SG Cowen25th Annual Health Care Conference

March 15, 2005

Express ScriptsAligning Interests

2

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.

Forward-Looking Statements

3

Our Interests are Aligned with Clients and Patients:

To make the use of prescription drugs safer and

more affordable

4

Alignment – Formulary Management

We Evaluate Drugs for Price and Value 1. Determine cost per Rx (AWP)

Ensure Clinical Quality at Lowest Cost

•$0 •$20 •$40 •$60 •$80 •$100 •$120

Rela

tive c

lin

ical valu

e

Cost for 30-day supply

Drug B Drug A Drug D Drug C

5

Alignment – Formulary Management

We Evaluate Drugs for Price and Value 1. Determine cost per Rx (AWP) 2. Evaluate relative clinical value

Ensure Clinical Quality at Lowest Cost

•$0 •$20 •$40 •$60 •$80 •$100 •$120

Rela

tive c

lin

ical valu

e

Cost for 30-day supply

Drug B

Drug A

Drug C

Drug D

6

Alignment – Formulary Management

We Evaluate Drugs for Price and Value 1. Determine cost per Rx (AWP) 2. Evaluate relative clinical value 3. Account for market share

Ensure Clinical Quality at Lowest Cost

•$0 •$20 •$40 •$60 •$80 •$100 •$120

Rela

tive c

lin

ical valu

e

Cost for 30-day supply

Drug B

Drug A

Drug C

Drug D

7

Alignment – Formulary Management

Impact on Client

Impact on Patient

Impact on ESI

Lower drug cost

More choice

Lower co payment

More choice

Higher Profit/Rx

More flexibility

We Evaluate Drugs for Price and Value

1. Determine cost per Rx (AWP) 2. Evaluate relative clinical value 3. Account for market share 4. Select formulary products 5. Determine effects of rebate

Ensure Clinical Quality at Lowest Cost

•$0 •$20 •$40 •$60 •$80 •$100 •$120

Rela

tive c

lin

ical valu

e

Cost for 30-day supply

Drug D

Drug C

Drug A

Drug B

8

Impact on Client

Impact on Patient

Impact on ESI

Lower drug cost

Lower co payment

Higher Profit/Rx

Alignment – Clinical Programs

4.5

14.0

0

2

4

6

8

10

12

14

Mil

lio

ns

Q1 2003 Q4 2004

Members in Step Therapy Programs

Clients using step therapy realize on average a

2 percentage point increase in generic utilization

Plan Designs Encourage Greater Use of

Generics and Preferred Low-cost Brands

9

More Number of Drugs Fewer

Alignment – Supply Chain Management

Therapy Class

We Provide Flexible Management of

the Supply Chain 1. Select number of drugs in therapy class

# ofdrugs

# ofdrugs

# ofdrugs

# ofdrugs

10

More Number of Drugs Fewer

Alignment – Supply Chain Management

Therapy Class

We Provide Flexible Management of

the Supply Chain 1. Select number of drugs in therapy class 2. Determine formulary control

Ben

efi

t O

pti

on

s # ofdrugs

# ofdrugs

# ofdrugs

# ofdrugs

Open

DifferentialCo-pay

Closed

11

More Number of Drugs Fewer

Ben

efi

t O

pti

on

s

Impact on Client

Impact on Patient

Impact on ESI

Lower drug cost

More choice

Lower co payment

More choice

Higher Profit/Rx

More Flexibility

Alignment – Supply Chain Management

Therapy Class

We Provide Flexible Management of

the Supply Chain 1. Select number of drugs in therapy class 2. Determine formulary control 3. Drive towards lowest overall cost

