We’re calling for the end of: 

• Restricting Patient Care in the Name of “Cost Savings”: Express Scripts intentionally creates limited formularies based on what medications bring their corporation the largest kickback (rebate), not what is medically best or most affordable for the patient. This increases financial burdens on patients making it more difficult to afford essential medications and limiting patients' access to lifesaving treatments .

• Intentionally Limiting Patient Choice: designing benefits plans that require patients to use only PBM-owned/affiliated pharmacies and/or financially penalizing or threatening to withdraw coverage when patients use the pharmacy of their choice. Mandating mail order or the use of PBM-owned “specialty pharmacies” for expensive medications that require no special handling. 

• Disregard for Safety: Intervening in the patient’s treatment plan by requiring “fail first” protocols; engaging in non-medical switching; exposing patients to unnecessary risk through mail order pharmacy when drugs are rendered ineffective by improper shipping and/or temperature controls - with little to no recourse when issues arise; drastically cutting reimbursements for medication already dispensed and therapeutic counseling provided, leading to overwhelm as pharmacies are forced to cut staff while processing prescriptions and providing care for an ever-increasing number of patients. 

• Obvious Anticompetitive Behavior That Suppresses the Free Market: 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. With Express Scripts, CVS Caremark and UnitedHealth’s OptumRx holding 80% of the covered lives in the U.S., there's no incentive for any of the “Big 3” PBMs to compete.