Controls and Project Manager and Tn

							                      Effectively managing trend and providing
                      solid member satisfaction

       Costs continue to rise                                             Utilization increasing


        New drugs                                             $350

                                                                           Member better
        More expensive
                                                                          informed
        Just beginning                                        Billions




                                                                           More active in drug
                                                                          choice
                                                                   $0

               1960      1970    1980    1990    2000   2010
                                    Total Drug Spend




Source: 2001 Drug Trend Report                                                                     1
                    Balanced approach to cost control


         Balances member selection               Core Offering
                                                     3-tier copay means broad
          and convenience with trend                   access to brand medications
                                                     Extensive network of
                Provides member choice
                                                       pharmacies
                Engages & educates members
                                                  Programs
                                                      Member safety
                                                      Balanced cost controls
                 POTENTIAL                 1
                 SAVINGS             8%-13%
                                                  Member Support
                  MEMBER                             Education on ways to save
                 IMPACT              LOW             Award winning websites




A proven approach to manage trend and support members
    1   Over unmanaged 2-tier plan                                              TN   2
                             Why Move to a 3-Tier Plan?

              High Impact                           Maintains          Common Approach
                                                    Selection

      Proper member                             Drugs available as      Majority of clients
       incentives                                 needed                   utilize a 3-tier
                                                                           benefit design
      Enhances                                  Members decide
       manufacturers                              priorities
       discounts
                                                                           Plans using 3-tier
      Provides savings of                                                 benefit
                                          1
       up to 8%-13%

                                                                                     57%

                      An effective and balanced response to the increasing costs
1: Savings versus 2 tier unmanaged plan                                                          3
                               Managing Change with Members

        Perception is often worse                                … so proactive education &
        than reality...                                          communication are critical

                                                                     ESI Member Support
                   Natural tendency for members
                    to resist change
                                                                     Program Components
                              Lack of education leads to           Basic education & awareness
                               confusion
                                                                    Inbound member support
                   Impact manageable
                                                                    Member influence
                              Majority of call volume occurs
                               in first 6 weeks                          Proactive
                              Alleviated with proper                    Multi-channel
                               communication                             Physician communications

         Members want to
         understand benefit                                74%
         design rationale
Source: Express Scripts Guide to Pharmacy Benefit Design                                             4
                             Why Should I Promote Mail Service?

                  Offers meaningful plan savings
                           Reduced fees, higher discounts & improved use of generics
                           Best approach for managing maintenance medications


                  Delivers significant member benefits
                           Convenient: Discreet, multi-month fill
                           Lower net copays


                  Often an untapped source for improved member satisfaction
              Would use mail                                     Are unsure if benefit
              service if it saved                          67%   plan includes mail      38%
              money                                              service


                     Significant opportunity especially when promoted well
Source: Express Scripts Guide to Pharmacy Benefit Design                                   5
            What Makes ESI Mail Service Different?

                                    Efficient
Aligned Incentives                                             Superior Results
                                   Processing

   Never affiliated with        Unique advanced              Lower overall net
    another part of               technology                    costs
    distribution channel             Low cost, high
                                      speed capabilities
   First priority to save           27 mm                    Member Satisfaction
    money for sponsors                prescriptions             with Mail Service
    and members                       shipped in 2002
        Improved generic        Proper safeguards
         substitution rates          99.99% accuracy
                                                                           96%
        Formulary                    rate
         reinforcement               Pharmacists verify
                                      & inspect each
                                      prescription
                                                                                     6
                        Generics: A win-win solution

       A significant & expanding                      … with a simple, powerful
       opportunity …                                  solution


            Increased awareness and                     Generics Preferred
             acceptance of generics                        Creates incentives for
                                                            members to select generics
            New wave of generic
                                                           Provides clear guidelines to
             alternatives                                   pharmacists
                      26.7% of the 2001 spend will
                       lose patents by 2005              Proactive communications
                                                           Targets & educates “high
            Must align incentives to                       cost” members & physicians
             maximize savings                              Reinforced at point of sale




Source: 2001 Drug Trend Guide                                                              7
                 ESI Web Portal: Enhance service while reducing
                 costs

            #1 Ranked Website in Online Customer Experience*

                             Member                                                                    Superior Client
                            Education                                                                     Service

          Industry leading online service                                                     Ad-hoc executive reporting
          Streamlined prescription                                                            Predictive modeling tools
           fulfillment
                                                                                               Extensive plan management
          Enhanced health management




* According to the May 2003 Online Customer Respect study versus 38 consumer healthcare sites                                8
    Client Support: Services

   Account Management
      Timely consultative approach
      Superior client communication & services




   Clinical Leadership
      Independent formulary development
      Drug pipeline evaluations & reporting




   Financial Experts
      Unmatched pharmacy benefit expertise
      Proprietary design modeling tools




            A partner you can trust to deliver
                                                  9
Express Scripts Transition Program

     Well defined & tested transition process
                        System Readiness                         Communications

                        •   Eligibility                     •    Member
                        •   Benefits                        •    Pharmacy
                        •   Internet Tools                  •    Physician



        Operations                                                               PBM Transition Data

•   Call Center                              Implementation
                                                                             •   Prior Authorizations
•   Mail Service                                 Project                     •   Claims History
                                                Manager                      •   Open Refill File


                                                                   QA & Testing
                       Account Management

                   •   Dedicated Teams                  •       End-to-end Testing
                   •   Client Involvement               •       Benefit Verification
                   •   Cross-Functional
                       Coordination
                                                                                                        10
Why Express Scripts: Our Principled
Approach




                                      11