Medco Health Solutions

What Medco Health Solutions does

Medco Health Solutions, founded in 1983 and historically headquartered in Franklin Lakes, New Jersey, was a major US pharmacy benefit manager (PBM). The medcohealth.com domain now redirects to express-scripts.com, indicating that the Medco brand has been absorbed into Express Scripts, which itself was acquired by Cigna and rebranded as 'Express Scripts by Evernorth.' The operating entity processes and manages prescription drug benefits for health insurers, employers, Medicare plans, and government programs including TRICARE, and is one of three PBMs (alongside CVS Caremark and UnitedHealth/Optum Rx) collectively controlling approximately 80% of US prescriptions. Core products include Express Scripts Pharmacy (national mail-order home delivery), the Express Scripts Mobile App, Evernorth EnGuide℠ Pharmacy digital tools, and Medicare-specific pharmacy services, supplemented by affiliated brands Accredo (specialty pharmacy), InsideRx (discount prescriptions), and MD Live (telehealth).

The underlying technology stack combines mail-order pharmacy dispensing operations, real-time prescription processing, online member self-service (web and mobile), and integrated telehealth. The platform is supported by formulary and MAC list pricing systems using Medi-Span wholesale data from Wolters Kluwer, and holds URAC PBM and Mail Service Pharmacy accreditations, NABP Digital Pharmacy and Healthcare Merchant accreditations, NCQA Utilization Management, and LegitScript certification. The mobile app supports prescription management, automatic refills, order status, and bill pay; the website supports account registration and prior authorization submission for physicians.

Revenue is generated primarily through PBM service fees from plan sponsors (subscription/recurring) and mail-order pharmacy dispensing (ingredient costs plus dispensing fees, transaction-based), with pricing negotiated per-contract with employer-sponsored health plans, Medicare plans, and TRICARE. The go-to-market is enterprise sales-led, supplemented by self-serve digital member engagement. Customer segments include employer-sponsored health plan members, Medicare beneficiaries, and military/TRICARE enrollees. As of the most recent observable data, the operation employs 10,000+ people and runs from 1 Express Way, St. Louis, MO 63121, within Cigna's Evernorth health services ecosystem.

Name

Medco Health Solutions

Website

https://medcohealth.com

Company type

Private

Founded year

1983

Operating status

Operating

Headcount range

5,001–10,000 employees

Short description

Medco Health Solutions is a US pharmacy benefit manager (PBM), now operating under the Express Scripts by Evernorth brand within Cigna, serving employer health plans, Medicare beneficiaries, and TRICARE enrollees with mail-order pharmacy, specialty pharmacy, telehealth, and digital prescription 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)

SIC

Services-Health Services (8000)

akta.pro primary industry

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

akta.pro secondary industries

Mail-Order Pharmacy & Home Delivery (HLAEAKAF), Formulary Management & Clinical Pharmacy Programs (HLAEAKAA), Group Pharmacy Benefit (Rx) Coverage & PBM-Integrated Plans (FSAIAFAN), Specialty Pharmacy Benefit Management (Specialty PBM) (HLAEAKAE), Pharmacy-Integrated Virtual Care & ePrescribing (Employer Benefit) (HLALADAH)

Keywords

• Pharmacy benefit management
• Mail-order pharmacy
• Specialty pharmacy
• Prescription drug plans
• Medicare pharmacy services

Headquarters

HQ city

Franklin Lakes

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Pharmacy Benefit Management (PBM) Services: Express Scripts processes and manages prescription drug benefits for health insurers, employers, and government programs. As one of the three largest PBMs controlling approximately 80% of US prescriptions (alongside CVS Health's Caremark and UnitedHealth's Optum Rx), the company earns fees from plan sponsors for formulary management, rebate negotiation, and pharmacy network administration.
2. Mail-Order Pharmacy Dispensing: The company operates its own mail-order pharmacy (Express Scripts Pharmacy) that dispenses medications directly to patients, generating revenue through ingredient costs and dispensing fees paid by payers.

Pricing tiers

Go-to-market motion1 record

Distribution channels5 records

Marketing channels5 records

Core offering

Medco Health Solutions operates as a pharmacy benefit manager (PBM) that processes and administers prescription drug benefits for employer-sponsored health plans, Medicare plans, and government programs such as TRICARE. Its core offering is a mail-order home delivery pharmacy (Express Scripts Pharmacy) supported by a mobile app, real-time prescription processing, automatic refills, and 24/7 pharmacist access. The company is integrated within Cigna's Evernorth health services portfolio, alongside specialty pharmacy (Accredo), telehealth (MD Live), and discount prescription (InsideRx) offerings.

Product overview

Medco Health Solutions operates under the Express Scripts brand as a pharmacy benefit manager (PBM) offering a platform of integrated pharmacy services. The core offering centers on Express Scripts Pharmacy (mail-order home delivery), supplemented by the Evernorth EnGuide℠ Pharmacy digital tools and the Express Scripts Mobile App for on-the-go access. The portfolio includes Medicare-specific pharmacy services and is connected to affiliated brands including Accredo (specialty pharmacy), InsideRx (discount card program), and MD Live (telehealth services). Together, these products provide end-to-end pharmacy benefit management covering home delivery, specialty medications, cost savings, and virtual care access.

