On Friday (Nov. 15), the House Committee on the Judiciary held a hearing on the state of antitrust enforcement, where committee members raised concerns about the controversial 2012 merger of Express Scripts Inc. and Medco, which created the country’s largest pharmacy benefit manager (PBM).

The merger has led to painful consequences for patients and independent pharmacists across the country, which Rep. Doug Collins’ (R-Ga.) pressed in front of the committee, saying that the process “did not sufficiently protect customers, and pharmacy competition.”


The PBM industry, now dominated by Express Scripts, has proven its ability to drive independent pharmacists out of business, increase employer costs on prescription benefits, and force patients into mail-order programs, all while producing record profits for themselves.

Patients have been most impacted by widespread mandatory mail-order pharmacy programs established by PBMs, programs which Collins critiqued. Patients, particularly rural ones, increasingly are losing pharmacy choice and their connections with local pharmacists, while long-time community businesses are forced to close their doors.

A study published by the Journal of Managed Care Pharmacy this fall examined the attitudes of seniors on mandatory mail-order, particularly looking at the experiences of rural seniors. Some common concerns express were losing their pharmacy of choice, running out of medications, not receiving the proper medications, or losing the ability to consult a pharmacist. A staggering 83.7 percent of respondents said they would oppose mandatory mail order if it meant that their local community pharmacy would need to close.

Meanwhile, several recent stories have highlighted employers who discovered that large PBMs like Express Scripts have quietly been driving up their benefits costs, hidden under the lack of transparency typical in PBM contracts. After one year with Express Scripts, for example, Meridian Health Systems, Inc. saw its prescription benefits costs for employees rise by $1.3 million. The City of Houston also recently announced that they were overcharged by $3.7 million by Cigna for their employee pharmacy benefits.

Friday’s hearing, though, produces hope for patients, employers, and pharmacists frustrated with an oppressive industry with seemingly unending power. Collins avowed to the committee and FTC Chairwoman Ramirez that if nothing else would be done to protect patients and pharmacists, Congress would be forced to step in.

Policymakers should follow Collins’ lead and address the impacts of a growing industry that impacts so many and has benefitted from little oversight and regulation.

Wallace is the president of Pharmacists United for Truth and Transparency, a coalition of more than 1,000 pharmacists dedicated to exposing secretive and unethical practices in the pharmacy benefit manager (PBM) industry.