Express Scripts built a dominant position in the world of pharmacy benefits managers (PBM) through acquisitions and by offering insurance companies and company health plans a service that succeeded in holding down prescription drug pricing. It’s acquisition of Medco (2012) gave it the leading share of the market and it is the largest pure-play PBM in existence. Recently, trends in drug development and pricing and in insurers’ businesses due to the Affordable Care Act (ACA) are prompting insurers to move PBM functions in house. We are concerned that Express Scripts have built the dominant business for the trailing decade rather than for the next one.

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