Medco 2014 Annual Report Download - page 12

Express Scripts 2014 Annual Report
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Ourformularymanagementalsoincludesformularycomplianceservices.Throughtheseformularycompliance
services,wealertpatients,physiciansandpharmaciestoopportunitiestouseformulary-preferredgenericsandbranded
medicationsthatareclinicallyappropriateandmorecost-effectivegiventheformularyandplandesign.Wealwaysdefertothe
prescribingphysicianastotheappropriatenessoftheformulary-preferredalternativesforhisorherpatient.
Medicare, Medicaid and Public Exchange Offerings.WesupportourclientsbyprovidingseveralMedicare
programoptions:theRetireeDrugSubsidy(“RDS”)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(“EGWP”),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anumberofMedicareplansponsors.
AsaPBMsupportinghealthplans,weprovide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avarietyofmembercommunicationsrelatedtotheirprescriptionbenefit.Wealsoofferanindividual
prescriptiondrugplantobeneficiariesinall34MedicareregionsacrosstheUnitedStates,aswellasPuertoRico.
Ourrevenuesincludepremiumsassociatedwithourrisk-basedMedicarePartDPrescriptionDrugPlan(“PDP”)
productsofferings.Theproductsinvolveunderwritingthebenefit,chargingenrolleesapplicablepremiums,providingcovered
prescriptiondrugsandadministeringthebenefitasfiledwithCMS.Twoofourinsurancecompanysubsidiarieshavebeen
operatingundercontractswithCMSsince2006andonesince2007.Weprovide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.Wealsooffernumerouscustomizedbenefit
plandesignstoemployergroupretireeplansundertheMedicarePartDprescriptiondrugbenefit.
Ourmemberwebsitesupportspre-enrollmentandpost-enrollmentactivitiesonbehalfofourMedicarePartD
programsservingmultipleclients.ProspectiveMedicarePartDparticipantsandtheircaregiverscanusethepre-enrollment
site’sPlanComparetooltoaccuratelyprojectcostsforalloftheirmedications.Thepost-enrollmentsiteallowsmemberswho
havesigneduptoreceiveaMedicarePartDbenefitfromeitherExpressScriptsoroneofourclientstosecurelymanageall
aspectsoftheirprescriptionprogram.
WesupporthealthplansservingMedicaidpopulationsbyofferingapharmacydrugbenefit.Thisbusinessisdriven
bystaterequirementsandweearnrevenuesbasedontransaction-relatedactivity.Commonservicesincludetransitioning
members’accesstodrugsasplanofferingschange,generationofdatatothestatethroughencounterfilesandcoordinationof
benefitsbetweenstatesandotherpayors.MedicaidpopulationsareexpectedtogrowinstateschoosingtoexpandMedicaid
eligibility.
WealsosupporthealthplansservingtheinsuredPublicExchangemembers,whichisapopulationexpectedto
growwiththecontinuingimplementationofthePatientProtectionandAffordableCareAct(“AffordableCareAct”).This
businessisdrivenbybothfederalandstaterequirementsandweearnrevenuesbasedontransaction-relatedactivity.Weoffer
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.Weoperateagrouppurchasingorganization(“GPO”)that
providesvariousadministrativeservicestoparticipantsintheGPO.Servicesprovidedincludecoordination,negotiationand
managementofcontractsforgroupparticipantstopurchasegenericpharmaceuticalsandrelatedgoodsandservicesfrom
pharmaceuticalmanufacturersandsuppliers,aswellasprovidingstrategicanalysisandadviceregardingpharmacy
procurementcontractsforthepurchaseandsaleofgoodsandservices.
Consumer Health and Drug Information.ExpressScriptsempowersmemberdecision-makingthroughonlineand
mobiletoolsthathelpguidemembersinmakinginformeddrug,pharmacyandhealthchoices.
ExpressScripts’digitalsolutionsprovideeasyaccessandclear,simplefunctionality.TheExpressScriptsMember
Website(www.express-scripts.com)andmobileapparedesignedtohelpkeepmembers’medicationinformationinstantly
availableontheircomputersormobiledevices.Whenmembersuseself-servicetools,ittypicallyresultsinlower
administrativecosts,betterdrugtherapyadherence,reducedwasteandfewerdoctorvisits,leadingtosavingsforbothclients
andmembers.Informationincludedonourwebsiteandmobileapparenotpartofthisannualreport.
Other Business Operations Services
Overview.ThroughourOtherBusinessOperationssegment,weoperatetwoadditionalbrandsthatservicethe
patientthroughmultiplepaths.OursubsidiaryCuraScriptSpecialtyDistributiondistributesspecialtypharmaceuticalsand
medicationstotreatrareandorphandiseasesdirectlytoproviders,clinicsandhospitalsintheUnitedStates.Italsooperates
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