# ofdrugs

# ofdrugs

# ofdrugs

# ofdrugs

Open

DifferentialCo-pay

ClosedLowestOverall

Cost

12

Alignment – Home Delivery

Impact on Client

Impact on Patient

Impact on ESI

Lower drug cost

Choice

Lower co paymentChoice

Higher profit/Rx

Video of Express Scripts High Volume Mail Pharmacy

We Offer Highly Efficient, Cost-effective

Home Delivery

13

16.4%

18.5%

22.6%

20.2%

17.2%

13.8%

15.8%

13.1%0

100

200

300

400

500

600

1996 1997 1998 1999 2000 2001 2002 2003 2004

Ad

just

ed C

laim

s* (

mill

ion

s)

13.0%14.0%15.0%16.0%17.0%18.0%19.0%20.0%21.0%22.0%23.0%24.0%

% m

ail p

enet

ratio

n

Total Adjusted Claims Mail Penetration

* Represents network claims plus 3 times mail claims - mail claims are 90 days vs. 30 days in the network. Excludes UHC claims

D IVERSIFIED®

Increased mail penetration

Home Delivery Helps Manage the Cost of Maintenance Drugs

Alignment – Growing Demand for Mail

14

Alignment – Generic Utilization

Generic Utilization Rate

38%40%42%44%46%48%50%52%54%

Q102

Q202

Q302

Q402

Q103

Q203

Q303

Q403

Q104

Q204

Q304

Q404

ESI PBM B PBM C

Impact on Client

Impact on Patient

Impact on ESI

Lowest drug cost

Lowest co payment

Highest profit/Rx

Source: From public filings

Express Scripts Leads in Generic Utilization

15

$7.0

$8.1 $8.4

$6.1

$8.6

$0

$1

$2

$3

$4

$5

$6

$7

$8

$9

$ -

bil

lio

ns

2004 2005 2006 2007 2008

U.S. Sales for Brand Products with Patent Expirations From 2004-2008

ESI Analysis

Represents

approximately

18% of 2003

branded

drug sales

Our Clients and Members Will Benefit From a Growing Generic Opportunity

Alignment – Growing Generic Opportunity

16

100%$35 Total

19%3.5Other

1%0.5Growth Hormone

1%0.5Infertility

2%0.6RSV prophylaxis

4%1.5Rheumatoid arthritis

4%1.5Multiple sclerosis

4%1.5Transplant

5%1.6Hepatitis C

5%1.6Hemophilia

9%3.2Renal

10%3.4HIV/AIDS

36% $12.6Oncology

Biotech Market, $35B, 15%

Traditional Rx Market,

$200B, 85%

Alignment – Specialty Pharmacy

Specialty Market

2004

Billions

Source: ESI Analysis

Impact on Client

Impact on Patient

Impact on ESI

Lower drug cost

Lower co payment

Higher profit/Rx

Improved reporting

Improved quality of

care

Higher client

satisfaction

Clients are Seeking Solutions for High-cost

Specialty Drugs

17

Alignment -- PBM Tools Work

Availability of Proven PBM Cost Management Tools Will Produce Savings of 20 – 25% (CBO)

18

What Do Plan Sponsors Want?

• Affordability

• Flexibility

• Accountability-5%

0%

5%

10%

15%

20%

2001

2002

2003

2004

2005

2006

2007

2008

Plan Sponsors Want Value for Their Drug Spend

Unmanaged Drug Trend

Source: 2003

ESI Drug Trend Report

19

What Does Express Scripts Provide?

• Affordability– Low-cost formulary– Effective clinical

programs– Mail pharmacy services

• Flexibility– Customized

management of the pharmacy benefit

• Accountability– Alignment of interests– Transparency

-5%

0%

5%

10%

15%

20%

2001

2002

2003

2003

1 N

ew T

oo

l

2003

2 N

ew T

oo

ls

Source: 2003

ESI Drug Trend Report

Unmanaged Drug Trend

2003

Man

aged

ESI Provides Value for Clients’ Drug Spend

Managed trend - 2003

20

Alignment – A Win-Win-Win Proposition

Retail Non-pref. Brand

Retail Pref.

