Two weeks ago, Axios got their hands on a 36-page contract template leaked by a source in the healthcare industry that gave insight into the mysterious way Express Scripts negotiates prescription prices with drug companies.
Alas, within a fortnight, Express Scripts forced the document to be taken off the web. So Axios came in pens a blazin’, fighting back the only way they know how — a 4-part expose outlining Express Scripts secretive process for setting drug prices.
Pharmacy benefits managers like Express Scripts act as middlemen between drug companies and employer health plans. And they have a few tricks up their sleeves when it comes to making money off medicine…
Like a secret, “proprietary algorithm”
AKA, a black box of calculations used to determine whether a drug is billed as a brand, or a generic (labeling a drug as a “brand” costs employers a ton more — and is far more lucrative for Express Scripts).
Not to mention a vise-grip on pharmacies: Independent pharmacists report being strong-armed into signing contracts that reimburse them at rock-bottom rates for filling prescriptions, rather than lose their patient base.
And they’re not exactly paying their profits forward
Anthem dumped Express Scripts last year after accusing them of collecting lucrative rebates from drug companies and keeping them all to themselves, instead of passing those benefits on to Anthem.
States that partner with Express Scripts to provide Medicaid are following suit — the state of West Virginia, for example, predicts it’ll save $30m this year by being its own pharmacy benefit manager.
