company public. Toan left GenCare in 1992 to turn his full attention to ESI.

Growth in the Early- to Mid-1990s

ESI revenues rose rapidly as it entered the 1990s, from $27.4 million to nearly $72 million by the end of 1991. Membership in ESI prescription plans had also increased to more than 1.5 million. Part of the companys growth could be attributed to the evolving role of PBMs in general, from mail-order prescription drug discounters and claims processors to playing an active role in patient pharmaceutical management. By 1991, less than 80 percent of ESI revenues were achieved through its mail-order sales. PBMs also began to play a more prominent role in health care management: as managed care slowly became the dominant form of health insurance, patient prescriptions became one of the most expensive insurance benefits. PBMs offered not only discounted drugs but also the ability to offer increased data analysis of the care process, working with providers to define cost-effective treatment, offer patient drug education services, and alert providers to potential inappropriate drug treatment stratagems. ESIs services also expanded to provide eye wear and home infusion therapy programs.

Toan took ESI public in 1992, joining a wave of health care-related firms filing initial public offerings in the early 1990s. ESIs IPO, which raised more than $28 million, was made in part to enable New York Life Insurance to maintain control over the company. ESI offered two classes of stock. The class A stock, which accounted for most of the shares being sold, gave shareholders one vote per share. The class B stock, of which New York Life, through its NYLife Healthcare Management subsidiary, controlled nearly 97 percent, gave shareholders ten votes per share. In addition, only the class A stock would be traded on the NASDAQ index. Toan was named CEO of ESI, which by then had more than 220 employees and 1,150 clients. Sanus members, however, continued to account for nearly 55 percent of all ESI sales.

Company Perspectives:

Our vision is to lead the industry through excellent, innovative, and ethically grounded pharmacy services and through trusted, impartial, and practical counsel that enables our clients to navigate the rapidly changing pharmaceutical landscape.

ESI stock rose rapidly, from its IPO of $13 per share to a high of $35.25 per share early in 1993. However, investors grew nervous after the inauguration of President Clinton and his attempted health care reforms. ESI stock slipped to $28 per share and then to $21.50. However, ESI continued to grow, expanding its pharmacy network to 28,000, and membership reached two million customers in 1992. The following year, ESI signed on FHP International Corp. and Maxicare Health Care, both based in California, which together held three percent of the national HMO market. ESI also added such corporate clients as Lockheed Corp., Service Merchandise Co., and Ingersoll-Rand Co. These new clients doubled ESIs customer base, boosting its share of the pharmacy mail-order market to 2.5 percentbehind leader Medcos 50 percent. In 1993, ESI more than doubled its revenues, to $264.9 million for net income of over $8 million. In response to the increase in its West Coast business, ESI opened a second mail-order service facility in Tempe, Arizona.

ESI was also helped by another trend that swept through the PBM industry. In 1993, Merck & Co. paid $6.6 billion for Medco. This acquisition was quickly followed by SmithKline Beechams $2.3 billion purchase of Diversified Pharmaceutical Services. Then PCS was purchased by Eli Lilly & Co. for $4 billion. Caremark, a division of J.C. Penney with roughly 15 percent of the PBM market, instituted alliances with Pfizer, Bristol-Myers, Rhone-Poulenc, and Lilly in 1994. The last of the large PBMs, Value Health, announced its joint venture with Pfizer in 1995. Distrust of these new relationshipsand suspicion that the drug companies would exert too much influence on the PBMs to include their parent companies drugs in their formularies, that is, the list of drugs approved for their customers useproved beneficial to ESI. The companys independent status helped lure FHP as a clientone executive at FHP told the New York Times: Large employers and health plans dont want to get in bed with Lilly or Merck. In 1994, Coventry Corp., a national HMO based in Nashville, also chose Express Scripts as their PBM.

By 1994, ESI had expanded its pharmacy network to 34,000 stores. Its revenues reached $384.5 million, producing a net income of $12.7 million. The company expanded its services by adding workers compensation prescription services and reinsurance. The companys growth also fueled its stock price, which reached $50.50 per share in April 1994. In that year, the company also began to emphasize computer technology, introducing its RxWorkbench software used for analyzing patient prescription data. By the end of 1994, ESI membership had grown to 5.7 million.

