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Critics of Pharmacy Benefit Managers to Protest at Express Scripts

Updated: May 21

“They have the power to create a monopolistic system, which is what they're doing,” says Loretta Boesing


Loretta Boesing’s son is a transplant survivor who needs medication every 12 hours. His family, like many others, decided to try a mail order pharmacy. They say it nearly killed him.


At the time, Boesing didn’t know the ins and outs of the pharmacy industry like she does now. But after his medication was delivered with no ice pack or temperature protections on a 102-degree day in Missouri, she learned — fast.


“I felt his liquid oral transplant medications, I'm like, ‘Gosh, these are so hot,’ but in our minds and as patients, and I think most patients across America would agree, that we just think surely they wouldn't do this if it's not safe. But we don't know that it's not being regulated by the FDA or the state boards of pharmacy,” she tells RFT. “I give him the medication, he’s in rejection.”


Two weeks after switching to the mail order pharmacy — which she’d later learn was part of St. Louis-based Express Scripts — she says her son was in the hospital and fighting for his life.


If you search “Express Scripts” on social media, you’ll find hundreds of stories condemning the company, some of them similar to Boesing’s. 


Boesing swore she’d never use a mail order pharmacy again, but she was later forced to due to her health insurance. This time it was CVS Caremark. 


She felt it was inhumane and un-American to be forced into a mail order pharmacy again. Especially when she trusted Cardinal Glennon, where she had been picking up the medication, much more.


“I just broke down at the pharmacy counter,” she says. “I was afraid after what we had been through.”


She says she would call the FDA to share her concerns about the medication’s temperature. She also filed a complaint with the Department of Labor when her son’s medication continued to be shipped without ice packs.


She says she was told the problem was unethical but not illegal. “This is gonna have to go through the legislative process,” she says she was told.


The situation sparked Boesing to become a national activist on the issue of what’s known as Pharmacy Benefit Managers — companies like Express Scripts. PBMs manage the pharmacy benefits for different insurance companies, yet they’ve also become part of them.


“They've merged with insurance companies. The three largest are Optum Rx, CVS Caremark, and Express Scripts,” Boesing says. “Express Scripts has merged with Cigna. Aetna has merged with CVS Caremark. United Healthcare has merged with Optum Rx.”

PBMs are supposed to negotiate drug prices for patients, but it doesn’t always work like that, she says. Instead, she says, they can create a sort of monopoly where customers pay higher prices than they would at their local pharmacy.


Express Scripts did not respond to requests for comment.


There is some movement on a national level to reform PBMs. House Bill 2880 has been introduced in Congress and is dubbed the “Protecting Patients Against PBM Abuses Act.” A bipartisan coalition of 39 attorneys general have signed a letter urging Congress to take action against PBMs. Notably, Missouri Attorney General Andrew Bailey did not sign on.


In Missouri, SB 843 was recently heard before the Senate Insurance and Banking Committee and would allow freedom of choice in pharmacies. Similarly, SB 1105 relates to PBMs and prescription drug payments and was also heard by the committee.


The only bill that seems to stand a chance of passage is SB 751, which would enact provisions regarding the distribution of medications, Boesing says. It is on the Senate’s informal calendar for a third reading but time is running out, and she points out that drug manufacturers are lobbying against it.


The Protest


Boesing is one of the organizers of a demonstration Friday in St. Louis, where she says more than 250 protestors from around the country (and Canada) are preparing to descend on St. Louis this Friday. The activists plan to rally outside Express Scripts headquarters to protest their business practices.


“Express Scripts, being a pharmacy benefit manager and a mail order pharmacy, they have the power to create a monopolistic system, which is what they're doing,” Boesing says. “They create obstacle courses, like when we try to get medications, we have to go through like the prior authorization processes, sometimes for even medications that are lower cost. And due to the ability to have that monopolistic power 30 percent of America's pharmacies are at risk of closure.”


Protestors are calling on Express Scripts to stop limiting patient choice by designing benefits plans that require patients to use only PBM-owned pharmacies, end what they call its “disregard for safety,” and stop restricting patient care.


They also demand the company end its “anticompetitive behavior.”


“As ‘negotiators,’ PBMs shouldn’t own pharmacies (it’s a conflict of interest), and yet Express Scripts is the 3rd largest pharmacy in the U.S. In a drive to make patients dependent on its pharmacies, Express Scripts offers its competitor pharmacies non-negotiable contracts with perpetually changing, unconscionable terms; mandated below-cost reimbursements; and no guarantee of steering the pharmacies’ patients to Express Scripts’ own pharmacies,” organizers say in a release. “With Express Scripts, CVS Caremark and UnitedHealth’s OptumRx holding 80 percent of the covered lives in the U.S., there's no incentive for any of the ‘Big 3’ PBMs to compete.”


The rally will take place at Express Scripts’ Headquarters (1 Express Way) in north county from 9 a.m. to 1:30 p.m. on Friday.


Reporter: Kallie Cox

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