Express scripts is the Walmart of PBM's
Pros
I was at Medco back when it was still Merck Medco 11 years ago and then independently Medco. The culture of the call centers was one of truly helping the customer and educating them on benefits. People liked their job, benefits, and coworkers. All those things are gone now.
Cons
After the merger with Express Scripts it became clear quickly that they are all about the money. Every decision made was done from a financial standpoint. Many SOP's we had for assisting members was struck down or revised because they cost money even though they were the right way to treat members and do business. Entire departments were laid off via conference call and policies changed to justify not needing people anymore. Policies like reducing the quality requirements of many different aspects of business. For example entire compliance departments being let go because 'we stopped having compliance issues." What really happened is that under Medco, we had dozens of different scenarios where there could be violations that would need people to research how they happened and put in fixes...ESI changed the definition of what they considered a violation to be very narrow and only a handful of things so suddenly, oh look! We don't need all these people to fix problems anymore because we don't consider them problems. Also their email dept was abysmal with low quality requirements compared to Medco's yet the majority of Medco's email reps were laid off with no notice in favor of ESI's lesser quality service. Their reps are required to do less and answer less emails than Medco. Things like that really killed morale and made Medco people feel like they were being forced to give crappy service