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7Express Scripts 2015 Annual Report
the fees associated with the administration of retail pharmacy networks contracted by certain clients, medication counseling
services and certain specialty distribution services, accounted for the remainder of our revenues.
Prescription drugs are dispensed to members of the health plans we serve primarily through networks of retail
pharmacies under non-exclusive contracts with us and through home delivery fulfillment pharmacies, specialty drug
pharmacies and fertility pharmacies we operate. More than 70,000 retail pharmacies, which represent over 97% of all United
States retail pharmacies, participated in one or more of our networks as of December 31, 2015. The top ten retail pharmacy
chains in the United States represent approximately 62% of the total number of stores in our largest network.
Express Scripts, Inc. (“ESI”) was incorporated in Missouri in September 1986, and was reincorporated in Delaware in
March 1992. Aristotle Holding, Inc. was incorporated in Delaware in July 2011. On April 2, 2012, ESI consummated a merger
(the “Merger”) with Medco Health Solutions, Inc. (“Medco”) and both ESI and Medco became wholly-owned subsidiaries of
Aristotle Holding, Inc. Aristotle Holding, Inc. was renamed Express Scripts Holding Company (the “Company” or “Express
Scripts”) concurrently with the consummation of the Merger. When we use the terms “Express Scripts,” the “Company,” “we,”
“us” or “our” in this Annual Report on Form 10-K, we mean Express Scripts Holding Company and its subsidiaries on a
consolidated basis, unless we state or the context implies otherwise.
Our principal executive offices are located at One Express Way, Saint Louis, Missouri, 63121. Our telephone number
is 314.996.0900 and our website is www.express-scripts.com. Information included on our website is not part of this annual
report.
Products and Services
Pharmacy Benefit Management Services
Overview. Our core PBM services involve management of prescription drug utilization to drive high quality, cost-
effective pharmaceutical care. We consult with clients to assist in the selection of plan design features that balance clients’
requirements for cost control with member choice and convenience. We focus our solutions to enable better decisions in four
important and interrelated areas: benefit choices, drug choices, pharmacy choices and health choices. As a result, we believe we
deliver healthier outcomes, higher member satisfaction and a more affordable prescription drug benefit. During 2015, 97.3% of
our revenues were derived from our PBM operations, compared to 97.5% and 97.8% during 2014 and 2013, respectively.
Clinical Solutions. We offer innovative clinical programs to drive better health outcomes at lower cost. Our physician
connectivity program facilitates well-informed prescribing by delivering benefit and formulary evaluation and medication
history, both electronically and in real-time, as physicians write prescriptions. RationalMed® evaluates medical, pharmacy and
laboratory data to detect critical patient health and safety issues which are then addressed through timely notification to
physicians, pharmacies, patients and case managers. ScreenRx® uses proprietary predictive models to detect patients at risk for
nonadherence and proactively addresses the problem through interventions tailored specifically for that patient.
ExpressAlliance® offers patient care coordination services that enable client-authorized healthcare professionals to share a
common view of a patient’s health record and coordinate patient outreach and counseling. Personalized medicine programs
combine the latest advances in pharmacogenomics testing with patient and physician outreach to help providers understand
which drugs or dosages work best for individual patients, empowering them to make more informed and cost-effective
decisions that improve patient care and safety.
Specialized Pharmacy Care. At the center of Express Scripts’ condition-specific approach to care are Therapeutic
Resource Center® services, pharmacy practices that specialize in caring for members with the most complex and costly
conditions, including cardiovascular disease, diabetes, cancer, HIV, asthma, depression and other rare and specialty conditions.
Therapeutic Resource Center services are designed to optimize the safe and appropriate dispensing of therapeutic agents,
minimize waste and improve clinical and financial outcomes. Through our Therapeutic Resource Center services, specialist
pharmacists provide the expert, personalized care patients increasingly demand.
Home Delivery Pharmacy Services. We dispense prescription drugs from our four high-volume automated dispensing
home delivery pharmacies and one non-automated dispensing home delivery pharmacy. In addition to the order processing that
occurs at these home delivery pharmacies, we operate several non-dispensing order processing facilities and patient contact
centers. Our pharmacies provide patients with convenient access to maintenance medications and enable us to manage our
clients’ drug costs through operating efficiencies and economies of scale as well as provide greater safety and accuracy.
Through our home delivery pharmacies, we are directly involved with the prescriber and patient and, as a result, research
shows we are generally able to achieve a higher level of generic substitutions, therapeutic interventions and better adherence
than is achieved through the retail pharmacy networks.