Good morning ... Hey, if you're enjoying Vitals, why not mention to your friends or coworkers that they, too, might enjoy Vitals? And if someone forwarded you this newsletter, feel free to sign up — everybody can join the party right here.
Illustration: Sarah Grillo/Axios
Pharmacy benefit managers have an enormous role in determining how much consumers pay for prescription drugs. But they operate largely in secret, making it hard to objectively assess how well they actually help consumers.
Driving the news: Last month, my colleague Bob Herman obtained a copy of a template that Express Scripts, the country's biggest PBM, used for its contracts — a document that helped shed new light on a particularly opaque part of the health care system, and one that affects us all.
But this is still important. So we've dug even deeper into PBMs' contracting practices. Bob read through that Express Scripts document a couple (dozen) more times, called more experts, and obtained additional PBM contract information through publicly available channels.
Why it matters: Americans fill 4.5 billion prescriptions per year. The biggest PBMs are profiting from the vast majority of those transactions, largely through sophisticated and complex financial engineering. Critics argue these tactics contribute to the country's high drug prices, which makes it important to understand how all of this works.
What's next: In lieu of reposting the initial document, today we're presenting you with a five-part deep dive into this part of the drug-pricing process and the specific practices that tilt the balance of power toward PBMs.
The House and the Senate have now passed differing versions of “right to try” legislation, which would create a new process for terminally ill patients to try drugs that are still being reviewed by the Food and Drug Administration. But the path to reconciling those two bills is unclear.
What we're hearing: Senate aides told Axios’ Caitlin Owens they're skeptical the bill will get Senate floor time.
Between the lines, per Caitlin: Yes, Senate GOP leaders have other priorities and an interest in avoiding controversial votes. But it also doesn't help that Johnson has been a constant thorn in Majority Leader Mitch McConnell's side over the past year, and annoyed the rest of the caucus in the process.
One side effect of the leadership change at the Department of Veterans Affairs: Even more uncertainty for its expensive and controversial contract for a new system of electronic health records.
The intrigue: This process has been dogged by controversy for over a year, beginning with then-secretary David Shulkin’s decision to award the contract without a competitive bidding process — a move that was reportedly influenced by Jared Kushner.
Why it matters: $16 billion is an awful lot of money, and it’s particularly a lot of money to spend without soliciting bids. At the same time, there’s relatively broad bipartisan agreement that the VA and DOD systems do need to work better together.
What's on your radar this week? I always welcome your tips and feedback. Send to firstname.lastname@example.org, or just reply to this email.