Express Scripts

What Express Scripts does

Express Scripts is a pharmacy benefit manager (PBM) and integrated pharmacy services company, operating as a wholly-owned subsidiary of The Cigna Group under the Evernorth health services division. Founded in 1986 and headquartered at 1 Express Way, St. Louis, Missouri, the company is one of the "Big Three" PBMs — alongside CVS Caremark and OptumRx — that collectively process roughly 80% of the U.S.'s 6.6 billion annual prescriptions and cover approximately 270 million lives. Cigna acquired Express Scripts in 2018 for approximately $54 billion and subsequently renamed the holding company to Evernorth Health, Inc., while continuing to operate under the Express Scripts brand for consumer-facing PBM services. The company employs 10,000+ staff, including approximately 1,000 pharmacists available 24/7, and operates mail-order pharmacies, specialty pharmacies, telehealth, and medical benefits management under a multi-brand portfolio.

The core platform combines mail-order pharmacy with integrated PBM services including formulary management, prior authorization, and specialty pharmacy capabilities. Notable proprietary technology includes Smart Coverage Review (SCR), an AI-enabled prior authorization logic that auto-decisions approximately 10% of cases and processed 3 million questions across 2.4 million cases in 2022; the MyAccredoPatients (MAP) digital communication platform used by 70% of specialty providers; and the iAssist specialty pharmacy toolset. Express Scripts serves health plans, self-insured employers, unions, and government programs through enterprise field sales and B2B relationships, with consumer-facing engagement via its mobile app, website, and direct mail-order delivery channels. Accredo, the specialty pharmacy subsidiary, dispenses $265 billion in specialty drugs — 39% of all pharmacy specialty revenues — and Express Scripts with competitors control roughly two-thirds of specialty dispensing revenue.

The business model centers on negotiating drug prices with manufacturers, charging health plans and employers, and retaining margins through spread pricing and rebate retention. Revenue streams include PBM administration and spread pricing (the FTC documented that spread pricing on specialty generics generated over $7.3 billion in excess revenue industry-wide from 2017-2022), manufacturer rebates, mail-order dispensing fees, specialty pharmacy (Accredo), and the Switzerland-based Ascent Health Services GPO. The company has come under significant regulatory pressure: an FTC settlement in February 2026 requires delinking compensation from list prices, transitioning to cost-plus pharmacy reimbursement, and reshore the Swiss-based Ascent GPO to the U.S. by January 1, 2027. In response, Evernorth launched a rebate-free pharmacy benefit model in 2025-2026 that passes negotiated discounts directly to patients, and the company continues to litigate against state-level PBM-ownership restrictions in Tennessee, Arkansas, and other jurisdictions.

Name

Express Scripts

Legal name

Evernorth Health, Inc. (f/k/a Express Scripts Holding Company)

Website

https://express-scripts.com

Company type

Private

Founded year

1986

Operating status

Operating

Headcount range

5,001–10,000 employees

Short description

Express Scripts is a pharmacy benefit manager and integrated pharmacy services company, wholly-owned by The Cigna Group, serving U.S. health plans, employers, unions, and government programs with mail-order, specialty (Accredo), and formulary management services.

Ownership category

akta.pro rank

Product category

Pharmacy Benefit Management

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Pharmacies and Drug Retailers (456110)

SIC

Hospital & Medical Service Plans (6324), Insurance Agents, Brokers & Service (6411)

akta.pro primary industry

Pharmacy Benefit Management (PBM) & Pharmacy Network Administration (HLAFALAI)

akta.pro secondary industries

Specialty Pharmacy Benefit Management (Specialty PBM) (HLAEAKAE), Formulary Management & Clinical Pharmacy Programs (HLAEAKAA), Manufacturer Contracting, Rebates & Revenue Management (HLAEAKAD), PBM Technology Platforms (ePA/eRx/Real-Time Benefit Tools) (HLAEAKAL), Pharmacy Benefit Analytics, Reporting & Employer Consulting (HLAEAKAK)