Differentiator

Problem solved

Functional benefit

Products and services

• Express Scripts Pharmacy (Mail-Order Home Delivery) Mail-order pharmacy service that delivers prescriptions directly to members' homes, offering automatic refills and 24/7 pharmacist access for health plan members.
• Evernorth EnGuide℠ Pharmacy Digital pharmacy tools and resources to help health plan members understand and manage their pharmacy benefits.
• Express Scripts Mobile App Mobile application enabling members to manage prescriptions, check order status, and access pharmacy services anytime, anywhere.
• Medicare Pharmacy Services Pharmacy benefit services specifically designed for Medicare beneficiaries, including Medicare Part D coverage and home delivery of maintenance medications.
• Accredo (Specialty Pharmacy)
• InsideRx Prescription discount card program offering savings on medications for uninsured and underinsured patients.
• MD Live (Telehealth) 24/7 telehealth care services providing virtual access to doctors and healthcare providers, integrated with pharmacy services.

Quantifiable outcome

• Save time and money with home delivery compared to retail pharmacy trips

Named customers3 records

Segments4 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration2 records

Feature5 records

Partnerships

Five partnerships are on record, tiered core and minor.

• MD Live (by Evernorth)coreStrategic or Co-development PartnerMD Live provides 24/7 telehealth care integrated into Express Scripts' pharmacy services, allowing members to consult with doctors for prescriptions and medication management without waiting for doctor's appointments.
• Accredo (by Evernorth)coreStrategic or Co-development PartnerAccredo is a specialty pharmacy operated within the Evernorth ecosystem, offering complex and chronic disease medication management. Listed as a partner site within the Express Scripts family of services.
• InsideRx (by Evernorth)minorStrategic or Co-development PartnerInsideRx offers discounted prescription pricing, extending cost-saving options to patients even outside traditional insurance coverage. Operated as part of the Evernorth ecosystem.
• Berkeley Research GroupminorOthersThird-party vendor that experienced a security incident impacting Express Scripts customer data. The incident was acknowledged on the Express Scripts website with a link to a Privacy Incident Notice.
• EvernorthcoreStrategic or Co-development PartnerEvernorth is the parent health services brand under Cigna that encompasses Express Scripts, Accredo, MD Live, and other health services. Express Scripts is branded as 'Express Scripts by Evernorth' and 'Express Scripts Pharmacy by Evernorth'.

Scale indicators1 record

Recent moves6 records

Expansion highlights4 records

Broad incumbents

• Cigna / Evernorth: Cigna owns Express Scripts and houses it within Evernorth Health Services. Overlapping payer and PBM capabilities make Cigna the parent-level comparable rather than a head-to-head competitor, but the Evernorth division is the umbrella under which ESI competes.
• Centene Corporation: Centene runs a sizeable PBM (panomex/Cenpatico) that administers pharmacy benefits primarily for Medicaid and Marketplace plans. Overlaps with Express Scripts' government and Medicaid-facing PBM business.
• Walgreens Boots Alliance (PBM operations): Walgreens operates PBM-adjacent services (including its retail-pharmacy network and past investment in Prime Therapeutics) that intersect with Express Scripts' pharmacy network administration, mail-order, and specialty services.

Emerging players

• Amazon Pharmacy: Amazon Pharmacy is a digital-first pharmacy and PBM-adjacent service targeting the same consumer segment, with home delivery and, via Amazon Clinic, telehealth prescribing. Represents the most credible emerging threat to Express Scripts' mail-order share.
• Walmart Pharmacy: Walmart's pharmacy is a major mail-order and retail-script competitor, especially in $4 generics and discount cash-pay segments. Express Scripts' $0 copay and InsideRx are direct strategic responses to Walmart's pricing model.

Direct peers

• CVS Health (Caremark): CVS Caremark is one of the three dominant U.S. PBMs alongside Express Scripts/Medco and Optum Rx, controlling roughly a third of U.S. prescriptions. Same buyer (employers, Medicare, government), same formulary/rebate model, same mail-order specialty footprint.
• Prime Therapeutics: Prime Therapeutics is a large, PBC-owned PBM serving Blue Cross Blue Shield plans and other payers with formulary management, rebate negotiation, and mail-order—directly comparable services and customers to Express Scripts.
• UnitedHealth Group (Optum Rx): Optum Rx is the third leg of the 'big three' PBM oligopoly and shares virtually identical customers (employer plans, Medicare Part D, TRICARE-adjacent government contracts). Comparable formulary, rebate, and mail-order economics, and the same target market.
• Humana Pharmacy Solutions: Humana's PBM arm administers pharmacy benefits for its Medicare Advantage and PDP plans as well as employer clients. Directly competing with Express Scripts for the same Medicare and commercial plan-sponsor contracts.
• MedImpact Healthcare Systems: MedImpact is an independent, mid-sized PBM offering commercial, Medicaid, and Medicare formulary management and pharmacy network administration. Competes for the same employer and health-plan RFPs as Express Scripts.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks6 records

Key highlights6 records

Customer concentration

Compliance6 records

Revenue estimate

Valuation estimate

Number of profiles

Funding overview

Funding rounds

Investors

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

M&A1 record

Investments

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

Frequently asked questions about Medco Health Solutions