by its National Pharmacy & Therapeutics Committee (National P&T Committee), a panel composed of independent physicians and pharmacists in active clinical practice, representing various specialties and practice settings and typically with major academic affiliations. The company’s standard formularies are governed by decisions of its National P&T Committee. Its formulary management also includes formulary compliance services. Through these formulary compliance services, the company alerts patients, physicians and pharmacies to opportunities to use formulary-preferred generics and branded medications that are clinically appropriate and cost-effective given the formulary and plan design. Medicare, Medicaid and Health Insurance Marketplace (Public Exchange) Offerings The company supports its clients by providing various Medicare program options, such as the Retiree Drug Subsidy program, which is offered by CMS to reimburse municipalities, unions and private employers for a portion of their eligible expenses for retiree prescription drug benefits; the Employer-Sponsored Group Waiver Plan, a group-enrolled Medicare Part D option for employers and labor groups; and the ‘PBM inside’ service that offers drug-only and integrated medical and Medicare drug benefits to various Medicare plan sponsors. As a PBM supporting health plans, the company provides prescription adjudication services, in addition to a suite of required programmatic offerings, such as a Medication Therapy Management program, an Explanation of Benefits for members using prescription services and various member communications related to their prescription benefit. The company also offers an individual prescription drug plan to beneficiaries in all 34 Medicare regions across the United States, as well as Puerto Rico. The company provides two Medicare Part D PDP options for beneficiaries, a standard Medicare Part D benefit plan as mandated by statute and, for an additional premium, a benefit plan with enhanced coverage that exceeds the standard Medicare Part D benefit plan. The company also offers various customized benefit plan designs to employer group retiree plans within its Medicare Part D PDP product offerings. The company’s member Website supports pre-enrollment and post-enrollment activities on behalf of its Medicare Part D PDP product offerings serving multiple clients. Prospective Medicare Part D participants and their caregivers can use the pre-enrollment site’s Plan Compare tool to project costs for medications. The post-enrollment site allows members who have signed up to receive a Medicare Part D benefit from either the company or one of its clients to manage all aspects of their prescription program. The company supports health plans serving Medicaid populations by offering a pharmacy drug benefit. Common services include transitioning members’ access to drugs as plan offerings change, generation of data to states through encounter files and coordination of benefits between states and other payors. The company also supports health plans serving insured Public Exchange members. This business is driven by both federal and state requirements. The company offers pharmacy benefit solutions that can be leveraged in plan design to align with any exchange strategy to achieve desired cost and clinical objectives. Administration of a Group Purchasing Organization The company operates a group purchasing organization (GPO) that provides various administrative services to participants in the GPO. Services provided to group participants include coordination, negotiation and management of contracts, as well as strategic analysis and advice regarding pharmacy procurement contracts for purchase of generic pharmaceuticals, and related goods and services from pharmaceutical manufacturers and suppliers. Consumer Health and Drug Information The company empowers member decision-making through online and mobile tools that help guide members in making informed drug, pharmacy and health choices. The Express Scripts Member Website (www.express-scripts.com) and mobile app are designed to help keep members’ medication information instantly availab
express scripts holding co
One Express Way
St. Louis, MO 63121
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