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Express Scripts Holding Co.  (ESRX)
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What are Express Scripts Holding Co.'s Business Segments?



Retail Pharmacy Network Administration. We contract with retail pharmacies to provide prescription drugs to members of the pharmacy benefit plans we manage. In the United States, we negotiate with pharmacies to discount the price at which they will provide drugs to members. We manage several nationwide networks in the United States that are responsive to client preferences related to cost containment and convenience of access for members. We also manage networks of pharmacies that are customized for or under direct contract with specific clients. We manage one nationwide network in Canada.

All retail pharmacies in our pharmacy networks communicate with us online and in real time to process prescription drug claims. When a member of a plan presents his or her identification card at a network pharmacy, the network pharmacist sends the specified member and prescription information in an industry-standard format through our systems, which process the claim and respond to the pharmacy. The electronic processing of the claim includes, among other things, the following:

confirming the member’s eligibility for benefits under the applicable health benefit plan and the conditions to or limitations of 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 will receive payment for the drug dispensed

informing the pharmacy of the co-payment amount to be collected from the member based upon the client’s plan design

Mail Pharmacy. We operated mail pharmacies, located in Maryland Heights, Missouri; Albuquerque, New Mexico; Bensalem, Pennsylvania; Harrisburg, Pennsylvania; Troy, New York and two in Tempe, Arizona. These pharmacies provide members with convenient access to maintenance and specialty medications and enable us to manage our clients’ drug costs through operating efficiencies and economies of scale. In addition, through our mail service pharmacies we are directly involved with the prescriber and member and, as a result, are generally able to achieve a higher level of generic substitutions and therapeutic interventions than can be achieved through the retail pharmacy networks.

Benefit Plan Design and Consultation. We offer consultation and financial modeling to assist our clients in selecting benefit plan designs that meet their needs for member satisfaction and cost control. The most common benefit design options we offer to our clients are:

financial incentives and reimbursement limitations on the drugs covered by the plan, including drug formularies, tiered co-payments, deductibles or annual benefit maximums

generic drug utilization incentives

incentives or requirements to use only network pharmacies or to order certain maintenance drugs (i.e. therapies for diabetes, high blood pressure, etc.) only by mail

reimbursement limitations on the amount of a drug that can be obtained in a specific period

The client’s choice of benefit design is entered into our electronic claims processing system, which applies the plan design parameters as claims are submitted and enables our clients and us to monitor the financial performance of the plan.

Formulary Development, Compliance and Therapy Management. Formularies are lists of drugs for which coverage is provided under the applicable plan. We have over ten years of formulary development expertise and maintain an extensive clinical pharmacy department.

Our foremost consideration in the formulary development process is the clinical appropriateness of the drug. In developing formularies, we first perform a rigorous assessment of the available evidence regarding the drug’s safety and clinical effectiveness. No drug is added to the formulary until it is approved by our National Pharmacy & Therapeutics Committee – a panel composed of seventeen independent physicians in active clinical practice, representing a variety of specialties and practice settings, typically with major academic affiliations. We fully comply with the Committee’s clinical recommendations. The Committee does not consider any information regarding the discount or rebate arrangement that we might negotiate with the manufacturer in making its clinical recommendation. This is designed to ensure that the clinical recommendation is not affected by our purchasing arrangements. After the clinical recommendation is made, the drugs are evaluated on an economic basis to determine optimal cost-effectiveness.

   

Express Scripts Holding Co. Tax Rate Companies within the Pharmacy Services & Retail Drugstore Industry


Express Scripts Holding Co. Segments

 
Network revenues
   54.5 % of total Revenue
Mail revenues
   40.96 % of total Revenue
Other revenues
   2.48 % of total Revenue
Service revenues
   2.06 % of total Revenue
PBM
   97.18 % of total Revenue
EM
   2.82 % of total Revenue
 

Business Segments (Sep. 30, 2015)
Revenues
(in millions $)
III. Quarter
%
(of total Revenues)
(Sep. 30, 2015)
Income
(in millions $)
III. Quarter
%
(Profit Margin)
Network revenues
13,747.20 54.5 % 0.00 -
Mail revenues
10,331.80 40.96 % 0.00 -
Other revenues
624.30 2.48 % 0.00 -
Service revenues
519.30 2.06 % 0.00 -
PBM
24,511.40 97.18 % 1,150.80 4.69 %
EM
711.20 2.82 % 15.40 2.17 %
Total
25,222.60 100 % 1,166.20 4.62 %

• Express Scripts Holding Co. Income Statement • Express Scripts Holding Co. supply chain • Revenue growth ranking by company and industry

Growth rates by Segment (Sep. 30, 2015)
Y/Y Revenue
%
III. Quarter
Q/Q Revenue
%
(Sep. 30, 2015)
Y/Y Income
%
III. Quarter
Q/Q Income
%
Network revenues
-6.62 % -3.71 % - -
Mail revenues
2.58 % 2.46 % - -
Other revenues
9.16 % 1.55 % - -
Service revenues
25.89 % 8.53 % - -
PBM
-2.47 % -1 % 18.42 % 3.41 %
EM
10.2 % 2.48 % 22.22 % -22.61 %
Total
-2.16 % -0.91 % 18.47 % 2.96 %

• Express Scripts Holding Co. Growth Comparisons Express Scripts Holding Co. Profile • Express Scripts Holding Co. Market Share

To get more information on Express Scripts Holding Co.'s Network revenues, Mail revenues, Other revenues, Service revenues, PBM, EM, Total segment. Select each division with the arrow.


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