INVESTORS’ MEETING — ORLANDO, FL
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INVESTORS’ MEETING — ORLANDO, FL. April 28, 2005. Forward-Looking Statements.

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Investors meeting orlando fl

INVESTORS’ MEETING — ORLANDO, FL

April 28, 2005


Forward looking statements

Forward-Looking Statements

Statements included in this presentation or in the oral comments made as part of this presentation may contain forward-looking statements, including but not limited to statements of the Company’s plans, objectives, expectations or intentions, that involve risk and uncertainties.

The Company’s actual results may differ significantly from those projected or suggested in any forward-looking statement due to a variety of factors, which are discussed in detail in the Company’s filings with the Securities and Exchange Commission.


Investors meeting orlando fl

Agenda

Express Scripts’ Value Proposition

Express Scripts’ Value Proposition

Engaging the Market

Multi-Faceted Growth

Managing the Supply Chain

Providing a Cost-Effective

Solution for Specialty Drugs

Break

Adding Value Through

Service Performance

Medicare: An Opportunity for Our Clients

Delivering Superior Financial

Results and ROIC

Positioning for the Future

George Paz

Larry Zarin

Ed Ignaczak

Chip Casteel

Dom Meffe

David Lowenberg, Doug Porter

Patrick McNamee

Agnès Rey-Giraud

Ed Stiften

George Paz


George paz president and ceo

Express Scripts’ Value Proposition

George Paz

President and CEO


What we do

What We Do

We Make the Use of Prescription Drugs Safer and More Affordable

But more importantly …


Is how we do it

… Is How We Do It

  • Supported by Best in Class

    • People

    • Service

    • Technology

A Business Model Based on An Unwavering Commitment to Alignment


What are the results

What Are the Results?

  • High Client and Patient Satisfaction

  • Superior Trend Management

  • The Validation of Our Business Model

  • Innovative Culture

  • State-of-the-Art Facilities

  • Outstanding Track Record


What are the savings

What Are the Savings?

Retail, Clinical.

Formulary

And Rebate

Savings 24%

Paid by

Cash Customer

at Pharmacy

Retail Pharmacy Cash Price

Mail Savings 6%

Express Scripts Client Savings

Express Scripts Client Costs

C

O

S

T

Paid by

Express Scripts

Clients

Total Savings 30%

Availability of Proven PBM Cost Management Tools

Will Produce 20%–25% Savings (CBO)


Why this model works

Moving to preferred brands, mail and generics

Moving to preferred brands, mail and generics

Moving to preferred brands, mail and generics

Why This Model Works

Increased Savings

Opportunities:

Client

Member

Increased

Profit

Opportunities:

Express Scripts

Retail Non-Preferred Brand

Retail Preferred Brand

Home Delivery

Generics

We Make Money by Saving Clients and Members Money


Strong management team

Strong Management Team

Executive

Role

Tom Boudreau

Chip Casteel

Ed Ignaczak

David Lowenberg

Patrick McNamee

Dom Meffe

Chris Pawlowicz

Doug Porter

Agnès Rey-Giraud

Ed Stiften

Larry Zarin

Legal

Supply Chain Management

Sales and Account Management

Operations

Information Technology

Specialty Pharmacy

Human Resources

Patient and Client Services

Research and Product Management

Finance

Marketing & Corporate Communications


Recent additions to strong corporate governance

Recent Additions to Strong Corporate Governance

Gary Benanav

Frank Borelli

Maura Breen

Nicolas Lahowchic

Thomas Mac Mahon

John Parker

George Paz

Samuel Skinner

Seymour Sternberg

Barrett Toan

Howard Waltman

Norman Zachary*

Board Member

Principal Occupation

Vice Chairman, New York Life Insurance

Ret. CFO, Marsh & McLennan

Senior Vice President, Verizon

President & CEO, Limited Logistics Services

Chairman & CEO, LabCorp

Chairman, Care Capital, LLC

President & CEO, Express Scripts

Ret. Chairman, President & CEO, USF Corp

Chairman, President & CEO, New York Life Insurance

Ret. CEO, Express Scripts

Director, Chairman of the Corp. Governance Cmtte.

