Express Scripts 

Pharmacy Benefit Services 

Regulated Markets

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Health plans need expanded capabilities to succeed in today's highly competitive marketplace

When having the right PBM matters

You and your members deserve a PBM who can help you thrive among industry and regulatory complexities, personalize care to your needs, and evolve rapidly to keep up with the pace of new drugs and data.

Health plans must do more than simply maintain membership

They must grow strategically to ensure long-term success while delivering high-quality care.

Shaping the future of health care in Regulated Markets

Through deep expertise, operational excellence, strategic guidance and industry-leading innovation, Express Scripts helps health plans succeed and lead in Regulated Markets.

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Taking a proactive approach

Express Scripts Regulated Markets drives affordability and cost containment for our health plan clients.
In 2023, our clients realized $64B in savings, a -0.9% decrease in member cost share and a 20% negative trend.1

Our Regulated Times newsletter keeps you up to date on the latest federal and state legislation, breaking news, current initiatives, thought leadership and upcoming events related to Medicare, Medicaid, Marketplace plans and EGWP.

View latest newsletter

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Tailored guidance to ensure quality for the life of your plan

Extract more value with effective and compliant methods of managing costs.

80% of Express Scripts MAPD enrolled lives are in 4-5 Star Part D plans2

 

We leverage industry metrics and data to identify opportunities and enact strategies that enhance the quality of your plan

 

39% of Express Scripts health plan clients achieved a 4 or higher Quality Rating System (QRS) score, outperforming the average of other leading PBMs3 

BEYOND GROWTH

Building a strong future, together

Sustainable growth encompasses more than just metrics; it involves fostering member engagement, maintaining compliance and operational excellence, and ensuring adherence to regulatory standards in a constantly evolving environment. That’s why we don’t just focus on acquisitions–we help health plans build long-term value.

a leader among colleagues

34M

health plan lives supported across all regulated markets4

Extensive experience, unmatched expertise

Through client engagement, advocacy and market presence, we provide best-in-class care and strategic guidance, empowering clients to navigate the constantly changing Regulated Markets landscape.

a leader among colleagues
The world of Regulated Markets is constantly changing.

You need a dependable information source that changes along with it. Watch our webinars below to learn more.

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Webinar: Creating Better Health Outcomes with Digital Tools and Artificial Intelligence

Webinar: Driving Quality and Advancing Healthcare Access at the Pharmacy

Webinar: Meeting Members Where They Are

Webinar: Improving Member Accessibility to Care

Webinar: Building CMS Health Equity Competencies through Quality Care Enhancements

Webinar: Improving Member Health through Technology and Population Interventions

Additional Regulated Markets Resources

Medicare Prescription Payment Plan Educational Overview

Learn how we can help support your plan.

Express Scripts Regulated Markets provides flexible support for Medicare, Medicaid, and Marketplace populations.
Contact us

Sources

  1. 2023 DTR Key Data Points document from the Evernorth Research Institute

  2. Calculated using the following: 2025 Star Ratings Data Tables — Part C and D Performance Data | CMS. Monthly Enrollment by Contract — September 2024 — Enrollment by Contract 2024 09 | CMS. Internal CMS client information — Utilized our client list for 2023 Plan year which is the data used for calculating the 2025 Star Ratings

  3. October 2024 Quality Rating System (QRS) data from CMS and data from Tableau

  4. Internal reporting and CMS Enrollment Data