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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

14 mins ago - World

Scoop: Israel launches maximum pressure campaign against Ben & Jerry's

A Ben & Jerry's store in the Israeli city of Yavne. Photo: Ahmad Gharabli/AFP via Getty

The Israeli government has formed a special task force to pressure Ben & Jerry's ice cream and its parent company Unilever to reverse their decision to boycott Israeli settlements in the West Bank, Israeli officials tell me.

Why it matters: The Israeli government is concerned the move by Ben & Jerry's will encourage other international companies to take similar steps to differentiate between Israel and the West Bank settlements. A classified Foreign Ministry cable, seen by Axios, makes clear the government wants to send a message.

Video game developers at Activision Blizzard say they'll walk out Wednesday

Illustration: Shoshana Gordon/Axios

Employees at Activision Blizzard will hold a walkout Wednesday in protest of widespread harassment allegations across the company, a spokesperson on behalf of the group told Axios.

Why it matters: Walkouts are a drastic measure for developers in a largely non-unionized field, a testament to just how angry employees currently are.

Updated 1 hour ago - Politics & Policy

Atlanta-area spa shooter sentenced to life without parole

The Gold Spa, one day after a gunman shot and killed eight people at three separate Atlanta spa locations. Photo: VIRGINIE KIPPELEN/AFP via Getty Images

Robert Aaron Long, 22, of Georgia, was sentenced Tuesday to life without parole after pleading guilty to murder and other charges related to a series of deadly spa shootings in Atlanta, AP reports.

The big picture: Cherokee County Superior Court Chief Judge Ellen McElyea accepted the plea deal, and Long was given four life sentences after a prosecutor said investigators found no evidence of racial bias.