ESRX - Express Scripts

[muscleman]

The PBM does not get $300. Usually 90% of rebates are passed on to payers.

 

http://insights.cvshealth.com/sites/default/files/cvs-health-insights-executive-briefing-epipen-what-you-need-to-know-october-2016.pdf

 

The Payors in the executive briefing are the employers, not the patients.  In fact the briefing clarifies the patients are paying higher in high deductible plans.  Many plans now a days have higher deductible than 600$.  The quote from Briefing is given below.  The above articles I gave from The Hill and Forbes talk about the PBMs getting the rebates, but yet the patient in high deductible plan paying full price which the briefing is supporting.

 

"Members of consumer-driven or high deductible plans can

also face a large payment, which can pose a real deterrent

when filling the prescription. Payors can make a broad plan

design change to share all rebates with consumers at the

point of sale to help make prescriptions more affordable for

their members." Emphasis in bold added.

 

Can you please clarify a bit? I am confused. Who are the employers? You mean insurance companies?

From the briefing it sounds like consumers always pay $70 and insurance companies pay $220, and the $220 cost raises by 3.6% or so a year, which is small.

If this is the case, then what's the point of hiking the drug prices by 150% and make everyone angry, only to give big discounts later and not making much money from the hike?

 

 

[Investor20]

The PBM does not get $300. Usually 90% of rebates are passed on to payers.

 

http://insights.cvshealth.com/sites/default/files/cvs-health-insights-executive-briefing-epipen-what-you-need-to-know-october-2016.pdf

 

The Payors in the executive briefing are the employers, not the patients.  In fact the briefing clarifies the patients are paying higher in high deductible plans.  Many plans now a days have higher deductible than 600$.  The quote from Briefing is given below.  The above articles I gave from The Hill and Forbes talk about the PBMs getting the rebates, but yet the patient in high deductible plan paying full price which the briefing is supporting.

 

"Members of consumer-driven or high deductible plans can

also face a large payment, which can pose a real deterrent

when filling the prescription. Payors can make a broad plan

design change to share all rebates with consumers at the

point of sale to help make prescriptions more affordable for

their members." Emphasis in bold added.

 

Can you please clarify a bit? I am confused. Who are the employers? You mean insurance companies?

From the briefing it sounds like consumers always pay $70 and insurance companies pay $220, and the $220 cost raises by 3.6% or so a year, which is small.

If this is the case, then what's the point of hiking the drug prices by 150% and make everyone angry, only to give big discounts later and not making much money from the hike?

 

I wanted to post a follow up but did not get to my computer.  The pictorial "Payor cost significantly reduced" also says

 

"Illustrative example of a single fill of EpiPen under a flat copay plan design". Emphasis in bold added

 

That is it is applicable in good old days where there is no deductible.

 

The situation with deductible plans is given in the text where they mention "Members of consumer-driven or high deductible plans can

also face a large payment"...that is under most plans today with deductibles, patients are paying full 600$ price, not 70$.

[muscleman]

The PBM does not get $300. Usually 90% of rebates are passed on to payers.

 

http://insights.cvshealth.com/sites/default/files/cvs-health-insights-executive-briefing-epipen-what-you-need-to-know-october-2016.pdf

 

The Payors in the executive briefing are the employers, not the patients.  In fact the briefing clarifies the patients are paying higher in high deductible plans.  Many plans now a days have higher deductible than 600$.  The quote from Briefing is given below.  The above articles I gave from The Hill and Forbes talk about the PBMs getting the rebates, but yet the patient in high deductible plan paying full price which the briefing is supporting.

 

"Members of consumer-driven or high deductible plans can

also face a large payment, which can pose a real deterrent

when filling the prescription. Payors can make a broad plan

design change to share all rebates with consumers at the

point of sale to help make prescriptions more affordable for

their members." Emphasis in bold added.

 

Can you please clarify a bit? I am confused. Who are the employers? You mean insurance companies?

From the briefing it sounds like consumers always pay $70 and insurance companies pay $220, and the $220 cost raises by 3.6% or so a year, which is small.

If this is the case, then what's the point of hiking the drug prices by 150% and make everyone angry, only to give big discounts later and not making much money from the hike?

 

I wanted to post a follow up but did not get to my computer.  The pictorial "Payor cost significantly reduced" also says

 

"Illustrative example of a single fill of EpiPen under a flat copay plan design". Emphasis in bold added

 

That is it is applicable in good old days where there is no deductible.

