1. 2006 Healthcare Conference
Citigroup
2006 Healthcare Conference
March 1, 2006

2. Forward-Looking Statements
Statements included in this presentation or in the oral comments made as part of this presentation may contain forward-looking statements, including but not limited to statements of the Company’s plans, objectives, expectations or intentions, that involve risk and uncertainties.
The Company’s actual results may differ significantly from those projected or suggested in any forward-looking statement due to a variety of factors, which are discussed in detail in the Company’s filings with the Securities and Exchange Commission.

3. Our Value Proposition: Complete Alignment
To reduce pharmacy costs, without compromising health outcomes, while maximizing patient satisfaction

4. The Art of Trend Management -- Alignment
High Performance Formulary
Restricted Retail Network
Ability to manage trend
Exclusive Home Delivery
Specialty Pharmacy
Step Therapy
Generic Utilization Programs
3-tier
2-tier
Plan sponsor appetite for innovative clinical tools
As Plan Sponsors Take Advantage of Our Tools to Better Mange Trend, The Better We Perform

5. What Are the Savings? C O S T
Retail, Clinical.
Formulary
And Rebate
Savings 24%
Paid by
Cash Customer
at Pharmacy
Home Delivery Savings 6%
Retail Pharmacy Cash Price
Express Scripts Client Savings
Express Scripts Client Costs C O S T
Paid by
Express Scripts
Clients
Total Savings 30%
Availability of Proven PBM Cost Management Tools
Will Produce 20%–25% Savings (CBO)

6. Alignment – A Win-Win-Win Proposition
Retail Non-pref. Brand
Retail Pref. Brand
Generics
Mail Pharmacy
Increased Savings
Opportunities:
Client
Member
Increased
Profit
Express Scripts
Moving to preferred brands, home delivery and generics
Moving to preferred brands, home delivery and generics
Moving to preferred brands, home delivery and generics
We make money by saving clients and members money

7. Express Scripts has demonstrated a proven track record
Our Financial Results
Express Scripts has demonstrated a proven track record

8. Q4 2005 Highlights Adjusted EPS of $0.77*, up 45% from $0.53 last year
For 2005, adjusted EPS of $2.60*, up 34% from 2004
Cash flow from operations of $262 M vs. $193 M last year
For 2005, cash flow of $793 M vs. $496M in 2004
Gross profit of $364 million, up 38%
Gross profit per adjusted claim was $2.54, up 34%
EBITDA of $220 M, up 42%
EBITDA per adjusted claim was $1.53, up 37%
* Reconciliation of reported EPS to adjusted EPS is included in
Table 4 of the 4Q 2005 earnings release

9. Quality of Earnings (5) (1) (4) (4) (3) (2)
Reflects a $70-$75 million reduction in Q due to one-time impact of implementing a new wholesale purchase agreement
Excludes a $0.04 per share charge for the early retirement of debt
Excludes a $0.10 charge to increase legal reserves for the cost of defense.
Excludes an $0.08 and $0.02 prior year tax benefit in Q2 and Q3, respectively
Excludes a $0.02 charge for the early retirement of debt
* Reflects a 12-month moving average of free cash flow (cash from operations less CapX)

10. Profits Per Claim Growth
EBITDA* per adjusted claim
10% CAGR***
Pricing can be lowered as clients tighten formulary compliance, increase home delivery, utilize generics and restrict retail networks. These changes result in lower prices to our clients and greater profits to Express Scripts.
* A reconciliation of EBITDA to net income and to net cash provided by operating activities can be found in the Investor Relations
section of Express Scripts’ Web site, under Presentations.
** Excluding $25 million charge to increase legal reserves for the cost of defense and $5.5 million termination payment received.
*** Based on 2005 average EBITDA per adjusted Rx of $1.29

11. Claims Volume Vs. EPS Growth
Expanding Margins Supports Strong EPS Growth on More Modest Claims Growth
(5)
(3)
(2)
(1)
(4)
Excludes a $0.10 charge to increase legal reserves (4) Reflects the June 1st anniversary of the DoD retail contract
Excludes an $0.08 prior year tax benefit (5) Excludes a $0.02 charge for early retirement of debt
Excludes a $0.02 prior year tax benefit