Keywords

• Pharmacy benefit management
• Mail-order pharmacy
• Specialty pharmacy services
• Prescription drug coverage
• Drug formulary management

Headquarters

HQ city

Mt Pleasant

HQ country

United States

HQ region

North America

Offices3 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

Operations, Personnel, Technology or R&D, Supply Chain, Marketing or Sales, Infrastructure

Revenue model

1. PBM Administration and Spread Pricing: Express Scripts generates revenue by negotiating drug prices with manufacturers, charging health plans and employers, and retaining margins between negotiated and billed prices. The FTC documented that spread pricing on specialty generics generated over $7.3 billion in excess revenue from 2017-2022.
2. Manufacturer Rebates and Kickbacks: Express Scripts negotiates rebates from pharmaceutical manufacturers for formulary placement, with a portion retained as revenue rather than passed through to clients. The FTC settlement requires full rebate pass-through and delinking compensation from list prices.
3. Mail-Order Pharmacy Dispensing: Home delivery pharmacy services for maintenance medications, generating dispensing fees and capturing spread on drug acquisition costs.
4. Specialty Pharmacy (Accredo): High-cost specialty drug dispensing through Accredo specialty pharmacies, which dispense $265 billion in specialty drugs (39% of all pharmacy revenues). Express Scripts and competitors control roughly two-thirds of specialty dispensing revenue.
5. Group Purchasing Organization (Ascent): Swiss-based GPO (Ascent Health Services) aggregates purchasing volume for rebates. Settlement requires reshoring to the U.S. by January 1, 2027.

Pricing tiers

Go-to-market motion2 records

Distribution channels5 records

Marketing channels5 records

Core offering

Express Scripts operates as a pharmacy benefit manager (PBM) providing pharmacy benefit administration, drug formulary design, manufacturer rebate negotiation, prior authorization, and claims processing for health plans, employers, unions, and government programs. It also dispenses prescription medications through its mail-order pharmacy and the Accredo specialty pharmacy, and supports members with 24/7 pharmacist access, a mobile app, and telehealth via MD Live.

Product overview

Express Scripts, operating under the Evernorth Health Services division of The Cigna Group, is a pharmacy benefit manager (PBM) and integrated pharmacy services company offering a multi-brand portfolio of products. At its core is the Pharmacy Benefit Management Services platform managing drug benefits for approximately 270 million people, which includes formulary design, rebate negotiation, network management, and claims processing. The consumer-facing Express Scripts Pharmacy provides mail-order delivery with 90-day supplies and automatic refills, while the Express Scripts Mobile App enables on-the-go prescription management. Specialty pharmacy needs are served through Accredo (with tools iAssist, MyAccredoPatients, and Smart Coverage Review for prior authorization), CuraScript SD for distribution, and Freedom Fertility for fertility medications. Telehealth is integrated via MD Live, and consumer cost savings are supported through InsideRx discounts. Evernorth's broader portfolio includes eviCore (medical benefits management), MyMatrixx (specialty site-of-care management), and CareContinuum, all under a unified rebate-free pharmacy benefit model launched in 2025-2026.

Differentiator

Problem solved

Functional benefit

Brands

• Accredo: Specialty pharmacy by Evernorth providing medications for complex chronic conditions including oncology, immunology, and rare diseases.
• InsideRx
• MD Live

