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Catch up on coronavirus stories and special reports, curated by Mike Allen everyday

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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  • Express Scripts dismissed the document as out of date and irrelevant.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

White House nominates Rick Spinrad as NOAA leader

In this NOAA GOES-East satellite handout image, Hurricane Dorian, a Cat. 4 storm, moves slowly past Grand Bahama Island on September 2, 2019. (Photo by NOAA via Getty Images)

The White House on Thursday evening nominated Rick Spinrad, an oceanographer at Oregon State University, to head the National Oceanic and Atmospheric Administration (NOAA).

Why it matters: Filling the NOAA slot would complete the Biden administration's leadership on the climate and environment team. The agency, located within the Commerce Department, houses the National Weather Service and conducts much of the nation's climate science research.

3 hours ago - World

Israeli officials will object to restoration of Iran deal in D.C. visit

Photo: Anadolu Agency / Getty Images

Israeli Prime Minister Benjamin Netanyahu has instructed the delegation traveling to Washington, D.C. next week for strategic talks on Iran to stress their objection to a U.S. return to the 2015 nuclear deal and to refuse to discuss its contents, Israeli officials say.

Why it matters: That position is similar to the one Israel took in the year before the 2015 nuclear deal was announced, which led to a rift between the Israeli government and the Obama administration. History could now repeat itself.

Updated 3 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Brendan Lynch/Axios

  1. Health: Coronavirus cases aren't budging — even after vaccinations doubled— Health care workers feel stress, burnout more than a year into the pandemic — Handful of "breakthrough" COVID cases occurred in nursing homes, CDC says.
  2. Vaccines: Johnson & Johnson's vaccine production problems look even bigger — All U.S. adults now eligible for COVID-19 vaccine.
  3. Political: Watchdog says agency infighting increased health and safety risks at start of pandemic.
  4. World: EU regulator: Benefits of J&J vaccine outweigh risk of rare blood clots.
  5. Variant tracker: Where different strains are spreading.

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