Ret. President, Logica Data Architects

*Director Emeritus


Investors meeting orlando fl

Express Scripts’ Value Proposition

Engaging the Market

Larry Zarin

Vice President

Marketing and Corporate Communications


Common cause

Common Cause

  • Keeping the prescription-drug benefit off the

    endangered list

  • Member buy-in versus fear of member disruption


Investors meeting orlando fl

Fact

  • We have the strategies and tools to control drug spend with no compromise to health outcomes.


Value proposition complete alignment

Value Proposition: Complete Alignment

  • Reduce pharmacy costs

… eliminate waste

… drive generics,

low-cost brands

and home delivery

  • No compromise to health outcomes

… no cost shifting

  • Maximize member satisfaction


Investors meeting orlando fl

“Tell me and I’ll forget. Show me and I may not remember. Involve me and I will understand.”

— Native American Saying


The express scripts way

The Express Scripts Way

  • Face-to-face

  • Workshops, symposiums, seminars

    • AKA “Business Theater”

Great for brand, relationships,

retention and new sales.


Ed ignaczak senior vice president sales and account management

Ed IgnaczakSenior Vice PresidentSales and Account Management

Express Scripts’ Value Proposition

Multi-Faceted Growth


Capturing new business

Capturing New Business

Service

Improvements

New

Highest

Programs to

Generic Fill

Meet Market

Rate

Demands

Capturing

New

Business

Medicare D

Formulary

Support

Mgmt and

Services

Flexibility

Transparency

and Client

Alignment


Client satisfaction steadily improving

Client Satisfaction Steadily Improving

  • Service and satisfaction metrics have increased consistently quarter over quarter since 2003 with an early spike in 2005

100%

95%

2003

90%

2004

85%

80%

1q05

75%

70%

65%

60%

ESI Performance

Exceed

Likelihood to

Likelihood to

Expectations

Recommend

Renew


Renewals

Renewals

  • Service and Satisfaction have contributed to strong

    retention rates in ’04 and YTD ’05

Top 100 Accounts

Through 2006 (# of Clients)

Secured 90

Pending 6

Loss 4


2006 upsell pipeline is strong

2006 Upsell Pipeline is Strong

10,000

  • Significant potential to continue to manage client trends in key product categories

  • New products continue

    to be developed and

    rolled out

  • Strong track record of success

Sold

Weighted Pipeline

9,000

8,000

7,000

6,000

('000 Lives)

5,000

4,000

3,000

2,000

1,000

0

Home Delivery

Three Tier

Generic Enforcement

Specialty/CuraScript

New Clinical Products

Narrowing Formularies


Capturing new business1

Capturing New Business

New Business

  • Excellent new business growth for 2003 & 2004

  • Pipeline for 2005/2006 is strong with more than $9 Billion in revenues

  • Managed care ‘jumbo’ pipeline down as MCO’s focus on Medicare

12,000,000

10,000,000

8,000,000

6,000,000

4,000,000

2,000,000

0

Total Pipeline

2003 Wins

2004 Wins


Why express scripts

Why Express Scripts?

  • Alignment With Clients

  • Our People

  • Generics

  • Specialty

Exceeding Client Expectations


Chip casteel senior vice president supply chain

Chip CasteelSenior Vice PresidentSupply Chain

Express Scripts’ Value Proposition

Managing the Supply Chain


How do we get the best value from our suppliers

How Do We Get the Best Value From Our Suppliers?

  • By enhancing and harnessing the forces of competition

  • By rewarding “winners”

  • By reinvigorating competition at regular intervals


Traditional approach to suppliers

Harness Forces

“Preferred Savings Grid”

Reward Winners

Strengthen benefit designs

Narrow formularies

Move market share

Reinvigorate Competition

Rebid every 2 years

Traditional Approach to Suppliers

Pharma


Improvement in psg benefit design

Improvement in PSG Benefit Design

Restricted

(3-Tier / Closed)

Standard

75% of PSG utilization occurs within

Restricted Benefit Designs


2003 05 formulary analysis

2003-05 Formulary Analysis

Count of Brand Drugs on Formulary

Within Competitive Product Categories

Brand

Formulary

Drugs in

CPC Structure

  • Narrower formularies provide greater value to clients

  • Focus on lower net cost drugs — 16% of brand drugs

  • removed from formulary


Traditional approach to suppliers1

Harness Forces

“Preferred Savings Grid”

Reward Winners

Narrow formularies

Strengthen Benefit Designs

Move Market Share

Reinvigorate Competition

Rebid every 2 years

Harness Forces?

