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Express Scripts Holding Company is a pharmacy benefit management (PBM) organization. In 2017 it was the 22nd-largest company in the United States by total revenue as well as the largest pharmacy benefit management (PBM) organization in the United States. [2] Express Scripts had 2016 revenues of $100.752 billion. [2]
After a request comes in from a qualified provider, the request will go through the prior authorization process. The process to obtain prior authorization varies from insurer to insurer but typically involves the completion and faxing of a prior authorization form; according to a 2018 report, 88% are either partially or entirely manual.
In 2012 Express Scripts acquired rival Medco Health Solutions for $29.1 billion and became "a powerhouse in managing prescription drug benefits". [42] As of 2015, Express Scripts Holding Company was the largest pharmacy benefit management organization in the United States. [43]
In 2008, Surescripts merged with RxHub which was formed by a consortium of pharmacy benefit management companies comprising CVS Caremark, Express Scripts and Medco Health Solutions. [2] According to the U.S. Department of Health and Human Services, in 2014 96% of U.S. community pharmacies and 70% of U.S. physicians used Surescripts' e ...
Pharmacy staff can generate a renewal request (authorization request) that is delivered through the electronic network to the prescriber's system. The prescriber can then review the request and act accordingly by approving or denying the request through updating the system.
In their 2001 annual report, CVS anticipated that the "$16 billion specialty pharmacy market" would grow at "an even faster rate than traditional pharmacy due in large part to the robust pipeline of biotechnology drugs". [34] By 2014 CVS Caremark, Express Scripts and Walgreens represented more than 50% of the specialty drug market in the United ...