Who Owns Express Scripts?

Express Scripts was founded in 1986 in Maryland Heights, Missouri, as a subsidiary of Sanus Corporation Health Systems, a managed care company. The founding team, which included Barrett Toan and Sander Flaum, identified an opportunity to reduce prescription drug costs for health plans and employers by processing claims more efficiently and shifting appropriate prescriptions to lower-cost mail-order fulfillment. The company's initial business model centered on mail-order pharmacy services, which offered cost savings over retail pharmacy for maintenance medications by enabling bulk purchasing and eliminating retail markup.

The company was spun off from Sanus and became publicly traded in 1992, providing it with capital to expand its PBM capabilities and pursue acquisitions. Throughout the 1990s, Express Scripts grew rapidly as employers and health plans increasingly sought to manage escalating prescription drug costs. The company developed proprietary drug utilization management tools, formulary design capabilities, and clinical programs that helped clients control pharmacy spending while maintaining appropriate medication access. By the late 1990s, Express Scripts had established itself as one of the top three PBM companies in the United States alongside Medco Health Solutions and Caremark Rx.

A series of strategic acquisitions in the 2000s further consolidated Express Scripts' market position. The company acquired National Prescription Administrators in 2000, Diversified Pharmaceutical Services from SmithKline Beecham in 1994, and ValueRx in 2000, among others. Each acquisition added client relationships, geographic coverage, or specialized capabilities that strengthened the company's competitive position. Express Scripts also invested heavily in specialty pharmacy, recognizing that high-cost specialty medications for conditions such as cancer, multiple sclerosis, and rheumatoid arthritis were becoming an increasingly significant driver of pharmacy benefit costs.

The most transformative transaction in Express Scripts' independent history was the acquisition of Medco Health Solutions, announced in July 2011 and completed on April 2, 2012, for approximately $29.1 billion. The Medco merger created the largest PBM in the United States by prescription volume, serving approximately 85 million members and processing more than 1.4 billion prescriptions annually. The Federal Trade Commission approved the merger after an extensive review, concluding that the combined entity would not substantially lessen competition in the PBM market. The merger significantly expanded Express Scripts' specialty pharmacy capabilities, clinical programs, and technology infrastructure.

Following the Medco integration, Express Scripts operated as an independent publicly traded company until Cigna's acquisition announcement on March 8, 2018. The $67 billion deal, which closed on December 20, 2018, was the largest acquisition in Cigna's history and represented a strategic bet that integrated health services companies combining insurance and pharmacy benefits would have structural advantages over standalone insurers or PBMs. The acquisition was completed after regulatory review and shareholder approval, with Express Scripts shareholders receiving $48.75 in cash and 0.2434 shares of Cigna stock per Express Scripts share.

Under Cigna's ownership, Express Scripts has been integrated into the Evernorth Health Services segment and has continued to evolve its PBM model in response to regulatory pressure and market dynamics. In 2025, Cigna and Express Scripts reached a landmark settlement with the Federal Trade Commission related to insulin pricing practices, resolving allegations that Express Scripts had manipulated insulin prices and impeded patient access to lower-cost alternatives. The settlement, announced in early 2026, required Express Scripts to implement specific formulary and pricing transparency measures. Cigna CEO David Cordani has described Express Scripts' evolving PBM model as aligned with regulatory expectations for greater transparency, with adjusted revenue from Express Scripts rising 18% in 2025 driven by volume growth and increasing biosimilar adoption.