The following year, ESI reached an agreement with San Diego-based American Healthcare Systems Purchasing Partners L.P. to provide for that groups network of 800 hospitals and 100 nursing homes. The company also made a deeper investment in information technology by launching its Practice Patterns Science (PPS) subsidiary in 1994. PPS offered clients the ability to combine medical and pharmaceutical data in order to identify treatment and spending patterns, allowing for improved patient outcomes at lower cost.

ESIs purchase of Canadian PBM Eclipse Claims Services allowed it to move into that market in 1995. Canadian customers included divisions of Aetna, Prudential, and Manufacturers Life insurance companies. The company also instituted an agreement with CIBA Vision Ophthalmics U.S. to form a managed eye care alliance, marketing disease management programs using technology developed by PPS. By the end of 1995, ESIs revenues had increased nearly 42 percent over the previous year to $544 million, with net earnings of over $18 million. The companys pharmacy network increased to 45,000 stores, while its membership swelled to more than eight million people.

ESIs membership jumped past nine million early in 1996 when APS Healthcarenewly formed in a merger among American Healthcare Systems, Premier Health Alliance, and SunHealth Alliancesigned ESI to provide pharmacy benefits. Growth continued the following year, when a contract was signed with RightCHOICE Managed Care, a subsidiary of Blue Cross & Blue Shield of Missouri.

ESI made two key acquisitions in the latter half of the 1990s that would prove to be highly beneficial and position the firm as a leading PBM. In 1998, ESI acquired ValueRx, the PBM business of Columbia/HCA Healthcare Corp. The deal, completed in April of that year, created the largest PBM in the U.S. that was independent of a drug manufacturer.

Just one year later, in April 1999, ESI purchased Diversified Pharmaceutical Services from SmithKline Beecham Corp. The $700 million cash deal secured ESIs position as the third-largest PBM overall in the U.S., managing nearly $10 billion in drug spending. Toan commented on the two purchases in a 1999 company press release, stating, These acquisitions have not only provided critical mass, but also competitive strength in key markets and scope of capability that translate into value for our customers.

Key Dates:

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 interest in ESI to Sanus Corp., now controlled by New York Life.
1991:
ESI revenues reach $72 million; membership increases to 1.5 million.
1992:
The company goes public; membership grows to two million customers.
1993:
ESI lands FHP International Corp. and Maxicare Heath Care as clients.
1994:
The company forms a subsidiary entitled Practice Patterns Science.
1995:
Canadian PBM Eclipse Claims Services is acquired.
1996:
Membership exceeds nine million after APS Healthcare signs ESI to provide pharmacy benefits.
1997:
Health Management Services is created and operates as a new division of ESI.
1998:
ESI purchases ValueRx, creating the largest independent U.S.-based PBM (pharmacy benefits manager).
1999:
Diversified Pharmaceutical Services is acquired; ESI purchases a 19.9 percent stake in PlanetRx.comInc.
2000:
ESI posts a $9 million loss after writing off the value of its PlanetRx.com stock.
2001:
ESI partners with Merck-Medco and AdvancePSC to form RxHub LLC.

ESI also teamed up with PlanetRx.com in late 1999 to offer ESI members options for purchasing prescriptions and over-the-counter health products via the Internet. The partnership made PlanetRx.com the exclusive online pharmacy for ESIs growing membership base and ESI received a 19.9 percent stake in the dotcom firm.

ESI published a 1999 Drug Trend Benefit Report which claimed spending on prescription drugs in 1999 rose by 17.4 percent over the previous year, and that average prescription costs rose by 9.6 percent. These trends complemented ESIs bottom line handsomely as revenue for 1999 reached $4.2 billion and net income exceeded $150 million, more than a 250 percent increase over the previous year.

ESI entered the new millennium on solid ground. It was ranked among the top 500 companies in the U.S. by both Fortune and Forbes and was well positioned to continue its dominance in the PBM industry. During 2000, however, the firm was forced to write off its $165 million relationship with PlanetRx.com when the Internet startup experienced financial difficulties. While the company posted a $9.1 million loss for 2000, management downplayed the deal-gone-bad, claiming it had provided cash for new technology ventures.

