Express Scripts reported a 20 percent boost in profit for the third quarter, but executives for the pharmacy benefit manager cautioned that the company faces a weaker outlook heading into 2013, and its shares plunged in aftermarket trading.

Express said in a statement "the current weak business climate and the unemployment outlook" could restrain performance next year. "Despite near-term headwinds and a challenging macroeconomic environment, we remain confident we are well-positioned for continued growth," said Express CEO George Paz.

Pharmacy benefits managers, or PBMs, run prescription drug plans for employers, insurers and other customers. They process mail-order prescriptions and handle bills for prescriptions filled at retail pharmacies.

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