BrandGenerics

Mail Pharma

cy

Increased Savings

Opportunities:

Client

Member

Increased

Profit

Opportunities:

Express Scripts

Moving to preferred brands, mail and generics

We make money by saving clients and members money

Moving to preferred brands, mail and generics

Moving to preferred brands, mail and generics

21

PBM’s Are Part of the Solution for Medicare

$1,610

$2,322

$3,160

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

2000 2003 2006E

Average Annual Drug Spend

Among Medicare Population

Source: Actuarial Research Corporation

The Medicare Prescription Drug Act will shape

the direction of our industry for years to come

Medicare Prescription Drug Act of 2003

• PBM’s are expected to play an important role

- Congressional Budget Office estimated

PBM’s would save Medicare about 25%

• We will review the regulations to evaluate

our participation in the program

• We will work closely with employers and

plans supporting their participation in Part D.

22

Benefits of ePrescribing

Prescription & Pharmacy Benefit Information

Point of Sale

Point of Care

Benefit / Gain

ClinicalMessages at pharmacy

Physicians see clinical issues

Better informed, safer prescribing

Formulary

Enforcement after prescribing

Awareness at prescribing

Better choices, increased generics

BenefitReferenced at pharmacy

Real-time guidance

Cost-effectiveness, fewer callbacks

Medication History

Partially known

History while prescribing Patient safety

Prescription

Carried, faxed, called, mailed

Convenience at pharmacy

More efficient, patient safety

Medicare Part D Will Advance Important Initiatives Including e- Prescribing

23

We Deliver Against Client and Patient Expectations:

To make the use of prescription drugs safer and

more affordable

24

Client/Patient Focus

Commercial26%

Canada10%

Managed Care39%

Public Sector25%

By membership

• Successful track record in growing membership to over 50 million

• Differentiation through flexible formulary, clinical programs and retail network management

• New market opportunities – 70 to 100 million unmanaged lives

– Medicare– Medicaid– Uninsured

Health Plan Sponsors Recognize Express Scripts Single

Focus on Making Prescription Drugs More Affordable

25

Case Study: Medium-Sized Employer

Generics policyPlan designClinical/trend programs

$1,000

800

600

400

1999 2000 2001 2002 2003

PMPY

Mbr share

GFR

0

60%

40

20

26

Case Study: Medium-Sized Employer

Generics policyPlan designClinical/trend programs

$1,000

800

600

400

1999 2000 2001 2002 2003

PMPY

Mbr share

GFR

0

60%

40

20

SAVINGS:$250 PMPY

Express Scripts’ Major Locations –Thru Mid 2004

St. Louis, MO• Corporate Headquarters

• Patient Contact Center• Mail Service Pharmacy

St. Marys, GA• Patient Contact Center

Orlando, FL• CuraScript

• High Vol Mail Services

Tempe, AZ• Patient Contact Center

• Mail Service Pharmacy• Mail Service Pharmacy

Albuquerque, NM• Patient Contact Center

• Mail Service Pharmacy

Troy, NY

• Patient Contact Center

Bensalem, PA

• Patient Contact Center

E. Hanover, NJ• Patient Contact Center

• Mail Service Pharmacy

Harrisburg, PA• Patient Contact Center

• Mail Service Pharmacy• High Vol Mail Services

Farmington Hills, MN• Patient Contact Centers

Bloomington, MN• Patient Contact Centers

• High Vol Mail Services• High Vol. Mail Services

Express Scripts’ Major Locations –2005 Plan

St. Louis, MO• Corporate Headquarters

• Patient Contact Center

• High Vol Mail Services

St. Marys, GA• Patient Contact Center

Orlando, FL• CuraScript

Tempe, AZ• Patient Contact CenterAlbuquerque, NM

• Patient Contact Center

Farmington Hills, MN• Patient Contact Centers

Bloomington, MN• Patient Contact Centers

Troy, NY

• Patient Contact Center

Bensalem, PA• High Vol Mail Services• Patient Contact CenterHarrisburg, PA

• Mail Service Pharmacy

• Mail Service Pharmacy

• Mail Service Pharmacy

• Rx Entry

• Rx Entry

• Mail Service Pharmacy• Mail Service Pharmacy

Albuquerque, NM• Patient Contact Center

• Mail Pharmacy Services

• Patient Contact Center

29

70%

80%

90%

100%

2002 2003

Client Satisfaction "Top 2 Boxes"

