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Express Scripts mails millions of prescriptions every year. Photo: Scott Varley/Digital First Media/Torrance Daily Breeze via Getty Images

Express Scripts sent a notification this month to pharmacies saying its networks will expand to include "pharmacies predominantly engaged in mail-order practice" by the first quarter of 2019.

Why it matters: Express Scripts, which negotiates drug prices for 80 million Americans, may be opening the door for any mail-order pharmacy — including Amazon's newly acquired PillPack — to get full access to its large network, as long as the pharmacy agrees to Express Scripts' contract terms.

What they're saying: The company said it took this action because many pharmacies — even those that said they were retail pharmacies — conduct more than half of their business via mail order.

  • "Having pharmacies be clear about what they do — mail order or retail — helps our clients to determine what they need from their pharmacy network. Also, it ensures pharmacies are in legal compliance with their contracts," Express Scripts spokesman Brian Henry said.
  • The company did not provide an update on its relationship with PillPack, which was in a contract dispute with Express Scripts over the summer. PillPack declined to comment on contract negotiations.

Between the lines: Express Scripts, a dominant pharmacy benefit manager that is getting gobbled up by Cigna, owns a massive mail-order drug business that represents almost half of its revenue. The company has been criticized (and sued) for steering patients toward itself, by excluding other pharmacies that deliver drugs to people's homes.

  • Mail order is big business for Express Scripts. While these changes could be spurred by the looming threat of Amazon, Express Scripts is not going to leave money on the table.

The big question: What's included in the company's contracts with mail-order pharmacies? The secretive terms will dictate how much mail-order pharmacies get paid and what credentials they need to be part of the network.

  • "If a pharmacy decides not to participate due to the terms and conditions imposed by Express Scripts, this avoids the perception that Express Scripts is blocking or kicking out mail-order pharmacies from their network," said Stephen Buck, a pharmaceutical industry expert.

What to watch: Whether CVS Caremark and OptumRx, the other two dominant PBMs, follow suit. CVS said it includes "mail-order pharmacies as a subset of our retail pharmacy network." OptumRx has "other mail-order pharmacies in network" but did not say which ones.

Update: The story has been updated with comments from CVS, OptumRx and PillPack.

Go deeper

4 hours ago - World

Over 170 Palestinians injured in clashes with Israeli police in Jerusalem

An injured man is carried away as Israeli security forces clash with Palestinian protesters at the al-Aqsa mosque compound in Jerusalem. Photo: Ahmad Gharabli/AFP via Getty Images

At least 178 Palestinians have been injured in clashes with Israeli police in Jerusalem, Reuters reported late Friday.

The big picture: The clashes come amid growing anger over the threatened eviction of Palestinians from their homes on land claimed by Jewish settlers in East Jerusalem. Tensions have also escalated in the occupied West Bank in recent weeks.

Updated 6 hours ago - Politics & Policy

Coronavirus dashboard

Illustration: Annelise Capossela/Axios

  1. Health: Coronavirus cases hit a seven-month low — Majority back vaccine proof requirements for travel, schools and work — The race to avoid a possible "monster" COVID variant.
  2. Politics: Oklahoma secures $2.6 million refund for hydroxychloroquine purchase — Why Biden's latest vaccine goal is his hardest yet.
  3. Vaccines: Pfizer begins application for full FDA approval of COVID-19 vaccine — Moderna says its COVID booster shot shows promise against variants.
  4. Economy: U.S. adds just 266,000 jobs in April, far below expectations — Americans' return to the skies could benefit smaller airlines.
  5. World: WHO authorizes China's Sinopharm COVID-19 vaccine for emergency use — Mixed response in Europe to Biden's vaccine patents bombshell.
  6. Variant tracker: Where different strains are spreading.

Ohio GOP censures Rep. Anthony Gonzalez over Trump impeachment vote

Photo: Bill Clark/CQ-Roll Call, Inc via Getty Images

The Ohio Republican Party on Friday censured Rep. Anthony Gonzalez (R-Ohio) and called for him to resign for voting to impeach former President Trump in January, Reuters reports.

The big picture: Gonzalez is the latest Republican lawmaker to be punished for voting to impeach the former president on a charge of inciting the deadly Jan. 6 insurrection.

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