 

The situation with deductible plans is given in the text where they mention "Members of consumer-driven or high deductible plans can

also face a large payment"...that is under most plans today with deductibles, patients are paying full 600$ price, not 70$.

 

Got it!

For high deductible plans, like the HSA plan, it is most likely the patients who are paying, so the insurers don't care as much the drug prices they pay. But for copay plans, the insurers care more, so they have to negotiate harder on the drug prices. Is this true?

 

I've been using an HSA plan for the past few years and kind of feel like being ripped off.......  ::)

 

 

[Investor20]

The PBM does not get $300. Usually 90% of rebates are passed on to payers.

 

http://insights.cvshealth.com/sites/default/files/cvs-health-insights-executive-briefing-epipen-what-you-need-to-know-october-2016.pdf

 

The Payors in the executive briefing are the employers, not the patients.  In fact the briefing clarifies the patients are paying higher in high deductible plans.  Many plans now a days have higher deductible than 600$.  The quote from Briefing is given below.  The above articles I gave from The Hill and Forbes talk about the PBMs getting the rebates, but yet the patient in high deductible plan paying full price which the briefing is supporting.

 

"Members of consumer-driven or high deductible plans can

also face a large payment, which can pose a real deterrent

when filling the prescription. Payors can make a broad plan

design change to share all rebates with consumers at the

point of sale to help make prescriptions more affordable for

their members." Emphasis in bold added.

 

Can you please clarify a bit? I am confused. Who are the employers? You mean insurance companies?

From the briefing it sounds like consumers always pay $70 and insurance companies pay $220, and the $220 cost raises by 3.6% or so a year, which is small.

If this is the case, then what's the point of hiking the drug prices by 150% and make everyone angry, only to give big discounts later and not making much money from the hike?

 

I wanted to post a follow up but did not get to my computer.  The pictorial "Payor cost significantly reduced" also says

 

"Illustrative example of a single fill of EpiPen under a flat copay plan design". Emphasis in bold added

 

That is it is applicable in good old days where there is no deductible.

 

The situation with deductible plans is given in the text where they mention "Members of consumer-driven or high deductible plans can

also face a large payment"...that is under most plans today with deductibles, patients are paying full 600$ price, not 70$.

 

Got it!

For high deductible plans, like the HSA plan, it is most likely the patients who are paying, so the insurers don't care as much the drug prices they pay. But for copay plans, the insurers care more, so they have to negotiate harder on the drug prices. Is this true?

 

I've been using an HSA plan for the past few years and kind of feel like being ripped off.......  ::)

 

Actually no, it is worse.  Taking Epipen as an example.

 

Epipen retail price (price one would pay at pharmacy) is about 600$ - a person without insurance.

For epipen (based on forbes article I posted before in this thread), a person with a high deductible also pays 600$.

But the Manufcturer Mylan claims that they get $274 (see below).

The rest is shared by PBM, Insurer and they pass on some of this in form of premium reduction to Employer/patient. Who keeps how much of this extra 325$ is the conversation.

 

The part I don't like about this is for people who don't have insurance or chose high deductible plan, they are artificially inflating a 274$ (+distribution costs) product to 608$ retail price.

 

""The WAC for a two-unit pack of EpiPen Auto-Injectors is $608. After rebates and various fees, Mylan actually receives $274. "

http://www.cnbc.com/2016/09/21/mylan-ceo-says-epipen-profits-no-where-near-devices-600-sticker-price.html

PBM claims

[DooDiligence]

I work for a large privately owned company which self insures & uses ESRX.

 

I was recently considering the huge implications of a company self insuring & its contribution to our overall compensation (I'm pretty healthy & would prefer to not collect the "bonus" but the potential is there & the liability to the company could be enormous.)

 

My sense of fairness causes me to bridle at how high deductible patients bear a bigger brunt here but at the same time, I can see how low deductible plan sponsors would kind of need to recapture some of their spend.

 

Do you think there's any merit to the system actually reducing frivilous or gratuitous abuse of end user prescription purchases (kind of not for my low deductible plan but maybe overall?)

 

Do low deductible plans have more exclusions to the formulary than high deductible plans?

 

BTW thanks to all for helping me wrap my head around this extremely complicated business!

 

I'm looking for a corrolary for my pharma bets & ESRX and / or CVS are my favs (haven't decided yet...)