High Client Satisfaction

Our Focus on Service is Evident from High Overall Client Satisfaction

70%

80%

90%

100%

2002 2003

Likelihood to Recommend ESI

30

Our Financial Results

Express Scripts has demonstrated a proven track

record

31

Financial Overview

• 4Q EPS $1.07, up 24% from last year

• Record cash flow from operations of $193.0 million• Repurchased 2.4 million shares for $176 million

• Record mail claims of 10.1 million, up 17% from last year

• Generic drugs were 52% of total prescriptions vs. 48% last year

• Gross profit up 13%

Q4 2004 Highlights

32

518 26

4358

73

113

212

242

294

355

379399

0

50

100

150

200

250

300

350

400

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

Network Claims* (Millions)

1992-2004 = 44% CAGR

0.7 1.2 1.6 2.1 2.83.9

7.4

10.6

15.2

20.5

27.2

32.3

39.1

0

5

10

15

20

25

30

35

40

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

Mail Claims (Millions)

1992-2004 = 40% CAGR

• * Excludes UHC claims

•

Greater Rx Volumes Have Created Economies of Scale

Claims volume growth

Financial Overview

33

Financial Overview

$0.68

$0.80$0.88

$1.03

$1.12

$1.05

$0.50

$0.70

$0.90

$1.10

1999 2000 2001 2002 2003 2004**

Pricing can be lowered as clients tighten formulary compliance, increase mail, utilize generics and restrict retail networks. These changes result in lower prices to our clients and greater profits to ESI

EBITDA* per adjusted claim

* 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 at www.express-scripts.com under Presentations.

** Excluding $25 million charge to increase legal reserves for the cost of defense and 5.5 million termination payment received.

34

Financial Overview

$0.00

$0.20

$0.40

$0.60

$0.80

$1.00

$1.20

$1.40

$1.60

Q1'01

Q2'01

Q3'01

Q4'01

Q1'02

Q2'02

Q3'02

Q4'02

Q1'03

Q2'03

Q3'03

Q4'03

Q1'04

Q2'04

Q3'04

Q4'04

Per

sh

are

EPS Free cash flow per share*

(1) Reflects a $70-$75 million reduction in Q2 2003 due to the one-time impact of implementing a new wholesale purchase agreement

(2) Reflects a $0.10 per share charge for the early retirement of debt

(3) Reflects a $0.20 charge to increase legal reserves for the cost of defense.

Quality of earnings

(1)

(2)

* Reflects a 12 month moving average of free cash flow (cash from operations less CapX)

(3)

35

Focus on Return on Invested Capital (ROIC)

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

2000

2001

2002

2003

2004**

Express Scripts ROIC*

ROIC is our Preferred Performance Metric

* 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

36

Industry-Leading ROIC

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

Expre

ssScr

ipts

Car

dnia

lH

ealt

h

Pri

ori

tyH

ealt

h

Mck

esso

n

Acc

redo

Hea

lth

Am

eris

ourc

e

Med

co

Comparison of Peer Group ROIC - 2004

We Lead Our Peer Group in ROIC Performance

37

Our Value Proposition Will Continue to Drive Growth

• Making the use of drugs safer and more affordable is more important than ever

• Plan sponsors will increasingly deploy our tools

• Express Scripts is well-positioned for sustainable growth

• Strong market fundamentals/new business opportunities • Increased use of home delivery and generic drugs• Growth in management of specialty pharmacy• Productivity and capital structure improvements

• We have taken a different approach• Alignment -- we make money by saving our clients money

• Strategic acquisitions have enhanced our value proposition

Express ScriptsAligning Interests