A huge pharma middleman just lost its biggest customer — and it shows how drug pricing really works

Express Scripts is losing a big customer. Anthem, the big health insurer, is ending its contract with the company following a 2016 lawsuit.

Anthem claimed Express Scripts overcharged the insurer by billions of dollars. Anthem contracts with pharmacy benefit managers (PBMs) like Express Scripts to help negotiate lower prices for prescription drugs. Anthem accused Express Scripts of not passing along those savings, claiming Express Scripts overcharged the insurer by billions of dollars. Anthem is responsible for roughly 18% of Express Scripts’ revenue.

The relationship between Anthem and PBMs like Express Scripts shows that it’s not just drugmakers that are to blame for the rising price prescription prices.

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