Broad networks for maximum locations

Reward Winners?

No “Losers”

No market share movement

Reinvigorate Competition?

Custom Networks – value for specific clients

Traditional Approach to Suppliers

Pharma

Retail


Retail strategy for the future

Retail Strategy For the Future

It’s not all about locations anymore ...

Its about good access and client savings.


Express scripts broadest network

Express Scripts’ Broadest Network


Broad network without two large chains

Broad Network Without Two Large Chains


Network management

Network Management

Greater Management


Home delivery wholesale suppliers

Home Delivery Wholesale Suppliers

  • Brand Pharmaceuticals: All purchased from licensed wholesalers ($4.1B in 2004)

  • Generic Pharmaceuticals: 95+% purchased direct from manufacturers ($250M in 2004)

  • Express Scripts does not purchase from repackagers or from alternate source suppliers


Wholesaler purchases brand pharmaceuticals

Wholesaler Purchases(Brand Pharmaceuticals)

  • Product delivered twice daily to all Express Scripts Pharmacies

  • 99% service level for top 200 drugs, 98% for all other products

  • Sites keep approximately 5-6 days supply on hand


Generic pharmaceutical purchasing

Generic Pharmaceutical Purchasing

  • Express Scripts purchases direct from about 45 generic manufacturers

  • Substantial savings compared to purchase through wholesalers

  • Sites keep approximately 30-day supply on hand


Annual generic bid process

Annual Generic Bid Process

  • All generic contracted products put out to bid annually

  • All generic manufacturers participate, covering more than 2000 NDCs

  • Annual bid process savings average 8%–10%


Dom meffe president and ceo curascript senior vice president specialty pharmacy

Dom MeffePresident and CEO, CuraScriptSenior Vice President, Specialty Pharmacy

Express Scripts’ Value Proposition

Providing a Cost-Effective

Solution for Specialty Drugs


Specialty pharmacy the gathering storm

Specialty Pharmacy — The Gathering Storm

Payers’ Dilemma: Looming Costs for Chronic Conditions

Biotechnology Healthcare, April 2005

Biologics’ Looming Price Tag Has Payers Retooling Pharmacy Coverage

Biotechnology Healthcare, April 2005


What are specialty medications

What are Specialty Medications?

  • High-cost oral, injectable, infused

    or inhaled medications

  • Self-administered or administered

    by a healthcare provider

  • Outpatient or a home setting


Characteristics of specialty medications

Characteristics of Specialty Medications

  • Frequent dosage adjustments

  • More severe side-effects than traditional drugs

  • Specialized storage, handling and distribution requirements

  • Narrow therapeutic range

  • Require periodic laboratory or

    diagnostic testing

  • Cost in excess of $1,300 per 30 day supply


Investors meeting orlando fl

National Specialty Product Mix

Hemophilia 3%

IVIG 1%

RSV

10%

Growth Hormone

Deficiency 3%

Chemotherapy 32%

Hepatitis C 7%

$12.53 PMPM

Psoriasis 12%

Chemotherapy

Supportive Care 15%

Rheumatoid Arthritis 8%

Multiple Sclerosis 9%


Biotech rapid growth

Biotech - Rapid Growth

Traditional Spend

$210 Billion

Specialty Spend

$35 Billion

2004 Total Outpatient Pharmacy Spend $190 Billion

Specialty Spend

$73 Billion

26%

18%

2008 Projected Outpatient Pharmacy Spend

$283 Billion

Traditional Spend

$155 Billion

Sources:

IMS Data through November 2004

Wall Street Equity Research, 2004

CMS National Healthcare Expenditure

Projection: 2003 – 2013

Data on file: CuraScript.

