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General - Concentration of Business (Details) - USD ($)
$ in Thousands
3 Months Ended 6 Months Ended
Jun. 30, 2016
Jun. 30, 2015
Jun. 30, 2016
Jun. 30, 2015
Concentration of Business        
Net revenue $ 1,164,345 $ 1,157,607 $ 2,281,367 $ 2,138,575
Medicare Part D Revenues $ 48,100   $ 98,400  
Minimum        
Concentration of Business        
Term of Contract     1 year  
Term of renewed contract     1 year  
Notice period for termination of contract     60 days  
Maximum        
Concentration of Business        
Term of Contract     3 years  
Term of renewed contract     2 years  
Notice period for termination of contract     180 days  
CMS        
Concentration of Business        
Net revenue     $ 115,500  
Medicare Part D Revenues     98,400  
Pennsylvania Counties        
Concentration of Business        
Net revenue     $ 226,000 $ 186,100