Products and services

• Pharmacy Benefit Management Services Core PBM services providing formulary management, pharmacy network administration, rebate negotiation, prior authorization, and claims processing for health plan sponsors and members across the U.S.
• Express Scripts Pharmacy Mail-order pharmacy service that delivers prescription medications to patients' homes, offering 90-day supplies, automatic refills, real-time order tracking, and 24/7 pharmacist access for plan members.
• Express Scripts Mobile App Mobile application for iOS and Android enabling members to manage prescriptions, schedule dose reminders, order refills, track shipments, receive push notifications, and connect with pharmacists.
• Medicare Part D Plans Medicare prescription drug coverage options administered by Express Scripts, providing home delivery and retail network access for Medicare beneficiaries.
• Accredo Specialty Pharmacy Specialty pharmacy dispensing high-cost, complex medications for chronic or rare conditions (oncology, immunology, rare diseases) with dedicated patient support, prior authorization tools, and clinical management.
• MD Live Telehealth 24/7 telehealth care services integrated with Express Scripts pharmacy benefits, providing virtual access to physicians and specialists for consultations, prescriptions, and care coordination.
• InsideRx Consumer discount program offering reduced cash prices on prescription medications at participating retail pharmacies, accessible regardless of insurance coverage.
• $0 Copay Prescriptions Program offering certain ACA preventive medications at zero copay, supported by 24/7 pharmacist access from the privacy of home.
• eviCore by Evernorth Medical benefits management solution providing utilization management, prior authorization, and clinical review services for health plans and providers, integrated with pharmacy benefits.
• MyMatrixx Specialty pharmacy solutions for complex medication management under workers' compensation and site-of-care pharmacy programs, part of Evernorth's value-based care offerings.
• CuraScript SD Specialty drug distribution service providing logistics and fulfillment for specialty pharmaceuticals across the Express Scripts pharmacy network.
• Freedom Fertility Pharmacy Fertility pharmacy under Accredo providing specialized medications, clinical support, and patient services for fertility treatments.
• Evernorth EnGuide℠ Pharmacy Pharmacy services offered through Evernorth's integrated health services platform, providing additional prescription management and clinical support to members.
• Evernorth Rebate-Free Pharmacy Benefit Model New rebate-free pharmacy benefit model that passes negotiated discounts directly to patients, eliminates spread pricing in favor of upfront discounts, and supports local pharmacies; a hybrid PBM offering from Evernorth.

Quantifiable outcome

• Up to $7 billion in patient savings over 10 years from FTC settlement
• +2 more outcomes

Named customers6 records

Segments4 records

Ideal customer profiles3 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration11 records

AI capability4 records

Feature4 records

Partnerships

14 partnerships are on record, tiered minor and core.

• Milestone PharmaceuticalsminorGTM or Marketing Partner · 1 March 2026Express Scripts added CARDAMYST (etripamil) nasal spray to national formulary coverage, providing patient access to Milestone's cardiovascular drug.
• TrumpRxminorGTM or Marketing Partner · 5 February 2026Express Scripts agreed to count TrumpRx payments toward deductibles under certain conditions, integrating government drug pricing platform with commercial PBM services.
• Managed Health Care Associates (MHA)coreStrategic or Co-development Partner · 21 January 2026Collaboration to implement new enhanced reimbursement model for Long-Term Care pharmacies, addressing dispensing fee levels under Maximum Fair Price reimbursement under the Inflation Reduction Act.
• Accord BioPharmaminorGTM or Marketing Partner · 1 January 2026HERCESSI biosimilar gained preferred status on Express Scripts' largest commercial formularies. This marks Accord BioPharma's second major formulary agreement with Express Scripts in four months.
• Trividia HealthminorGTM or Marketing Partner · 1 October 2025TRUE METRIX Blood Glucose Systems preferred for commercial patients on Express Scripts National Preferred Formulary. Products manufactured in the US.
• Shields Health SolutionscoreStrategic or Co-development Partner · 11 September 2025$3.5 billion investment by Evernorth in Shields Health Solutions for specialty pharmacy at sites of care, with Evernorth receiving preferred stock and option to invest further without acquiring controlling stake.
• Accredo by EvernorthcoreChannel Partner/ Reseller/ DistributorAccredo is Express Scripts' specialty pharmacy subsidiary handling high-cost, complex medications for chronic conditions. It operates with 70% provider adoption of its digital tools and serves as a core differentiator in specialty drug dispensing.
• MD Live by EvernorthcoreChannel Partner/ Reseller/ DistributorMD Live provides 24/7 telehealth services integrated into Express Scripts' pharmacy benefits, enabling virtual doctor visits and expanding access to care beyond traditional pharmacy services.
• InsideRxminorGTM or Marketing PartnerInsideRx offers consumer discount solutions for prescription medications, providing savings programs for uninsured or underinsured patients.
• CuraScript SDcoreChannel Partner/ Reseller/ DistributorCuraScript SD provides specialty drug distribution services supporting the specialty pharmacy network.
• Evicore by EvernorthcoreImplementation/ SI/ Consulting PartnerEvicore provides medical benefits management services including prior authorization and utilization review integrated with pharmacy benefits.
• MyMatrixx by EvernorthcoreChannel Partner/ Reseller/ DistributorMyMatrixx provides specialty pharmacy solutions specifically focused on complex medication management.
• Freedom FertilityminorChannel Partner/ Reseller/ DistributorFertility pharmacy partner integrated into Express Scripts specialty pharmacy network.
• Evernorth EnGuide℠ PharmacycoreChannel Partner/ Reseller/ DistributorIntegrated pharmacy solution providing additional dispensing options within the Express Scripts network.