One such venture was inked in February 2001, when ESI joined with competitors Merck-Medco and AdvancePCS Inc.together, the firms were the top three PBMs in the U.S. industryto create RxHub LLC. The joint venture was designed to develop an electronic exchange that would allow participating physicians to link to PBMs, health plans, and pharmacies. The venture however, was met with concern by pharmacies throughout the industry that were leery about the costs and the flow of information from doctor to pharmacy. There was also fear that the three companies would divert prescription orders to their own mail-order operations versus having them filled at a retail location. Nevertheless, ESI and its partners forged ahead with their plans.

In 2001, ESI predicted that drug spending would increase an average of 15 percent per year for the next five years. While management remained focused on new technology ventures, controlling costs, and growth options, the companys rank as a leading PBM left it in a favorable position to secure positive financial results in the years to come.

Principal Subsidiaries

Practice Patterns Science, Inc.; ESI Canada Inc.; Express Scripts Specialty Distribution Services; IVTx Inc.; Value Health Inc.; Diversified Pharmaceuticals Services Inc.

Principal Divisions

Health Management Services.

Principal Competitors

AdvancePCS Inc.; Caremark Rx Inc.; Merck-Medco.

Further Reading

Chesler, Caren, Leaders Success, Investors Business Daily, December 20, 1993, p. 1.

Express Scripts Completes Acquisition of Diversified Pharmaceutical Services, PR Newswire, April 1, 1999.

Express Scripts Completes ValueRx Deal, Chain Drug Review, May 25, 1998.

Express Scripts, PlanetRx Complete Deal, Chain Drug Review, November 22, 1999.

Express Scripts Searches For Ways to Manage Costs, Chain Drug Review, March 26, 2001.

Frederick, James, Pharmacy Leaders Voice Concerns About RxHub Prescribing Concept, Drug Store News, May 21, 2001, p. 15.

Jacobson, Gianna, Independence Creates Niche in Health Care, New York Times, July 15, 1995, p. 40.

Lau, Gloria, Concentrating Drug Purchases to Reduce Costs, Investors Business Daily, April 20, 1994, p. A6.

Manning, Margie, Express Scripts On a Roll Despite Setbacks in 2000, St. Louis Business Journal, March 9, 2001, p. 1.

Roller, Kim, Express Scripts PBM Reports Record Increase in Drug Spending, Drug Store News, August 14, 2000, p. 41.

Steyer, Robert, Rx for Growth: Express Scripts Pays off Quickly for Investors, St. Louis Post-Dispatch, March 1, 1993, p. 12.

M.L. Cohen

update: Christina M. Stansell

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Express Scripts Incorporated

Express Scripts Incorporated

14000 Riverport Drive
Maryland Heights, Missouri 63043
U.S.A.
(314) 770-1666
Fax: (314) 567-3082
Internet:http://www.express-scripts.com

Public Company
Incorporated:
1986
Employees: 1,127
Sales: $544.46 million (1995)
Stock Exchanges: NASDAQ

SICs: 5961 Catalog & Mail-Order Houses; 7374 Data Processing & Preparation

Express Scripts Incorporated (ESI) is the leading independent pharmacy benefits manager (PBM) in the United States. Headquartered outside of St. Louis, with a second and larger service facility in Tempe, Arizona, ESI provides the full range of PBM services from claims and mail-order processing to benefit design consultation, formulary management, drug utilization review, and data analysis. ESI also provides vision care services and infusion therapy services. The companys subsidiary, Practice Patterns Science (PPS), launched in 1995, provides data analysis services by developing, marketing, and supporting proprietary software technology.