600

600

500

Biotech Drugs in Development

Biotech Drugs on the Market

369

400

Number of Drugs

300

240

Source:

PhRMA, International Federation of Pharmaceutical Wholesalers & Biotech Industry Organization

197

200

100

92

100

29

10

0

2000

2005

Estimated

1990

1995


Routes of administration specialty drug pipeline

Routes of Administration Specialty Drug Pipeline

  • Late-stage development; Phase II or later

  • Majority are injectable

Source: Express Scripts data


Current distribution channels today s wild wild west

Current Distribution ChannelsToday’s Wild, Wild West

Typical Payer Injectable Spend

Retail

Pharmacy

15%-20%

Mail Order

Pharmacy

5%-10%

Specialty

Pharmacy

5%-25%

Physician

Office

40%-60%

Outpatient

Hospital

15%-20%

Home Care

& Infusion

5%-10%

  • Unmanaged injectables result in:

  • Inappropriate utilization

  • Inconsistent clinical management

  • Variable reimbursement

  • Higher cost for payer

  • Reduced effectiveness of treatment

  • Reduced patient care

  • Reduced member satisfaction

  • Physician panel frustration


Our specialty solution

Our Specialty Solution

CARE

The CuraScript Difference

Making specialty

drug therapy more

effective and affordable,

one patient at a time

COST SAVINGS

CONVENIENCE


Curascript value proposition a legacy of results

CuraScript Value Proposition: A Legacy of Results

Current cost

100%


Curascript value proposition a legacy of results1

CuraScript Value Proposition: A Legacy of Results

Lower unit costs

Current cost

100%

7.2% savings


Curascript value proposition a legacy of results2

CuraScript Value Proposition: A Legacy of Results

Clinical based utilization savings

Lower unit costs

Current cost

100%

7.2% savings

8.2% savings


Curascript value proposition a legacy of results3

CuraScript Value Proposition: A Legacy of Results

Clinical-based utilization savings

Lower administrative costs

Lower unit costs

Current cost

100%

7.2% savings

8.2% savings

5.9% savings


Curascript value proposition a legacy of results4

CuraScript Value Proposition: A Legacy of Results

Clinical based utilization savings

Lower administrative costs

Lower unit costs

Current cost

100%

7.2% savings

8.2% savings

5.9% savings

21.3% savings

overall


Care logic patient care management

CARELogic™ Patient Care Management

  • Care management programs designed to specifically manage a disease state and the related drug therapy

Tools of the program include:

  • Patient assessment and risk stratification

  • Integration of diagnostic and medical data

  • Dedicated clinical patient support team

  • Critical pathway management

  • Intense patient education

  • Adherence support for medication regimen compliance

  • Psychosocial assessment and counseling

  • Utilization and dose management

  • Delivery coordination of medication

  • Outcomes reporting


Carelogic clinical management

CARELogic™ Clinical Management

Patient Admission

High risk Clinical assessment and on-going interventions

Three follow-up interventions in the first six months

Initial Clinical

Assessment

Disease Specific

Clinical Pathway

Initiated

Patient Care Coordination

Ongoing Clinical

Assessment and

Interventions

01/11/05


The value of clinical management

The Value of Clinical Management

Case Study

01/11/05


Proven clinical outcomes

Proven Clinical Outcomes ...

CuraScript’s MSLogic™ Case Study

Clinical Management Strategies

Goal: Reduce number and severity of relapses by improving patient compliance with their drug therapy

Interventions: Patient assessment, education, utilization management, side effect management, physician consultation

Translates into substantial impact on patient's quality of life and medical costs savings

2004 Client Savings Avoided Exacerbation Expenses:

$ 719,175.53

2004 Results of a 410,000 Life Health plan managed by CuraScript

Marks, A.S., Johnson, KE; Value in Health, 2002;5.

