由于和沃尔格林（walgreens）在延长合同的协商中不顺利，快捷药方（Express Script）的2011年下半年交出的成绩单并不好看。在2012年，快捷药方的客户依然不可以在沃尔格林药店购买处方药。也因此，西维斯（CVS）成为快捷药方最大的客户，而西维斯的药剂管理部门成为了快捷药方最大的竞争者。这对快捷药方的议价能力显然不是好消息。但是快捷药方通过话费290亿美元收购美可保健（MHS），又重新在议价方面占据了主动。也就在此时，快捷药方真正确认了一点：沃尔格林药店比快捷药方更需要对方。快捷药方的股价也因此增长了36%，而且由于像Jim Simons 和Ralph Whitworth这样的对冲基金经理也意识到了快捷药方获得的巨大竞争优势，使这个势头继续保持。

快捷药方2012年Q2的季报也令人影响深刻。这也是自从4月份完成收购美可保健后第一次公布报表。调整后每股收益上升24%到0.88美元，调整后处方药销售量也上升了118%到4.04亿单。又因为快捷药方此时拥有比西维斯多57%的处方单量，使快捷药方与西维斯的差距迅速拉大，但是这个差距预期会因为UnitedHealth (UNH)转投西维斯而有所减少。快捷药方的优异表现使管理层将其2012年指导调整后收益调高至每股$3.60-$3.75(之前的指导收益: $3.36-$3.66)。快捷药方的32倍的市盈率相比西维斯16倍的市盈率来说的确不便宜。公司有的内部人员已经注意到了快捷药方的过高市盈率，并在公司股价走势出现之后卖出了14.512万股份。在2012年6月31号，最大的内部持有人，乔治帕斯，卖掉了12.911
万股份，而现在帕斯还拥有73.1627万股份。

也许对快捷药方，最有价值的数字就是：在于沃尔格林的争执之后，他们预期到2013年能保留现有的95%的客户（除了联合保健之外）。药剂福利管理业务也被认为在未来的大趋势中受益。行业合并，老龄化趋势，品牌药的专利到期，保健护理费用降低，由于医改导致的更大规模的保险受众，以及消费者对于邮购处方药更大的接受度都为美国领先的药剂福利管理商描绘了一幅光明的前景图。医药福利管理部门在仿制药上能获得更高的毛利，而且美国处于一大波品牌药专利过期的趋势中。

药店行业内的一个发展方向是家庭递送和特种药店，这两者占据2003年总计5%的的处方药单量。在2007年之前，这个数字已经翻倍到了10%，而且预计在2012年底前达到20%。特种药店是通过销售昂贵的生物技术药物为有慢性病的病人服务的。特种药店配发的药品通常是注射剂和灌注剂，而且常常是诊所的专业人士所管理的。快捷药方认为他们的这个部门收入同比上升67亿美元，或者说在过去六个月上升了95.7%。这个部门过去六个月已经从占医药福利管理部门31%的收入上升到36%。

现在美国透明化医疗保健费用和疗法的压力越来越大。快捷药方最近推广一种创新性的在线工具，来帮助病人了解他们患的病以及治疗的机理，而这个新上线的在线服务结合了视觉和听觉上的信息。这个工具的目标用户是患有严重疾病的病人，比如丙型肝炎、血友病、除自我免疫缺陷的多发性硬化症。根据NCPIE（National Council on Patient Information and Education）最新公布的数据，超过60%的病人不能正确回忆起10分钟前医生告诉他们的用药信息。视觉上的教程的目标就是使这种情况尽量减少。

Express Scripts: Sustainable Competitive Advantage in a Growing Industry
By MIKE

Express Scripts (NASDAQ:ESRX) experienced a rough second half in 2011 stemming from the prolonged contract negotiations with Walgreens (NYSE:WAG). When 2012 rolled around, ESRX clients could no longer pick up their prescriptions from WAG. Without WAG in their network, CVS (NYSE:CVS) became ESRX’s biggest customer and CVS Caremark became their largest competitor. ESRX grew their bargaining power when they acquired Medco outright for $29 billion. This is when ESRX confirmed their preconceived notion that WAG needed ESRX more than ESRX needed WAG. YTD, ESRX has seen their stock price rise 36%, and momentum continues to build as hedge fund manager like Jim Simons and Ralph Whitworthbegin to realize the competitive advantageESRX has built.

Express Scripts reported impressive results for 2012 2Q on August 7. This was the first quarter since the Medco acquisition close last April. Adjusted EPS improved 24% to $0.88. Adjusted prescription volume was up 118% to 404 million. The spread widened between ESRX and their largest competitor, CVS, as ESRX managed 57% more prescriptions than CVS. This impressive spread between ESRX and the second largest PBM is expected to decline next year when ESRX loses UnitedHealth (UNH) business. The strong performance caused management to increase its adjusted earnings guidance for 2012 to $3.60-$3.75 per share (previous guidance: $3.36-$3.66). ESRX is not cheap with a PE ratio of 32 while CVS trades at 16x its earnings. Insiders have taken notice to the high P/E and have sold 145,120 shares since the company has picked up momentum. On June 31, 2012, the biggest insider at ESRX, George Paz, sold 129,110 shares. Paz currently hold 731,627 shares.

Perhaps the most impressive figure from ESRX is after the WAG dispute, they are expecting to retain over 95% of clients for 2013 (excluding UnitedHealth). PBM’s are also positioned to benefit from positive trends further down the road. Industry consolidation, an aging population, brand name drugs patent expirations, health-care cost-containment efforts, growth in the number of people with insurance as a result of health reform, and increasing customer acceptance of mail-order pharmacies all paint a bright future for America’s leading PBM. The PBM makes much higher margins on generic drugs, and the U.S. is in the midst of a massive wave of patent expirations on blockbuster brand-name drugs.

A growing division of the pharmacy industry is home delivery and specialty pharmacies, which comprised of 5% of total prescriptions in 2003. By 2007, that figure had doubled to 10%, and it is expected to represent 20% of total prescriptions by the end of 2012. Specialty pharmacies serve patients with chronic diseases by dispensing high cost biotechnology drugs. Specialty pharmaceuticals typically are administered by injection or infusion, and often, are administered by clinical professionals. Express Scripts saw their home delivery and specialty segment revenues increased $6.7 billion YOY, or 95.7% for the six months ended June 30, 2012. The segment has grown from 31% of the PBM’s revenues in 2010, to 36% for the six months ended June 30, 2012.

There has been a big push in America to make health costs and remedies more transparent. Express Scripts recently launched an innovative online tool to facilitate better understanding among patients of the disease affecting them and the mechanism of the resultant. Express Script’s new online offering give patients visual and audible information to help improve understanding. The tool targets patients suffering from serious diseases such as hepatitis C, hemophilia, multiple sclerosis apart from autoimmune deficiencies. According to data released by National Council on Patient Information and Education more than 60% of patients fail to reproduce correctly the information provided to them by their doctors about the drugs prescribed to them after ten minutes. Virtual coaching aims to bring down this discrepancy.