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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

Caitlin Owens, author of Vitals
57 mins ago - Health

What overwhelmed hospitals look like

A healthcare professional suits up to enter a COVID-19 patient's room in the ICU at Van Wert County Hospital in Ohio. Photo: Megan Jelinger/AFP

Utah doctors are doing what they say is the equivalent of rationing care. Intensive care beds in Minnesota are nearly full. And the country overall continues to break hospitalization records — all as millions of Americans travel to spend Thanksgiving with friends and family.

Why it matters: America's health care workers are exhausted, and the sickest coronavirus patients aren't receiving the kind of care that could make the difference between living and dying.

Felix Salmon, author of Capital
1 hour ago - Economy & Business

Southwest CEO: "You should fly"

The official guidance of the CDC says that "postponing travel and staying home is the best way to protect yourself and others this year."

  • Southwest Airlines CEO Gary Kelly, however, took the opposing position when he was interviewed by "Axios on HBO." "You should fly," he told me, adding that "we need to have as much commerce and business and movement as is safe to do."

Cárdenas: Democrats need to be more "culturally competent" to win

Photo: Paul Morigi via Getty Images

Rep. Tony Cárdenas (D-Calif.), who's running for chair of the Democratic Congressional Campaign Committee, told "Axios on HBO" that the DCCC needs to change "overnight" and his colleagues need to be more "culturally competent" if they want to be successful in the next election.

Why it matters: House Democrats are confronting what went wrong and what their party needs to change after they failed to expand their House majority and President Trump expanded his support among Latino voters.