[DooDiligence]

I just read recently that Lilly has partnered with

 

https://www.blinkhealth.com

 

to offer high deductible patients a 40% discount for prepaying their insulin.

 

I haven't done much more than glance at this (anyone else know how prevalent these programs are for other meds?)

[DooDiligence]

I have questions about ESRX revenue recognition.

 

The following are excerpts from their 2015 10K & may require additional reading of the original document. My choice of which content to include here may cause things to be taken out of context (In other words, you can't trust a newbie!)

 

10K - Revenues generated by our segments can be classified as either tangible product revenues or service revenues. We earn tangible product revenues from the sale of prescription drugs by retail pharmacies in our retail pharmacy networks and from dispensing prescription drugs from our home delivery and specialty pharmacies. Service revenues include administrative fees associated with the administration of retail pharmacy networks contracted by certain clients, medication counseling services and certain specialty distribution services.

 

Revenues related to the dispensing of prescription drugs by retail pharmacies in our networks consist of the prescription price (ingredient cost plus dispensing fee) negotiated with our clients, including the portion to be settled directly by the member (co-payment), plus any associated administrative fees. These revenues are recognized when the claim is processed. When we independently have a contractual obligation to pay our network pharmacy providers for benefits provided to our clients’ members, we act as a principal in the arrangement and we include the total prescription price as revenues. Although we generally do not have credit risk with respect to retail co-payments, the primary indicators of gross treatment are present. When a prescription is presented by a member to a retail pharmacy within our network, we are solely responsible for confirming member eligibility, performing drug utilization review, reviewing for drug-to-drug interactions, performing clinical intervention which may involve a call to the member’s physician, communicating plan provisions to the pharmacy, directing payment to the pharmacy and billing the client for the amount it is contractually obligated to pay us for the prescription dispensed, as specified within our client contracts. We also provide benefit design and formulary consultation services to clients. We have separately negotiated contractual relationships with our clients and with network pharmacies, and under our contracts with pharmacies we assume the credit risk of our clients’ ability to pay for drugs dispensed by these pharmacies to clients’ members. We, not our clients, are obligated to pay the retail pharmacies in our networks the contractually agreed upon amount for the prescription dispensed, as specified within our provider contracts. These factors indicate we are a principal and, as such, we record the total prescription price contracted with clients in revenues.

 

Me - The pharmacy carries the medication as an inventory item on the BS & yet Express Scripts reports the sale as their own revenue? Does the pharmacy also report the sale as revenue?

 

-----

 

10K - If we merely administer a client’s network pharmacy contracts to which we are not a party and under which we do not assume credit risk, we record only our administrative fees as revenue. For these clients, we earn an administrative fee for collecting payments from the client and remitting the corresponding amount to the pharmacies in the client’s network. In these transactions we act as a conduit for the client. Because we are not the principal in these transactions, drug ingredient cost is not included in our revenues or in our cost of revenues.

 

Me - Unless Express Scripts actually inventories & ships medications, shouldn't orders filled by pharmacy inventories also be treated same as above for ESRX revenue recognition?

 

-----

 

10K - In May 2014, the FASB issued Accounting Standards Codification (“ASC”) Topic 606, Revenue from Contracts with Customers, which supersedes ASC 605, Revenue Recognition. The new standard requires companies to recognize revenues upon transfer of goods or services to customers in amounts that reflect the consideration which the company expects to receive in exchange for those goods or services. In July 2015, the FASB delayed the effective date of the standard by one year. The new guidance is effective for financial statements issued for annual reporting periods beginning after December 15, 2017 and early application is not permitted before the original effective date of annual reporting periods beginning after December 15, 2016. We are currently evaluating the impact of this standard on our consolidated financial statements.

 

Me - Am I seeing revenue recognition in the wrong light or does this FASB change have the potential to make ESRX show significantly lower revenues & higher margins? (Possibly even higher margins than the manufacturers?)

 

-----

 

10K - Many of our contracts contain terms whereby we make certain financial and performance guarantees, including the minimum level of discounts or rebates a client may receive, generic utilization rates and various service guarantees. These clients may be entitled to performance penalties if we fail to meet a financial or service guarantee. Actual performance is compared to the guarantee for each measure throughout the period and accruals are recorded as an offset to revenues if we determine our performance against the guarantee indicates a potential liability. These estimates are adjusted to actual when the guarantee period ends and we have either met the guaranteed rate or paid amounts to clients. Historically, adjustments to our original estimates have been immaterial. (Emphasis added by me.)

