Reimbursent Management Assessment Business Acumen class Express Scripts, Inc (ESI) Case Study Company Background Core Strategies, Value Proposition, and Core Drivers Team members: Jon Maesner Kate Bielawiec Rose Ann Calegari Edmond Mack Geoff Carr Yelena Yakunina Venecia Alfonso Jessica Schmitz September 2014 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © Copyright 2012 Cigna 1 1

Express Scripts, Inc History and Background Reimbursent Management Assessment Express Scripts, Inc History and Background Quick Facts 1986 – Express Scripts begins as JV between retail store chain Medicare Glasner and Sanus Corp Health Systems. 1989 – Purchased by New York Life Insurance 1992 – Express Scripts becomes publicly traded 1996 – Established Express Scripts Canada 1998 - Express Scripts Inc. acquired ValueRx, the PBM business of Columbia/HCA Healthcare Corp. 2009 – Express Scripts purchased WellPoint's NextRx subsidiaries for $4.675 billion. 2012 - Express Scripts completed a $29.1 billion acquisition of Medco Health Solutions The acquisition positioned Express Scripts Holding Co. as the largest pharmacy benefit manager, filling 1.4 billion annual prescriptions Add comment re: Provider Selection ; What Contract Solution will address and what consuming applications will be expected to address. Growth by Acquisition Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © Copyright 2012 Cigna

Express Scripts, Inc History and Background Reimbursent Management Assessment Express Scripts, Inc History and Background Primary Products & Services Pharmacy benefit management services Geographic Operations US – New Jersey, Missouri(HQ), Philadelphia, Illinois Canada Europe Key Customers/Distribution Channels Express Scripts Holding Company provides its PBM services to managed care organizations, health insurers, third-party administrators, employers, union-sponsored benefit plans, workers’ compensation plans, and government health programs. Competitors include CVS, Cigna, Catamaran, Optum Rx Add comment re: Provider Selection ; What Contract Solution will address and what consuming applications will be expected to address. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © Copyright 2012 Cigna

Express Scripts, Inc Company Background Reimbursent Management Assessment Express Scripts, Inc Company Background CEO George Paz drives Express Scripts' strategy, ensuring our business model of alignment with clients’ best interests delivers better, more cost-effective health outcomes for millions of people. George joined Express Scripts in 1998 as Senior Vice President and Chief Financial Officer and became President in 2003. In 2005 he was named Chief Executive Officer and the following year was elected chairman of the board. He currently serves as a member of the board of directors for Honeywell, Inc. George holds a bachelor's degree in business administration and accounting from the University of Missouri - St. Louis and is a member of the American Institute of Certified Public Accountants. Add comment re: Provider Selection ; What Contract Solution will address and what consuming applications will be expected to address. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © Copyright 2012 Cigna

Express Scripts, Inc Company Background Reimbursent Management Assessment Express Scripts, Inc Company Background What is the role of this organization within healthcare environment? Express Scripts, Inc. is one of the nation's leading full-service pharmacy benefit management ("PBM") companies. The Company coordinates the distribution of outpatient pharmaceuticals through a combination of benefit management services, including retail drug card programs, Home Delivery services, formulary management programs and other clinical management programs. They also distribute a full range of injectible biopharmaceutical products directly to patients or their physicians, and provide extensive cost-management and patient-care services. These services are provided to health maintenance organizations, health insurers (including Cigna), employers, union-sponsored benefit plans, third-party administrators, workers’ compensation and governmental health programs. Relationship/impact with Cigna? Historically, Cigna’s relationship with ESI has evolved from market/supplier partners to currently being a PBM competitor. Market trend is toward specialty drugs (i.e. injectibles). ESI is looking to expand their earnings into this area which is achieved through Medical Benefits (not Pharmacy Benefits). In order to maximize their earnings in this area, they need to penetrate the Medical Benefits arena. Add comment re: Provider Selection ; What Contract Solution will address and what consuming applications will be expected to address. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © Copyright 2012 Cigna