O'Brien et al, BMC Health Services Research, Sept. 2003

01/11/05


Implementation expertise

Implementation Expertise

  • Program and Benefit Design Consultation

  • Communication Strategy

  • Ongoing Account Management

Ongoing Account Management

 Client satisfaction

  • Patient satisfaction

  • Implement new

  • programs

  • Support to the client’s

  • initiatives

  • Continuous communication

  • strategies


Curascript client network mix

CuraScript Client Network Mix

Mix 7%

Preferred

10%

Exclusive

40%

Open 43%

As Percent of Total Revenue

Source: Data on file


Curascript penetration into express scripts

CuraScript Penetration intoExpress Scripts

100

90

80

70

60

50

40

30

20

10

0

82%

73%

70%

69%

66%

Retail

Percentage of Plan Costs

CuraScript

25%

20%

17%

Mail

16%

14%

9%

2%

13%

13%

11%

Q1 2004

Q2 2004

Q3 2004

Q4 2004

Q1 2005

Express Scripts Enterprise Book of Specialty Medications


Break

BREAK


Express scripts value proposition adding value through service performance

David LowenbergChief Operating OfficerDoug PorterSenior Vice President, Client and Patient ServicesPatrick McNamee Senior Vice President and CIO

Express Scripts’ Value Proposition

Adding Value Through Service Performance


Win win solution for clients patients and stockholders

Win-Win Solution for Clients, Patients and Stockholders

EXPRESS SCRIPTS’ PROFITABILITY

Client Retention

Client Implementation

Home Delivery Growth

Generic Promotion

Cost Efficiencies

Service

People

Technology


Our success starts with our people

Our Success Starts With Our People

Results

Organization

Competencies

People


Focus on the customer

Focus on the Customer

Service

Improvement

Integration

Acquisitions

Organic

Growth

IPO

  • * Represents 3 times home delivery claims; home delivery claims are 90 days versus 30 days in the network

Service


Technology investment portfolio

Technology Investment Portfolio

High

Generic Promotion

Home Delivery Growth

Profit

Cost Efficiencies

Client

Implementation

High

Low

Expected Value

Technology


Client and patient services alignment

Client and Patient Services Alignment

Client Retention

Home Delivery Growth

Cost Efficiencies

Generics Promotion

Client Implementation


Client retention through service

Client Retention Through Service

  • Specific Attention, Personalization and Care

  • Deliver Value — Service, Savings and Lower Cost

  • Accepting Nothing Less Than Very Satisfied


Service enhancements

Service Enhancements

  • Knowledge Management

  • Integrating Critical Information Into Single Source

  • Prescription history

  • Patient-specific information

Improved First

Call Resolution

+

Specific,

Patient-Focused Outcomes

=

Patient Satisfaction

and Savings

  • Plan benefits and features

  • Client-specific requirements

  • Proactively Pushing Information

  • to Advocate’s Desktop

  • Situational scripting

  • Decision trees and case-based

    reasoning

  • Client-specific messaging


Optimal configuration for home delivery growth

Optimal Configuration for Home Delivery Growth

Regional Model

Former Configuration

Current Configuration

Patient Scripts

Order Processing

Fulfillment

Order Processing

Patient Scripts

Fulfillment


Investment in accuracy and cost efficiencies

Investment in Accuracy and Cost Efficiencies

  • Enterprise Contact Center Model

    • High-quality, low-cost labor market

    • Reduce attrition levels

    • Create a service-centric environment

      • St. Marys, GA - Q3 2004

      • Pueblo, CO – Q3 2005

  • Home Delivery Pharmacy Model

    • Proprietary dispensing technology

    • Engineered workflow

    • Proactive, caring and trusted

      patient consultation


Generic penetration growth

Generic Penetration Growth

  • Exclusive focus on patient savings through generics

  • Physician and patient-friendly process

  • Extend our industry leading conversion rate, enhancing our bottom line


Successful client implementations

1/1/05 CLIENT IMPLEMENTATION COMMENTS

“I really appreciate all that you and your team are doing for us. Express Scripts is really going the extra mile …”

“Way to start things off for 2005!”

“I've done more of these implementations than I care to count, and this one has been the smoothest by far.”

“I'm impressed with how responsive you guys are … very refreshing!”

“This has been by far the easiest transition I have gone through ...”

