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Business Segment Information - Operating Results by Business Segment (Details) - USD ($)
$ in Thousands
3 Months Ended
Mar. 31, 2020
Mar. 31, 2019
Operating results by business segment    
Net revenue $ 1,794,307 $ 1,739,489
Cost of care (951,642) (941,961)
Cost of goods sold (486,142) (489,793)
Direct service costs and other [1],[2] (287,731) (271,924)
Stock compensation expense 6,057 9,607
Changes in fair value of contingent consideration   144
Segment Profit (Loss) 74,849 45,562
Managed care and other    
Operating results by business segment    
Net revenue 1,272,936 1,223,979
PBM    
Operating results by business segment    
Net revenue 521,371 515,510
Healthcare    
Operating results by business segment    
Net revenue 1,208,674 1,164,253
Pharmacy Management    
Operating results by business segment    
Net revenue 638,213 616,460
Operating Segments | Healthcare    
Operating results by business segment    
Cost of care (951,642) (941,961)
Direct service costs and other (196,909) (179,190)
Stock compensation expense 2,021 1,750
Changes in fair value of contingent consideration   144
Segment Profit (Loss) 62,144 44,996
Operating Segments | Healthcare | Managed care and other    
Operating results by business segment    
Net revenue 1,208,674 1,164,253
Operating Segments | Pharmacy Management    
Operating results by business segment    
Cost of goods sold (537,574) (530,207)
Direct service costs and other (81,866) (79,635)
Stock compensation expense 2,107 1,672
Segment Profit (Loss) 20,880 8,290
Operating Segments | Pharmacy Management | Managed care and other    
Operating results by business segment    
Net revenue 64,435 59,895
Operating Segments | Pharmacy Management | PBM    
Operating results by business segment    
Net revenue 573,778 556,565
Corporate and Eliminations    
Operating results by business segment    
Cost of goods sold 51,432 40,414
Direct service costs and other (8,956) (13,099)
Stock compensation expense 1,929 6,185
Segment Profit (Loss) (8,175) (7,724)
Corporate and Eliminations | Managed care and other    
Operating results by business segment    
Net revenue (173) (169)
Corporate and Eliminations | PBM    
Operating results by business segment    
Net revenue $ (52,407) $ (41,055)
[1] Includes changes in fair value of contingent consideration of $144 for the three months ended March 31, 2019.
[2] Includes stock compensation expense of $9,607 and $6,057, for the three months ended March 31, 2019 and 2020, respectively