With the rising dominance of managed health care and increasing pressure to contain health care costs, ESI has grown rapidly in the 1990s. The companys net revenues reached $544 million in 1995, for a net income of over $18 million, sustaining annual growth rates of up to 50 percent. ESIs pharmacy networks cover more than 46,000 pharmacies in the United States. ESI fills pharmacy orders for more than nine million customers, through such managed care providers as FHP, Inc., NYLife Care Health Plans, Inc., Coventry Corporation, and the 1,700-hospital alliance APS Healthcare, as well as unions, self-insured employers, and insurance companies. Approximately 55 percent of ESI customers are members of HMOs; roughly 22 percent of the companys 1995 net revenues were generated through managed care providers NYLife (formerly Sanus) and FHP. In 1996, ESI expanded into Canada, servicing agreements with the Canadian divisions of Manufacturers Life, Prudential, and Aetna, among others, with the acquisition of a Canadian PBM, Eclipse Claims Services. ESI has also formed an alliance with CIBA Vision Ophthalmics U.S. to market disease management programs using technology developed by ESIs PPS subsidiary.

ESIs position as the sole independent among the countrys top PBMs has proved a strong selling point with its customers. The five other largest PBMs are closely affiliated with pharmaceutical companies: Medco Containment is owned by Merck & Company; PCS Health Systems was purchased by Eli Lilly in 1994; Diversified Pharmaceutical Services is owned by Smith-Kline Beecham; Value Health Inc. has entered a joint venture with Pfizer Inc.; and Caremark has developed exclusive agreements with several pharmaceutical companies. ESIs independence is likely to continue, as more than 90 percent of the companys stock is owned by its former parent, NYLife Healthcare Management, a subsidiary of New York Life Insurance Company, making the company an unlikely takeover target.

Founded in the 1980s

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 one of Missouris largest employers, left that company to start up their own HMO, called Sanus Corp. Health Systems. Backed by major investors McDonnell Douglas and General American Life Insurance Co., the private Sanus grew quickly, expanding into the Dallas, Fort Worth, Houston, and Washington, D.C., markets, as well as in St. Louis, signing up 90,000 members and reaching revenues of $30 million by 1985. One year later, Sanuss membership had swelled to 200,000, and revenues topped $100 million. As Sanus grew, it expanded its range of services as well. Considered innovative at the time, Sanus operated not only a HMO but also a preferred-provider plan, or PPO, and a standard health insurance plan. The expansion of Sanuss services led the company to establish GenCare Health Systems as an umbrella operation for the Sanus plans. By then, Barrett A. Toan had joined the company to serve as executive director.

Toan, who held a bachelors degree from Kenyon College and a masters degree from the University of Pennsylvanias Wharton School of Finance and Commerce, came to the private sector after years in public service. Early in his career, after a period of working as a high school teacher, Toan served as the assistant director with the office of state planning and development in Pennsylvania, and later as a budget analyst and deputy director for the Illinois Bureau of Budget. In the late 1970s, he was appointed commissioner of the division of social services for the state of Arkansas under Governor Bill Clinton, then in his first term as governor. In 1981, Toan moved to Missouri, where he was named director of that states department of social service.

As director of social service, Toan was placed in charge of Missouris Medicaid system, which had seen a 40 percent rise in costs in the year before alone. Toan convinced the state legislative to enact major changes in Medicaid, especially in that systems pricing structure. Where previously doctors and hospitals had been allowed to bill Medicaid for services after they were performed, which led to the charging of inflated fees, Toan argued for set fees to be negotiated in advance of treatment. These price caps forced providers to control their own costs, a trend that would lead to the rise of the HMO as the dominant form of health care provision by the mid-1990s.

Toan left public service in 1985, joining GenCare as its executive director, and GenCare, with additional investments from New York Life, expanded into the New York, New Jersey, and Maryland markets. Despite the greater efficiency of managed care over traditional health insurance plans, GenCare found itself paying high prices for its members prescriptions. Hiring a claims examiner to process prescriptions, however, would not have provided the company greater efficiency. Instead, Toan negotiated with St. Louis-based Medicare-Glaser to process and fill GenCare and Sanus members prescriptions. Data on prescription orders were then provided to GenCare, eliminating the need for GenCare to enter the data on its own. Medicare-Glaser was, at the time, one of the 25 largest pharmacy chains in the United States, operating nearly 90 pharmacies and full-line drug stores, as well as optical and home health centers, principally in Missouri, but also in Illinois and Connecticut.

