High Drug Prices and Pharmacy Deserts: Protesters Blame Drug Middlemen, Demand Regulation

Discouraged by a lack of action from Congress, leaders from America’s largest pharmacy associations marched with dozens of demonstrators Friday outside the St. Louis-based headquarters of Express Scripts, a major prescription drug middleman whose practices the group accuses of harming everyday Americans.

Protestors waved signs, shouted slogans and gave speeches at a makeshift podium across the street from the glass-and-brick building of the nation's second largest pharmacy benefits manager, or PBM.

As third-party administrators of health insurers’ prescription drug programs, PBMs negotiate drug prices with pharmaceutical companies, determine which drugs will be covered by insurance plans and set reimbursement rates for the pharmacies that buy and sell the drugs.

As the power of PBMs rose over the years, they demanded bigger rebates from drug manufacturers and pocketed increasingly bigger shares of those savings. They also lowered pharmacy reimbursement rates and tacked on hefty fees, prompting the closure of hundreds of independent pharmacies nationwide.

The three largest PBMs – ExpressScripts, owned by Cigna; CVS Caremark, owned by CVS Health; and OptumRx, owned by the same company as UnitedHealthcare – control a majority of the market.

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