 

Me - It seems that adjustments would be immaterial if you're evaluating your own performance...

 

-----

 

10K - Gross rebates and administrative fees earned for the administration of our rebate programs, performed in conjunction with claims processing services provided to clients, are recorded as a reduction of cost of revenues and the portion of the rebate payable to customers is treated as a reduction of revenues.

 

When we earn rebates and administrative fees in conjunction with formulary management services, but do not process the underlying claims, we record rebates received from manufacturers, net of the portion payable to customers, in revenues.

 

Me - Anyone remember the scene in Robin Hood where Russell Crowe was doing the "pea under the shell" thingy? He may have been honest in that there really was a pea but he still wound up in a pillory.

 

-----

 

10K - Because of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements. Also, projections of any evaluation of effectiveness to future periods are subject to the risk that controls may become inadequate because of changes in conditions, or that the degree of compliance with the policies or procedures may deteriorate.

 

/s/ PricewaterhouseCoopers LLP

St. Louis, Missouri February 16, 2016

 

Me - What does this mean?

 

----- end of excerpted 10K & start of newbie comments -----

 

It looks like net income & depreciation of goodwill are neck in neck as contributors to operating cash flow (lots of goodwill left...)

 

Am I wrong or can they continue to generate big FCF even if their net dropped significantly.

 

Am I creating hair that doesn't exist with regards to inflated revenue recognition?

[KCLarkin]

They arent trying to inflate revenue. They are trying to deflate margins. If they only counted net revenue, their margins would be obscene. Payers and politicians would put them in the pillory.

[DooDiligence]

They arent trying to inflate revenue. They are trying to deflate margins. If they only counted net revenue, their margins would be obscene. Payers and politicians would put them in the pillory.

 

Thanks for commenting.

 

That was my point.

 

Will the FASB ASC topic 606 force them to change this at the end of 2017?

 

I haven't looked at CVS PBM revenues so I don't know whether they use the same recognition methods as ESRX but it would be interesting if they didn't...

[KCLarkin]

10K - In May 2014, the FASB issued Accounting Standards Codification (“ASC”) Topic 606, Revenue from Contracts with Customers, which supersedes ASC 605, Revenue Recognition. The new standard requires companies to recognize revenues upon transfer of goods or services to customers in amounts that reflect the consideration which the company expects to receive in exchange for those goods or services. In July 2015, the FASB delayed the effective date of the standard by one year. The new guidance is effective for financial statements issued for annual reporting periods beginning after December 15, 2017 and early application is not permitted before the original effective date of annual reporting periods beginning after December 15, 2016. We are currently evaluating the impact of this standard on our consolidated financial statements.

 

Me - Am I seeing revenue recognition in the wrong light or does this FASB change have the potential to make ESRX show significantly lower revenues & higher margins? (Possibly even higher margins than the manufacturers?)

 

If the changes forced ESRX to use Net revenue, there would be a material impact on revenue. The fact that they say they are "currently evaluating" the impact, suggests to me that they think they will be able to continue with Gross revenue, for the most part. Otherwise, the disclosure would have stronger wording.

[DooDiligence]

10K - In May 2014, the FASB issued Accounting Standards Codification (“ASC”) Topic 606, Revenue from Contracts with Customers, which supersedes ASC 605, Revenue Recognition. The new standard requires companies to recognize revenues upon transfer of goods or services to customers in amounts that reflect the consideration which the company expects to receive in exchange for those goods or services. In July 2015, the FASB delayed the effective date of the standard by one year. The new guidance is effective for financial statements issued for annual reporting periods beginning after December 15, 2017 and early application is not permitted before the original effective date of annual reporting periods beginning after December 15, 2016. We are currently evaluating the impact of this standard on our consolidated financial statements.

 

Me - Am I seeing revenue recognition in the wrong light or does this FASB change have the potential to make ESRX show significantly lower revenues & higher margins? (Possibly even higher margins than the manufacturers?)

 

If the changes forced ESRX to use Net revenue, there would be a material impact on revenue. The fact that they say they are "currently evaluating" the impact, suggests to me that they think they will be able to continue with Gross revenue, for the most part. Otherwise, the disclosure would have stronger wording.

 

Thanks! Still learning here...

[DooDiligence]

In their recent earnings call, management stated that they pass 100% of DIR's back to sponsors.

