Express Scripts 2011 Annual Report Download - page 15

Express Scripts 2011 Annual Report 13
Company Operations
General. As of December 31, 2011, our U.S. PBM segment operated two dispensing home delivery pharmacies,
several non-dispensing order processing centers, patient contact centers, specialty drug pharmacies and fertility pharmacies,
and one non-dispensing home delivery pharmacy maintained for business continuity purposes. Electronic pharmacy claims
processing for our U.S. operations takes place at facilities owned by an outsourced vendor. At our Canadian facilities we
provide adjudication and processing services for pharmacy and dental claims for insurance carriers, third-party
administrators (TPAs) and public-sector clients. We also maintain sales and marketing, client services, pharmacy help desk,
clinical, network contracting and management, and certain management information systems capabilities in Canada. In
December 2011, we launched expanded services in Canada, which include a dispensing pharmacy, home delivery of
maintenance prescription medications and a member contact center. It is our intention to make this service available
throughout Canada in 2012.
Sales and Marketing. In the United States, our sales managers and directors market and sell PBM services,
supported by a team of client-service representatives, clinical pharmacy managers, and benefit analysis consultants. This
team works with clients to make prescription drug use safer and more affordable. In addition, sales personnel dedicated to
our EM segment use direct marketing to generate new customers and solidify existing customer relationships. In Canada,
marketing and sales efforts are conducted by our staff based in Mississauga, Ontario and Montreal, Quebec.
Pharma and Retail Strategy. Our Pharma and Retail Strategy group is responsible for contracting and
administering our pharmacy networks. To participate in our retail pharmacy networks, pharmacies must meet certain
qualifications, including the requirement that all applicable state credentialing and/or licensing requirements are being
maintained. Pharmacies can contact our pharmacy help desk toll free, 24 hours a day, 7 days a week, for information and
assistance in filling prescriptions for our clients’ members. In addition, our Pharma and Retail Strategy group audits
pharmacies in our retail pharmacy networks to determine compliance with the terms of their contracts.
Clinical Support. Our staff of highly trained pharmacists and physicians provides clinical support for our PBM
services. These healthcare professionals are responsible for a wide range of activities including tracking the drug pipeline;
identifying emerging medication-related safety issues and notifying physicians, clients, and patients (if appropriate);
providing drug information services; formulary management; development of utilization management, safety (concurrent
and retrospective drug utilization review) and other clinical interventions; and/or contacting physicians, pharmacists, or
patients.
Our clinical staff works closely with the P&T Committee during the development of our formulary and selected
utilization management programs. The P&T Committee’s goal is to ensure our decisions are evidence-based, clinically
sound, and aligned with the current standard of medical practice. The P&T Committee’s guidance is designed to ensure
decisions are clinically appropriate and not superseded by financial considerations.
We have a research team whose mission is to conduct timely, rigorous and objective research that supports
evidence-based pharmacy benefit management. Using pharmacy and medical claims data together with member surveys,
the research department conducts studies to evaluate clinical, economic and member impact of pharmacy benefits. The
release of our 2010 Annual Drug Trend Report in April 2011 marked our fourteenth consecutive year of tracking
prescription drug trends. Based on a large sample of our membership, the 2010 Annual Drug Trend Report examines trends
in pharmaceutical utilization and cost as well as the factors that underlie those trends, including behaviors that result in
wasteful spending in the pharmacy benefit. The Annual Drug Trend Report and results of our other studies are shared at our
annual Outcomes Conference and are available on our website. We also present at other client forums, speak at professional
meetings and publish in health-related journals.
Information Technology. Our Information Technology department supports our pharmacy claims processing
systems, our specialty pharmacy systems and other management information systems essential to our operations.
Uninterrupted point-of-sale electronic retail pharmacy claims processing is a significant operational requirement for us.
Claims for our PBM segment are presently processed in the United States through systems that are maintained, managed
and operated domestically by internal resources and an outsourced vendor. Canadian claims are processed through systems
maintained and operated by IBM in Canada and managed by us. We believe we have substantial capacity for growth in our
United States and Canadian claims processing facilities.
Specialty pharmacy operations are supported by multiple pharmacy systems that are maintained, managed and
operated internally. We have integrated the business to a common set of shared services and infrastructure, data processing
centers, and disaster recovery.