12. Focus on Return on Invested Capital (ROIC)
* Reflects operating income less tax divided by average invested capital, which consists of stockholder’s equity, plus interest
bearing liabilities plus long-term deferred income taxes, net.
** Excludes $25 million charge to increase legal reserves for the cost of defense and 5.5 million termination payment received
ROIC is our Preferred Performance Metric

13. Ed Ignaczak Senior Vice President Sales and Account Management
Express Scripts’ Value Proposition
Multi-Faceted Growth
Growth through….
Improving Client Satisfaction
Expanding Value Prop with Existing Clients
Capturing New Business
Ed Ignaczak Senior Vice President Sales and Account Management

14. Multiple Factors being leveraged to drive Client/Shareholder Value
New Sales
ESI and Client Values are Aligned
$ Value to ESI /
$ Value to Clients
Pipeline
Pipeline
Specialty
Specialty
Specialty
Generics
Generics
Generics
Generics
Home Delivery
Home Delivery
Home Delivery
Home Delivery
Home Delivery
Satisfaction
Satisfaction
Satisfaction
Satisfaction
Satisfaction
Satisfaction
# of Leveraged Factors
We can move the market…….

15. Client Satisfaction continues to improve..
Increases were recognized in all categories with Likelihood to Recommend making the largest jump during 2005.

16. Very Satisfied Clients Buy More Services and Promote ESI to others.
A 2004 Harvard Business Review article asserted that "net promoter scores," which measure the difference between the percentage of customers who give the highest Willingness to Refer ("promoters") and those who give low scores ("detractors"), correlate closely with a company's revenue growth.
CAGR = 5.1%
CAGR = 10.8%
EBITDA Drivers:
Increased Mail Penetration
Generics
Specialty
People / Talent

17. Significant Upside opportunities: Home Delivery
Room to Grow!
Improved Margin Opportunity
Home Delivery % of Total Adj. Rx
DoD-TRRx
Many initiatives focusing on driving to higher margin mail volumes.
DoD-TMOP
2006
Projected
9.6% CAGR

18. Significant Upside opportunities: Generic Usage
$43B in Brand Drugs losing patent protection ’
Industry Savings Opportunity
Class
Actual Generic Fill Rate
Generic Targets
Gap
Potential Target
Gastrointestinal
31%
95%
64%
$5.4 Billion
Antihyperlipidemics 7%
70%
63%
$5.1 Billion
Calcium Channel Blockers
43%
90%
47%
$484 Million
Antihypertensive
48%
75%
27%
$2.0 Billion
NSAIDs
85%
38%
$3.9 Billion
Anti-depressants
41%
34%
$3.2 Billion
Total Savings
$20 Billion
ESI Generic Fill Rate

19. Significant Upside opportunities: Specialty
Market Opportunity ’05-’09
Book of Business Penetration
Specialty Drugs Under Development
Curascript CAGR = 405%

20. Case Study: Actual ESI Client
Unmanaged Spend
Cumulative Savings $19.2m
Managed
Spend
Renewal Rates Implemented
Clinical Programs
Mail Education
Generics Incentives
High Performance Formulary
Specialty
Clinical Programs
ESI Value to client increased over time creating aligned benefits for both client and ESI.

21. Client Demand for Trend Management products/services drives EBITDA.
Up Sell Mail, Generics and Specialty

22. Multiple Factors Driving New Sales Success
When a large Employer changed PBM’s in 2005, they selected Express Scripts 72% of the time!
Sold!
Coverage/Quality
Strategic Acquisitions
$ in Sites/ Tech
Expert Consultation
Lowest Net Cost

23. 2006 New Sales Pipeline

24. Book of Business Dynamics
Recent Fortune 100 Wins and Market Dynamics are altering the composition of our Book of Business. A combination of increased Rx/Life and services per client driving higher EBITDA/client and EBITDA/claim.
Rx / Life
EBITDA / Rx
CAGR = 3.5%
CAGR = 4.3%