Photo: Julia Rendleman/Getty Images for Eventive Marketing

If Express Scripts is any kind of bellwether for drug rebates — pricing discounts that drug manufacturers pay to pharmacy benefit managers so their drugs get put on the drug coverage lists — then those dollars continue to rise.

By the numbers: Cigna, which bought Express Scripts last year, said it is owed almost $4 billion in rebates from pharmaceutical companies as of Sept. 30, according to new investor documents. That's up almost $600 million since the start of this year.

  • UnitedHealth Group, which owns OptumRx, counted $4.2 billion worth of drug rebate "receivables" as of Dec. 31, 2018, but hasn't provided updates since then. CVS and Humana similarly control billions of dollars in rebates.

Between the lines: Pharmacy benefit managers, or PBMs, don't keep all of those dollars. A lot goes back to large employers, governments and health plans as a way to lower premiums.

  • But even the small percentage that is retained results in hundreds of millions of dollars to their bottom line. It's why PBMs were so relieved when the Trump administration killed its drug rebate overhaul.

Go deeper: The drug rebate curtain

Go deeper

21 mins ago - Politics & Policy

Scoop: Meadows puts agencies on notice about staff shake-up

Internal government email obtained by Axios

White House chief of staff Mark Meadows told administration officials Monday to expect senior aides to be replaced at many government agencies, according to an internal email obtained by Axios.

Behind the scenes: Meadows asked the director of the White House Presidential Personnel Office John McEntee "to look at replacing the White House Liaisons (WHLs) at many of your agencies," according to the email. "John will be working with outgoing liaisons to explore other opportunities."

White House ricin package suspect allegedly urged Trump to "give up"

President Trump exits the Oval Office at the White House on Tuesday. Photo: Drew Angerer/Getty Images

A Canadian woman allegedly mailed a letter addressed to President Trump containing the poison ricin and the threat "give up and remove your application for this election," court papers filed Tuesday show.

Driving the news: Pascale Cecile Veronique Ferrier, 53, was arrested trying to enter New York from Canada on Sunday. She appeared briefly in a Buffalo, N.Y., courtroom where a judge entered a not guilty plea on her behalf to the charge of threatening the president, per CBC.

Updated 1 hour ago - Politics & Policy

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Global: Total confirmed cases as of 7 p.m. ET: 31,444,163 — Total deaths: 967,305— Total recoveries: 21,551,157Map.
  2. U.S.: Total confirmed cases as of 7 p.m. ET: 6,889,086 — Total deaths: 200,641 — Total recoveries: 2,615,974 — Total tests: 95,846,925Map.
  3. Health: The U.S. reaches 200,000 coronavirus deaths — The CDC's crumbling reputation — America turns against coronavirus vaccine.
  4. Politics: Elected officials are failing us on much-needed stimulus.
  5. Business: Two-thirds of business leaders think pandemic will lead to permanent changes — Fed chair warns economy will feel the weight of expired stimulus.
  6. Sports: NFL fines maskless coaches.

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