Successful Client Implementations

  • Unparalleled experience

  • Proven processes and tools

  • Client customization

  • Invaluable results for client retention and attracting new accounts


Information systems role

Information Systems Role

Knowledge Management

Patients

Technology

Clients

Deliver efficient and highly available systems in support of business vision, clients and patients


Operational excellence

Operational Excellence

  • Knowledge Management Tool

    • Single-source solution for advocates to retrieve critical client, plan and contact-specific information

    • Automatic, personal presentation of patient information

Generics Promotion

Client Retention

Home Delivery Growth


Patient interface

Patient Interface

  • Express-Scripts.com for Members

    • Promotes self-service, which drives cost efficiencies

    • Vehicle to facilitate home delivery and

      generics outcomes

    • Direct involvement from patients in their

      prescription drug benefit

Home Delivery Growth

Cost Efficiencies

Generics Promotion


Client focused tools

Client-Focused Tools

SM

  • Trend Central

    • Delivers claims experience to optimally manage trend

    • Facilitates client transparency into our business

Client Implementation

Client Retention

Home Delivery Growth


Win win solution for clients patients and stockholders1

Win-Win Solution for Clients, Patients and Stockholders

EXPRESS SCRIPTS’ PROFITABILITY

Client Retention

Client Implementation

Home Delivery Growth

Generic Promotion

Cost Efficiencies

Service

People

Technology


Express scripts value proposition medicare an opportunity for our clients

Express Scripts’ Value PropositionMedicare: An Opportunity for Our Clients

Agnès Rey-Giraud

Senior Vice President

Research and Product Management


Medicare part d 2006 strategy

Medicare Part D 2006 Strategy

Grow with our clients by becoming the most trusted Part D advisor for both employers and health plans.


The most trusted advisor on part d

The Most Trusted Advisor on Part D …

  • Express Scripts — the Part D PBM of choice for our managed care and carrier clients

  • World class consulting, modeling and education for our employers and labor clients

  • Flawless execution in 2006 and beyond


Investors meeting orlando fl

As the Dust is Settling, HMOs and Carriers Have Clarity on Key Objectives

  • Protect current business

  • (Medicare Supplement, Medicare Advantage, employer retirees)

  • Maximize growth on MA-PD, PDP

  • Manage adverse selection

  • Maintain flexibility for future

Protect and grow clients’ business by managing risk and positioning for 2007 and beyond


Investors meeting orlando fl

We’ll Help Our Clients Be Competitive

  • Plan Management

    • Manage to lowest net cost while meeting

      Medicare standards

  • Quality and Coordination

    • Assure quality care, driving out fraud and ensuring

      coordination with other Medicare coverage

  • Senior-Focused Solutions

    • Communicate effectively to members and actively

      managing those with high spend


Investors meeting orlando fl

Employers and Unions Are Also Gaining Clarity on Key Objectives

  • Reduce spend

  • Minimize retiree disruption

  • Minimize administrative burden

  • Avoid inherent risks of first year

  • Maintain flexibility for future

Generate certain and significant savings today with little or no changes, while positioning for 2007 and beyond.


Investors meeting orlando fl

Employers Have Evaluated Options Versus Objectives

Express

Scripts Dedicated

PDP

Employer PDP

Subsidy

Wrap

  • EXPRESS SCRIPTS’

  • RECOMMENDATIONS FOR 2006

  • If you qualify for the subsidy, TAKE IT.

  • If you don’t qualify, UPDATE or take a Wrap.

  • Regardless, position yourself for possible changes in 2007.

Reduce spend

Minimize retiree disruption

Minimize administrative burden

Avoid risk of first-year program

Maintain flexibility for future


The market responded favorably to our approach

The Market Responded FavorablyTo Our Approach

  • Current Book

    • Managed care and carrier clients: 36 MA-PDs and 14 PDPs

    • Completed a Subsidy analysis for nearly 2,000 employer and union clients

    • Two employer clients considering becoming their own PDP

  • New Business

    • 2006

      • Three new managed care clients won — 125,000 Medicare lives

      • Six prospective managed care prospects — 300,000 Medicare lives

    • 2007

      • Current pipeline growing as we speak


Getting ready for 2006

Getting Ready For 2006

  • Clients’ PDP applications

  • Benefit design consulting and implementation

  • Supply chain and client contracting

  • People, technology, service

  • CMS compliant policies and procedures

  • Senior-focused communications and education


Summary

Summary

  • Well positioned for 2006

  • Our 2006 offensive strategy is to help our managed care and carrier clients profitably grow their MA-PDs and PDPs