 

They also laid out pass throughs of rebates by saying they average 89% (some sponsors will take 10% because they only want to pay for one program & other sponsors who want a higher % of rebates will pay for more programs.)

 

Interesting call...

 

Did anyone else listen & if so, what's your take?

 

I'm thinking about buying some (blackout ends tomorrow I believe & management says they intend to start buying - FWIW.)

[KCLarkin]

ESRX officially announces that Anthem contract will not renew when contract ends Dec 31, 2019. Anthem is currently running an RFP process and ESRX is not bidding.

 

http://www.prnewswire.com/news-releases/express-scripts-announces-2017-first-quarter-results-provides-update-on-anthem-relationship-and-visibility-into-core-pbm-business-excluding-contribution-from-anthem-coventry-and-catamaran-300444525.html

 

Press release includes revenue and EBITDA contribution from Anthem.

[AzCactus]

Interesting to see about Brave Warrior here.  They initiated a position in Q4 and after the after hours drop wonder how they'll proceed.

[Phaceliacapital]

CEO Interview:

 

http://www.cnbc.com/2017/04/24/express-scripts-ceo-would-love-to-keep-anthem-as-client.html

 

Don't really know what to think..

[xtreeq]

It's all about the core!

[Spekulatius]

CEO Interview:

 

http://www.cnbc.com/2017/04/24/express-scripts-ceo-would-love-to-keep-anthem-as-client.html

 

Don't really know what to think..

 

98% retention rate does not matter, if you still lose your largest customer which accounts for 18% or your revenue. It is interesting that Anthem won't even talk about them with respect to a contract extension. This may be a watershed event.

 

I owned this ago years ago, but sold about 6 month ago, as I felt their customer relationships get more contentious.

[tooskinneejs]

Interesting article that explains and diagrams the money flows in the drug industry between manufacturers, wholesalers, pharmacies, consumers, PBMs, and insurers:

 

http://www.businessinsider.com/express-scripts-esrx-anthem-not-renewing-pbm-2017-4

 

 

 

 

[KCLarkin]

Interesting article that explains and diagrams the money flows in the drug industry between manufacturers, wholesalers, pharmacies, consumers, PBMs, and insurers:

 

http://www.businessinsider.com/express-scripts-esrx-anthem-not-renewing-pbm-2017-4

 

Except, the "article" appears to be complete BS. It says that the PBM is making $35 on a $100 list price script. ESRX in their last news release stated that they are making $2.05 in EBIDA per claim.

[DooDiligence]

NEW YORK, April 26 (Reuters) - Two days after Express Scripts Holding Co said it had lost its contract to do pharmacy benefit management for Anthem Inc, Anthem's top executive said the company had not made a decision on or ruled out any vendor.

 

While declining to comment specifically on the Express Scripts situation, which is being litigated in federal court, Anthem Chief Executive Officer Joseph Swedish said during a call with investors that "we've not ruled anyone in or out."

 

-----

 

Wentworth should check / raise here...

 

(I'm done scouting & now it's on to soldiering...)

[Phaceliacapital]

(I'm done scouting & now it's on to soldiering...)

 

Is that by any chance lingo from that ted talk on being right??

 

Also: If you read the conf call transcript and compare it to the language in their disclosure report on Anthem's economics etc, the language is quite different between the two.

[DooDiligence]

(I'm done scouting & now it's on to soldiering...)

 

Is that by any chance lingo from that ted talk on being right??

 

Also: If you read the conf call transcript and compare it to the language in their disclosure report on Anthem's economics etc, the language is quite different between the two.

 

Yeah it is & I know I'm ignoring many potential realities in defense of my decision to double up.

 

Back to scouting now...

 

Is this what you meant?

 

"Although conversations have been ongoing, the Company was recently told by Anthem management that Anthem intends to move its business when the Company's current contract with Anthem expires on December 31, 2019, and that Anthem is not interested in continuing discussions regarding pricing concessions for 2017-2019 or in receiving the Company's proposed pricing for the period beyond 2019"

 

That's what I meant by "bluff called" & Swedish's subsequent "check"

 

I'm a lousy poker player & am probably using this terminology wrongly.

 

(In fact, I'm not really a poker player at all...)

[Phaceliacapital]

Did you read the conf call? Happy to hear your thoughts..

 

Interesting to see that both ESRX & Anthem are up on this news.

[DooDiligence]

Did you read the conf call? Happy to hear your thoughts..

 

Interesting to see that both ESRX & Anthem are up on this news.