Toan quickly recognized that this arrangement had applications beyond the GenCare-Sanus network. In late 1986, GenCare and Medicare-Glaser formed ESI as a joint venture providing mail-order prescription drug and claims processing. Under the agreement, Sanus members in Missouri and Illinois continued to receive their prescription benefit through the Medicare-Glaser pharmacy chain. The remainder of Sanuss 200,000 member network became ESIs initial customers; however, the company quickly began marketing its services to health care providers across the country. Early ESI clients included the cities of Baltimore, Memphis, and San Antonio. Toan became head of ESI, while continuing to lead GenCare.

By 1987, New York Life had begun to increase its investment in Sanus Health Systems, investing more than $50 million in the company, and increasing its investment to as much as $75 million in the following year. New York Life was also an early investor in ESI. In 1988, Medicare-Glaser began to stumble as Walgreens moved to expand aggressively in the former companys core St. Louis market. By early 1989, with losses mounting, Medicare-Glaser announced it was merging with SupeRx of Arizona, Georgia and Alabama Corp., moving its headquarters to Arizona. At the time of the merger, Medicare-Glaser agreed to sell its 50 percent interest in ESI to Sanus, giving New York Life, which had already gained controlling interest in Sanus, full ownership of both GenCare and ESI. Medicare-Glaser subsequently filed for bankruptcy and closed or sold off all of its stores.

New York Life quickly sold GenCare back to General American, retaining the Sanus HMO and ESI. Toan, however, continued to serve as the head of both GenCare and ESI, both of which were based in St. Louis. Toan remained with GenCare through 1991, when he took the company public. Toan left GenCare in 1992 to turn his full attention to ESI.

Explosive Growth in the 1990s

ESI revenues rose rapidly as it entered the 1990s, from $27.4 million to nearly $72 million by the end of 1991. Membership in ESI prescription plans had also increased, to more than 1.5 million. Part of the companys growth could be attributed to the evolving role of PBMs in general, from mail-order prescription drug discounters and claims processors to playing an active role in patient pharmaceutical management. By 1991 less than 80 percent of ESI revenues were achieved through its mail-order sales. PBMs also began to play a more prominent role in health care management: as managed care slowly became the dominant form of health insurance, patient prescriptions became one of the most expensive insurance benefits. PBMs offered not only discounted drugs but also the ability to offer increased data analysis of the care process, working with providers to define cost-effective treatment, offer patient drug education services, and alert providers to potential inappropriate drug treatment stratagems. ESIs services also expanded to provide eye wear and home infusion therapy programs.

Company Perspectives:

Express Scripts has been providing integrated mail and network pharmacy benefit management services since 1986. Since our inception, our mission has been to provide superior services while managing the pharmacy benefit, not maximizing mail order or certain manufacturer products. In addition, we strive to: ensure quality and cost-effective pharmacy services through partnerships with our clients; apply proven managed care principles; provide high-quality customer service.

Toan took ESI public in 1992, joining a wave of health care-related firms filing initial public offerings in the early 1990s. ESIs IPO, which raised more than $28 million, was made in part to enable New York Life Insurance to maintain control over the company. ESI offered two classes of stock. The class A stock, which accounted for most of the shares being sold, gave shareholders one vote per share. The class B stock, of which New York Life, through its NYLife Healthcare Management subsidiary, controlled nearly 97 percent, gave shareholders 10 votes per share. In addition, only the class A stock would be traded on the NASDAQ index. Toan was named CEO of ESI, which by then had more than 220 employees and 1,150 clients. Sanus members, however, continued to account for nearly 55 percent of all ESI sales.

ESI stock rose rapidly, from its IPO of $13 per share to a high of $35.25 per share early in 1993. However, investors grew nervous after the inauguration of President Clinton and his attempted health care reforms. ESI stock slipped to $28 per share and then to $21.50. However, ESI continued to grow, expanding its pharmacy network to 28,000; membership reached two million customers in 1992. The following year, ESI signed on FHP International Corp. and Maxicare Health Care, both based in California, which together held three percent of the national HMO market. ESI also added such corporate clients as Lockheed Corp., Service Merchandise Co., and Ingersoll-Rand Co. These new clients doubled ESIs customer base, boosting its share of the pharmacy mail-order market to 2.5 percentbehind leader Medcos 50 percent. In 1993, ESI more than doubled its revenues, to $264.9 million for net income of over $8 million. In response to the increase in its West Coast business, ESI opened a second mail-order service facility in Tempe, Arizona.

