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Express Scripts--Back to Basics, Only Bigger

Executive Summary

After the failure of the drug company/PBM mergers of the mid-1990s, the notion that pharmacy benefit managers can play a strategic role in drug selection finds few takers among drug company executives who, instead, now embrace a status quo ante bellum view that new, innovative products and strong brands succeed or fail without the influence of PBMs. But several recent trends, including a significant industry consolidation, have left a core group of market leaders bigger and more focused than ever. In particular, the growing influence of the Internet as both a tool and information source and the likely passage of Medicare drug coverage should make PBMs more influential in product selection and formulary management. Behind both lies a newly empowered consumer, a force that has bedeviled PBMs in the past but which they now seek to embrace. Express Scripts officials argue that their focus on traditional PBM values should, if anything, make them more, not less relevant to drug companies in the future.

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