  • We are building the foundation for 2007


Ed stiften senior vice president and cfo

Ed StiftenSenior Vice President and CFO

Express Scripts’ Value Proposition

Delivering Superior Financial Results and ROIC


Financial overview

Financial Overview

Q1 2005 Highlights

  • 1Q EPS $1.14 — up 28% from last year

  • Cash flow from operations of $138.1 million versus $97.8 million last year

  • Record adjusted claims of 142 million, up 16% from last year

  • Record generic utilization of 54% versus 49% last year

  • Gross profit per adjusted claim of $1.87 versus $1.77 last year (excluding non-recurring gain last year)

  • Increased 2005 EPS guidance


Financial overview1

Financial Overview

Quality of Earnings

(1)

(3)

(2)

Reflects a $70-$75 million reduction in Q2 2003 due to one-time impact of implementing a new wholesale purchase agreement

Excludes a $0.10 per share charge for the early retirement of debt

Excludes a $0.20 charge to increase legal reserves for the cost of defense.

* Reflects a 12-month moving average of free cash flow (cash from operations less CapX)


Investors meeting orlando fl

Peer Group Total Return

Our Job Is to Outperform This Peer Group Median Over the Long Term

*Reflects dividend yield


Components of eps growth 2004

Components of EPS Growth — 2004

6%

7%

8%

* Excluding $25 million charge to increase legal reserves for the cost of defense and $5.5 million termination payment received


U s prescription growth

U.S. Prescription Growth

Caremark

Medco

Express Scripts

Note: Rx growth for Medco, Caremark and Express Scripts reflect as configured today


Financial overview2

Financial Overview

EBITDA* per adjusted claim

10.5% CAGR

Pricing can be lowered as clients tighten formulary compliance, increase home delivery, utilize generics and restrict retail networks. These changes result in lower prices to our clients and greater profits to Express Scripts.

* A reconciliation of EBITDA to net income and to net cash provided by operating activities can be found in the Investor Relations

section of Express Scripts’ Web site, www.express-scripts.com under Presentations.

** Excluding $25 million charge to increase legal reserves for the cost of defense and $5.5 million termination payment received.


Gross profit sga ebitda per adj rx

Gross Profit/SGA/EBITDA per Adj. Rx

Future EBITDA per Adj. Rx Must Come From Gross Profit per Adj. Rx

  • * Excluding $25 million charge to increase legal reserves for the cost of

  • defense and $5.5 million termination payment received.


Focus on return on invested capital roic

Focus on Return on Invested Capital (ROIC)

* Reflects operating income less tax divided by average invested capital, which consists of stockholder’s equity, plus interest

bearing liabilities plus long-term deferred income taxes, net.

** Excludes $25 million charge to increase legal reserves for the cost of defense and 5.5 million termination payment received

ROIC is our Preferred Performance Metric


Why express scripts industry leading roic

Why Express Scripts? Industry-Leading ROIC

We Lead Our Peer Group in ROIC Performance

Source: Express Scripts Analysis


Our financial goals

Our Financial Goals

  • 15% + EBITDA growth

  • Increase gross profit per claim

  • Maintain ROIC leadership

5%-7%

14%-16%


George paz president and ceo1

George PazPresident and CEO

Express Scripts’ Value Proposition

Positioning Us for the Future


Investors meeting orlando fl

Why Express Scripts?A Strong Value Proposition

  • Our 'Golden Rule' of Alignment

  • The People To Grow the Business

  • Technologies Second to None

  • Operational and Service Excellence


Investors meeting orlando fl

Why Express Scripts?All the Right Growth Levers

  • New Sales

  • Upsells and Retention

  • Generics, Home Delivery and Specialty

  • Innovative Product Development

  • Strategic Deployment of Capital


Investors meeting orlando fl

INVESTORS’ MEETING — ORLANDO, FL

April 28, 2005


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