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

Coronavirus cases flat or growing in 48 states

Data: The COVID Tracking Project, state health departments; Map: Andrew Witherspoon, Sara Wise, Naema Ahmed, Danielle Alberti/Axios

The number of coronavirus cases increased in the vast majority of states over the last week, and decreased in only two states plus the District of Columbia.

Why it matters: This is a grim reminder that no part of the United States is safe from the virus. If states fail to contain their outbreaks, they could soon face exponential spread and overwhelmed health systems.

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Driving the news: The pandemic is accelerating across the U.S., with the Sun Belt being hit particularly hard. Daily coronavirus case records were reported on Wednesday in Texas (8,076), Arizona (4,878), Georgia (2,946), North Carolina (1,843) and Tennessee (1,806).

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Democratic presidential candidate and former Vice President Joe Biden at Philadelphia City Hall in Pennsylvania in June. Photo: Jim Watson/AFP via Getty Images

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Why it matters: It's the most the presumptive Democratic presidential nominee has raised in a month. It's also more than the record $131 million President Trump's re-election campaign and the Republican National Committee raised last month.