ESI: Analysis of relationship of core strategies to 5 Drivers How does ESI influence Cigna’s Financial Performance? Key profit levers. Generate cash flow (buy-sell spread on): Mail order and specialty pharmacies, pharmacy network discounts, manufacturer contracts Cash Cash flow generates ability for asset investment Future assets likely to focus on Specialty Pharmacy, which increases competitive pressure with Cigna Growth People Profit Contracting and dispensing pharmacy assets drive lower COGS and contribute to profit Historically focused on inorganic growth drivers (most recently: Medco 2012) drives Rx volume and contracting leverage Limited future inorganic growth opportunities in traditional PBM Assets Example of key assets: High automation mail order pharmacies Specialty Rx Pharmacies Vendor contracting

Express Scripts, Inc Core Strategy and Value Proposition Reimbursent Management Assessment Express Scripts, Inc Core Strategy and Value Proposition Healthier Outcomes Require Better Decisions. The Express Way - Six core values Three values shape who we are: Integrity, Mutual Respect and Passion. Integrity is first and foremost for a reason; it's our guiding beacon. Three more values define how we work: Alignment, Collaboration and Service. Together, we do the right thing for clients and patients, who count on us every day. To achieve healthier outcomes, we design and deliver solutions to support better prescription-related decisions. Our experience and research show that achieving optimal outcomes ultimately requires better decisions on the part of patients, caregivers and providers. We apply decision science to help us understand why people make the decisions they do and to help us determine how to make better decisions easier. Our platform for discovery and innovation is Health Decision ScienceSM. Behavioral Sciences - We apply proven strategies from the behavioral sciences, including choice architecture and message framing, in an approach we call Consumerology®. Because patient engagement is often unachievable, we work to make the best decisions as easy as possible. Our research has shown that poor decisions typically reflect a gap between intentions and behaviors. By anticipating member needs and preferences, then earning their attention, we can close these "intent-behavior" gaps. Clinical Specialization - Our specialist pharmacists and nurses provide personalized attention to patients diagnosed with costly chronic and complex conditions. We have a deep understanding of specific disease states, allowing us to better anticipate patient care needs. More than 1800 Express Scripts clinical specialists work directly with patients to optimize the health choices they make, ensuring safety, improving affordability and delivering world-class care. Actionable Data - Actionable data means providing the right data at the point of prescribing and running real-time safety checks at the point of dispensing. It means advising clients with data-driven recommendations for formularies, and counseling patients with relevant safety and savings information. With actionable data, we can predict nonadherence risks and work toward determining the most cost-effective interventions. Health Decision Science is at the heart of how we add value for clients and members. With this expertise, we have built practical solutions for three decision areas: Drug Choices - Express Scripts drug-choice solutions facilitate the proper use, selection and amount of the safest, most cost-effective generics and preferred brands. Pharmacy Choices - Our pharmacy-choice solutions help patients and their providers choose the most cost-effective, high-quality pharmacies for their conditions. Health Choices - Our health-choice solutions increase the effectiveness, safety and affordability of clinical care. Add comment re: Provider Selection ; What Contract Solution will address and what consuming applications will be expected to address.

Express Scripts, Inc Balance Sheet Reimbursent Management Assessment Express Scripts, Inc Balance Sheet Document enterprise wide business processes we doing today to get to Contract Selection (Level 1 / Level 2); Leverage Claim Improvement, HBoR. Priorities Proclaim, PowerMHS, Facets, Payor Solutions, PPN. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © Copyright 2012 Cigna

Reimbursent Management Assessment Express Scripts, Inc Income Statement Profit Margins: Gross -7.8% Operating -2.88% Net - 1.7% Growth 2013 v. 2012: Revenue – 11% Net Income – 35% EPS – 28% Document enterprise wide business processes we doing today to get to Contract Selection (Level 1 / Level 2); Leverage Claim Improvement, HBoR. Priorities Proclaim, PowerMHS, Facets, Payor Solutions, PPN. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © Copyright 2012 Cigna

Express Scripts, Inc Income Statement 2013 Cash Flow = $4.8 bln. 2013 Cash & Cash Equiv. $1.99bln