Scale indicators7 records

Recent moves8 records

Expansion highlights6 records

Direct peers

• CVS Caremark: Pharmacy benefit management arm of CVS Health, one of the Big Three PBMs alongside Express Scripts. Operates a fully integrated PBM, retail pharmacy (CVS), and specialty pharmacy model serving comparable health plan and employer clients.
• OptumRx: PBM subsidiary of UnitedHealth Group and the third member of the Big Three. Combines pharmacy benefit management with Optum's broader health services analytics platform, directly competing with Express Scripts for large employer and health plan contracts.
• Humana Pharmacy Solutions: PBM owned by Humana serving primarily Medicare Advantage and group health clients. Competes with Express Scripts in Medicare Part D and senior-focused pharmacy benefit administration with comparable mail-order and specialty capabilities.
• Prime Therapeutics: Blue Cross Blue Shield-aligned PBM owned by multiple health plans. Direct competitor in PBM contracting for Blues plans and large employer accounts, and central to the Michigan AG antitrust case involving Express Scripts.
• MedImpact Healthcare Systems: Independent PBM serving health plans, employers, and government programs with transparent pass-through pricing model. Competes with Express Scripts for clients seeking non-Big-Three alternatives and lower-spread pharmacy benefit structures.
• Elixir Rx Solutions: Mid-sized PBM offering transparent pharmacy benefit administration to health plans and employer groups. Competes for the same mid-market and regional accounts that Express Scripts' enterprise field sales targets.

Emerging players

• Mark Cuban Cost Plus Drugs: Transparent cash-pay online pharmacy and PBM disruptor founded by Mark Cuban. Targets the same employer and consumer drug-purchasing market by eliminating spread pricing and rebate retention, directly challenging Express Scripts' core revenue model.
• Amazon Pharmacy: Online pharmacy leveraging Amazon's logistics and Prime membership. Competes with Express Scripts' mail-order business and consumer-facing pharmacy experience, and increasingly partners with PBMs and plans seeking digital-first fulfillment.
• GoodRx: Consumer prescription discount platform offering transparent cash prices at retail pharmacies. Competes with Express Scripts' InsideRx brand and pressures traditional spread-pricing economics by providing consumers a public benchmark for drug costs.

Broad incumbents

• Walgreens Boots Alliance: Major retail pharmacy chain with evolving PBM and specialty capabilities through Shields Health Solutions and other investments. Overlaps with Express Scripts in retail pharmacy network administration and emerging site-of-care specialty services.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat6 records

Key risks6 records

Key highlights6 records

Customer concentration

• Xx.com/expressscripts

Compliance8 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles10 records

Subsidiaries7 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A7 records

Investments2 records

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Express Scripts