ESI was also helped by another trend that swept through the PBM industry. In 1993, Merck & Co. paid $6.6 billion for Medco. This acquisition was quickly followed by SmithKline Beechams $2.3 billion purchase of Diversified Pharmaceutical Services. Then PCS was purchased by Eli Lilly & Co. for $4 billion. Caremark, a division of J.C. Penney with roughly 15 percent of the PBM market, instituted alliances with Pfizer, Bristol-Myers, Rhone-Poulenc, and Lilly in 1994. The last of the large PBMs, Value Health, announced its joint venture with Pfizer in 1995. Distrust of these new relationshipsand suspicion that the drug companies would exert too much influence on the PBMs to include their parent companies drugs in their formularies, that is, the list of drugs approved for their customers useproved beneficial to ESI. The companys independent status helped lure FHP as a clientone executive at FHP told the New York Times: Large employers and health plans dont want to get in bed with Lilly or Merck. In 1994, Coventry Corp., a national HMO based in Nashville, also chose Express Scripts as their PBM.

By 1994, ESI had expanded its pharmacy network to 34,000 stores. Its revenues reached $384.5 million, producing a net income of $12.7 million. The company expanded its services by adding workers compensation prescription services, and also reinsurance. The companys growth also fueled its stock price, which reached $50.50 per share in April 1994. In that year, the company also began to emphasize computer technology, introducing its RxWorkbench software used for analyzing patient prescription data. By the end of 1994, ESI membership had grown to 5.7 million.

The following year, ESI reached an agreement with San Diego-based American Healthcare Systems Purchasing Partners L.P. to provide for that groups network of 800 hospitals and 100 nursing homes. The company also made a deeper investment in information technology by launching its Practice Patterns Science (PPS) subsidiary. PPS offered clients the ability to combine medical and pharmaceutical data in order to identify treatment and spending patterns, allowing for improved patient outcomes at lower cost.

ESIs purchase of Canadian PBM Eclipse Claims Services allowed it to move into that market in 1995. Canadian customers included divisions of Aetna, Prudential, and Manufacturers Life insurance companies. The company also instituted an agreement with CIBA Vision Ophthalmics U.S. to form a managed eye care alliance, marketing disease management programs using technology developed by PPS. By the end of 1995, ESIs revenues had increased nearly 42 percent over the previous year, to $544 million, for net earnings of over $18 million. The companys pharmacy network increased to 45,000 stores, while its membership swelled to more than eight million people.

That number jumped past nine million early in 1996 when APS Healthcarenewly formed in a merger among American Healthcare Systems, Premier Health Alliance, and SunHealth Alliancesigned ESI to provide pharmacy benefits. Despite the gains of ESI and the PBM industry in general in the first half of the 1990s, a majority of large employers still had not switched to the greater discounts offered by PBMsa situation that only spelled future growth potential for ESI.

Principal Subsidiaries

Practice Patterns Science, Inc.; ESI Canada Inc.

Principal Divisions

Infusion Therapy (IVTx); Managed Vision Care (MVC).

Further Reading

Chesler, Caren, Leaders Success, Investors Business Daily, December 20, 1993, p. 1.

Jacobson, Gianna, Independence Creates Niche in Health Care, New York Times, July 15, 1995, Sec. 1, p. 40.

Lau, Gloria, Concentrating Drug Purchases to Reduce Costs, Investors Business Daily, April 20, 1994, p. A6.

Steyer, Robert, Rx for Growth: Express Scripts Pays off Quickly for Investors, St. Louis Post-Dispatch, March 1, 1993, Sec. Business, p. 12.

M. L. Cohen

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"Express Scripts Incorporated." International Directory of Company Histories. 1997. Encyclopedia.com. 29 Jun. 2016 <http://www.encyclopedia.com>.

"Express Scripts Incorporated." International Directory of Company Histories. 1997. Encyclopedia.com. (June 29, 2016). http://www.encyclopedia.com/doc/1G2-2842100056.html

"Express Scripts Incorporated." International Directory of Company Histories. 1997. Retrieved June 29, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-2842100056.html

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