Express Scripts and Prime Therapeutics collaborate to deliver more affordable care to more than 100 million Americans
Collaboration leverages scale and capabilities to drive greater valueDecember 19, 2019
Prime, collectively owned by 18 Blue Cross and Blue Shield Plans, subsidiaries or affiliates, provides total drug management solutions for more than 28 million people covered by 23 health plans, plus employers and government programs including Medicare and Medicaid. Prime will continue to supply full-service pharmacy benefit management offerings for its clients and customers.
Express Scripts serves more than 3,000 clients and 75 million customer relationships. Under this collaboration, Express Scripts will provide services to Prime related to retail pharmacy network and pharmaceutical manufacturer contracts. Both companies will continue to work independently with pharmaceutical manufacturers—Express Scripts handling negotiations for drugs on the pharmacy benefit, and each company separately managing certain relationships on the medical benefit and value-based contracting. Other relationships with members, caregivers and key stakeholders will also remain independent as they work to deliver better affordability and improved pharmacy care.
“As health care costs continue to grow at an unsustainable pace, improving the value we deliver in health care is critical. This collaboration will improve outcomes while still maintaining flexibility and transparency to the clients we proudly serve,” said Ken Paulus, president and CEO, Prime.
“Our agreement reinforces our position as a health services partner of choice for health plans, employers, government and other payers seeking the most value for their investments in health care,” said Tim Wentworth, president, Express Scripts. “This collaboration allows both Prime and Express Scripts to leverage our capabilities to deliver more affordable health care.”
Express Scripts expects this relationship will have an immaterial impact to adjusted income from operations¹ in 2020 with a more positive contribution beginning in 2021.
- Adjusted income (loss) from operations is defined as shareholders’ net income (loss) excluding the following adjustments: earnings contributions from transitioning pharmacy benefit management clients, Anthem Inc. and Coventry Health Care, Inc., net realized investment results, amortization of acquired intangible assets, and special items. Adjusted income (loss) from operations is measured on an after-tax basis for consolidated results and on a pre-tax basis for segment results. Adjusted income (loss) from operations is a measure of profitability used by management because it presents the underlying results of operations of businesses and permits analysis of trends in underlying revenue, expenses and shareholders’ net income. This consolidated measure is not determined in accordance with GAAP and should not be viewed as a substitute for the most directly comparable GAAP measure, shareholders’ net income.
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This press release, and oral statements made in connection with this release, may contain forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Forward-looking statements are based on our current expectations and projections about future trends, events and uncertainties. These statements are not historical facts. Forward-looking statements may include, among others, statements concerning our projected adjusted income (loss) from operations outlook on a consolidated, per share, and segment basis; projected growth; projected adjusted pharmacy scripts; future financial or operating performance; future growth, business strategy, strategic or operational initiatives; and other statements regarding our future beliefs, expectations, plans, intentions, financial condition or performance. You may identify forward-looking statements by the use of words such as “believe,” “expect,” “plan,” “intend,” “anticipate,” “estimate,” “predict,” “potential,” “may,” “should,” “will” or other words or expressions of similar meaning, although not all forward-looking statements contain such terms.
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