April 1, 2008 
The other day, Medco announced that they were going to work with Apoteket to develop a drug safety system for Sweden. Apoteket currently manages all the pharmacies there, but they are going to be deregulated in 2009.
It’s not likely to make a financial difference for Medco, but I think it’s an interesting step. US healthcare is often looking for ways to grow in a fairly mature US market. Going abroad has always been attractive, but a challenge given the different models. It made me think of some of the other moves over the past few years.
- Caremark invested in a Brazilian PBM – Vitalink
- Healthways recently announced a 10-year deal in Brazil with Fleury
- Health Dialog and Healthways (two disease management companies) both have international operations
- Cigna has an international group
- Express Scripts has a Canadian operation
I am sure there are a lot more, but those are the ones that I am familiar with.
Enabling Healthy Decisions 
You have a good point. I also think it’s interesting that the PBMs are also developing their own disease management programs – also in response to the maturing US market and their need to avoid becoming commoditized on smaller and smaller margins.