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Pharmacists, patients say Express Scripts business practices bad for consumers

An illustration shows colorful pills falling out of an amber-colored prescription bottle.
Rici Hoffarth
St. Louis Public Radio
Critics of Express Scripts and other pharmacy benefit managers say the company steers patients to its own pharmacies, decreasing access for other consumers.

Updated at 2:35 p.m. with comments from protestors

A group  of approximately 100 pharmacists and patient rights advocates protested Express Scripts’ business practices today outside the company’s headquarters in north St. Louis County. They claim the company’s negotiating tactics result in decreased availability of medicines and higher prices for consumers.

Express Scripts is a pharmacy benefits manager — an intermediary between pharmacies and insurance companies.

The Berkeley-based company is one of the largest pharmacy benefits managers in the country. Such companies determine which medicines are available with insurance plans, set co-pays and manage other requirements, including prior authorizations that patients need from insurers to receive certain medications.

Pharmacy benefits managers can increase drug prices through those negotiations, but don’t pass those savings to pharmacies and patients, said protest organizer Loretta Boesing, a St. Francois County resident and the founder of Unite for Safe Medications.

Boesing said companies limit availability of prescriptions by funneling patients to their own pharmacies and requiring patients to receive prescriptions through the mail.

“So many patients are not getting their medications on time,” she said. “We need options to use their local pharmacies in our coverage, we need Express Scripts to stop being so greedy….this has got to stop. We cannot allow this to happen to our pharmacy and medication access here in America.

Express Scripts representatives deny the claims made by protestors.

“The health of our customers is at the center of all we do,” said an Express Scripts spokeswoman in a statement. “We work relentlessly to ensure our customers can access their medications at the lowest possible cost and in the way that is most convenient for them.”

Boesing became an advocate against mandatory mail-order prescriptions after a vital medication for her young son was sent through the mail. He had recently received a liver transplant and needed daily medicine to keep his body from rejecting the new organ.

The medicine should be kept at room temperature, she said, but arrived at her door hot from the Missouri heat.

“I think most people, once they realize that… [think] ‘Wow, this is really monopolistic,’” Boesing said. “And this has the power to put all of our local pharmacies out of business.”

Maurice Shaw, a pharmacist and comedian from Springfield, Illinois, wore a blazer covered in a print of CVS receipts, a red “Make Pharmacy Great Again” hat and a chain bedazzled with the words “PBM REFORM.”

He said pharmacy benefits managers have squeezed retail pharmacies financially, which has resulted in under-staffed businesses. 

“They’re understaffed because of the terrible reimbursements on the medications,” Shaw said. “One thing that the chains can control is labor. So they cut back on the labor and make you do more and more and more, which in turn leads to pharmacy staff being stressed out. It leads to medication errors or decreases patient safety.”

Mark Boesen, an attorney and pharmacist, traveled to the protest from Arizona to represent the group Pharmacists United for Truth and Transparency. He said Express Scripts and other companies originally served a useful purpose, but have now monopolized healthcare as giant conglomerates control both benefits managers and health insurance plans. 

“This vertical integration has just led to a let's figure out a way to steer patients toward their own business interests,” Boesen said. “And that’s really sad.”

Julie Baak, a practice manager at the Arthritis Center in Bridgeton, said Express Scripts and other companies make it difficult for the rheumatology patients at her clinic to get the medicine they need by requiring excessive prior authorizations.

“They all want a piece of the pie from doing none of the work, so they make things very, very difficult with administrative burdens,” said Baak. “There's a lot of medicines and biologics in our toolbox that we can use, and insurance companies — and particularly the PBMs — want every patient to be a one-size-fits-all, and that one-size-fits-all is what makes them the most money.”

Express Scripts representatives have said negotiating with pharmacies and drug makers makes prices lower, not higher, for patients.

“Our flexible pharmacy networks include pharmacies of all scales and sizes, including large chains, regional and independent pharmacies, as well as home delivery options,” the spokeswoman said.

Company representatives said most prescriptions in the U.S. are filled at retail or chain pharmacies, and 98% of customers in St. Louis have an in-network pharmacy within a short drive of their home.

They also emphasized that health plans, employers and other clients have a say in what drugs are included in the list of medications insurers cover and are free to design their own prescription drug plans.

Sarah Fentem is the health reporter at St. Louis Public Radio.