 

Wentworth removed the overhang of losing Anthem in the call & then Swedish brought speculation back into play.

 

I'm going on the assumption that Anthem is gone (too hard to predict anything else...)

 

Cost containment will be key in continuing without Anthem since there's nothing out there that could replace Anthems lost business.

 

That said, the end of 2019 is still a ways off & service won't simply end at that time (it'll take a year or 2 to roll off while Anthem transitions to whoever they sign with.)

 

As long as ESRX continues to save their clients money on drug spend, they'll keep sucking in tons of cash with minimal CAPEX.

 

This is a complicated business & I admit to being attracted to the historically low bitch metrics (and the coiled spring short positions...)

 

----------

 

"if Anthem isn't interested in receiving $3 billion over the next three years that would be tremendously valuable to them, we're going to invest that as well into the core of this business and drive our solutions even further and faster."

 

"We're going to deploy our cash really carefully though. It's not to say that we will or won't do a deal, it's to say we are going to be really thoughtful about how we invest in ourselves, how we, both through technology, investments and other internal investments, deploy it back to shareholders, and then we do look at M&A. We do like cost containment and payer services sorts of opportunities. We like niche opportunities in areas like worker's compensation and specialty, we are interested in healthcare analytics or medical management."

 

"Depending on where things are at right now, buying our stock back is not going to be a bad use until such time as we find something that's also terribly strategically interesting, not just from a cash perspective."

 

-----

 

"They (Anthem) don't participate in our national preferred formulary. We will have 25 million members who we take to the table when we negotiate with pharma. Not one of those is an Anthem member. That will continue."

 

"Anthem is not particularly high mail, and our ability to negotiate with generic manufacturers, remember, we're still at over 1.2 billion prescriptions overall, we still have a strong mail service franchise and 90-day franchise generally, our ability to negotiate there will not be diminished by virtue of Anthem's 200 million claims."

 

"We've worked hard over the years to help them grow by giving them exception pricing on something like 400 individual accounts, mostly on larger national accounts, as you can appreciate, which was not contractually obligated, but we felt it was the right thing to do. We would clearly benefit, and they would clearly benefit from being able to win and grow their national account business.

 

"In addition, when they bought Amerigroup, we constantly updated their pricing on the Medicaid business, and that's why they moved Amerigroup's lives to us early. That was not contractually required, but we thought it was important to do. We've helped them on Medicare Part D, not only operationally, getting them off sanctions, but also actually in continuing to improve their rates there."

 

"The management team at the time at Anthem, again, I can't speak for them, but I believe they didn't see the generic discounts increasing as aggressively as they have in the market because of us and others doing our job. I believe they didn't see brand inflation being as high as it was in the outer years. And so I believe that, you know, there's certainly some sound bites that they thought they took some pretty good risk on this deal and they were going to be winners."

 

-----

 

"So how do you address investor concerns about what's seemingly becoming a more competitive environment, with Prime and Optum emerging as more aggressive players? And tying that with EBITDA per script visibility that you just provided to the Street and to your clients today. So, if I'm a client sitting on the sidelines seeing this EBITDA per script, how do you calm those clients down and say that we're not over-earning on your book? And how do you address investor concerns about that?"

 

"We always have to continue to drive at our cost structure and so forth. And I think there was a study that came out from Dezante just a couple months ago that showed a six to one return on PBM services to payers, if you looked at what they were paying all in. I can tell you that our clients are seeing that or better, and our job is going to be to continue to demonstrate our value. And as long as we demonstrate our value, I'm not concerned about what our EBITDA per script is."

[DooDiligence]

Follow up to my weak assed analysis & thanks to Phaceliacapital for forcing me into scout mode.

 

I sent a short email to my ex-employers chief medical officer in an attempt to gain some insights from an ESRX clients perspective (the email was also an attempt at DRM & we'll see how effective it is if the CMO calls me or if I have to call him for an expanded interview.)

 

---

 

It's interesting how competitive forces have improved transparency a bit.

 

Maybe ESRX & others can capitalize on selling with more altruistic efforts (content marketing at its finest...)

 

I think that their ability to demonstrate cost savings to clients is super important & requires a combination of understandable statements to clients & proactively using the clients accounting & oversight personnel to reinforce effectiveness & consequently retain (or not) their business.

 

My apologies to forum members & to Phil Fishers memory for not doing this before...

 

(apologies to my future self as well)