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Illustration: Sarah Grillo / Axios

Pharmacy benefit managers play an important but secretive role in controlling the prices of prescription drugs — and they're working hard to keep it that way. After Axios obtained a document that shed new light on this opaque process, Express Scripts, the country’s largest PBM, forced that document to be taken down.

Why it matters: Americans fill 4.5 billion prescriptions per year. The biggest pharmacy benefit managers are profiting from the vast majority of those transactions, largely through sophisticated and complex financial engineering. Critics argue these tactics contribute to the country's high drug prices, which makes it important to understand how all of this works.

The big picture: Pharmacy benefit managers, or PBMs, are middlemen. They administer the prescription drug coverage in employers’ health care plans, which includes negotiating for discounts with the pharmaceutical companies.

  • Critics say PBMs keep a lot of those savings for themselves, rather than passing them on to consumers. PBMs say they’re providing real value. But their contracts are highly complex and secretive, making it hard to determine who’s right.

Axios obtained a document that helps answer those questions — a copy of the template that Express Scripts uses for its contracts. We reported on its contents, and posted the document itself to DocumentCloud so readers could evaluate it for themselves.

  • Express Scripts dismissed the document as out of date and irrelevant.
  • But after our story ran, the company’s lawyers forced DocumentCloud to remove the contract template, claiming copyright infringement.

What’s next: In lieu of reposting the entire Express Scripts contract template, this series takes a fresh and more detailed look at some of the most important tactics large PBMs use to protect their financial interests. It is based on portions of the Express Scripts template as well as new reporting and pharmacy benefits documents. Express Scripts declined multiple requests to comment further.

Go deeper

Prosecutor to seek hate crime charges, death penalty in Atlanta shootings

In Hopkinton, Mass., the Rally & Run To Stop Asian Hate is held to show solidarity in the wake of deadly Atlanta shootings and to mourn the loss of eight lives including six Asian women. Photo: Jonathan Wiggs/The Boston Globe via Getty Images

Prosecutors unveiled murder charges against the white man accused of shooting and killing eight people, six of whom were Asian women, at Atlanta-area spas,.AP reports.

Driving the news: A prosecutor filed notice that she plans to seek hate crime charges and the death penalty in the case.

3 hours ago - Health

Study: Over 99% of hospitalized COVID-19 patients were not vaccinated

Photo: Joe Raedle/Getty Images

The Cleveland Clinic on Tuesday released a study showing that 99.75% of patients hospitalized with COVID-19 between Jan. 1 and April 13 were not fully vaccinated, according to data provided to Axios.

Why it matters: Real-world evidence continues to show coronavirus vaccines are effective at keeping people from dying and out of hospitals. The Pfizer-BioNTech and Moderna vaccines have been found to be 95% and 94% effective, respectively, at preventing symptomatic infections.

4 hours ago - Health

Biden reaches agreements with Uber and Lyft to give free rides to vaccine sites

The Biden administration has reached agreements with ride-sharing companies Uber and Lyft to offer free rides to coronavirus vaccination sites through July 4, the White House announced Tuesday.

Why it matters: The free rides, starting in the next two weeks, are part of the Biden administration's push to administer at least one vaccine dose to 70% of U.S. adults by Independence Day.

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