Congressional Letters Coming Out Against The Express Scripts-Medco Merger

Many members of Congress wrote letters stating their opposition or apprehension regarding the Express Scripts-Medco Merger.  Below are excerpts from those letters.

Mark Begich - Senator – Alaska:

"I write regarding the proposed merger between the two pharmacy benefit managers (PBMs), Express Scripts and Medco.  As the Federal Trade Commission makes its decision on this large and potentially significant merger, I urge you to take into account any possible impact on patients and community pharmacies - especially in rural or isolated areas of Alaska."

"Alaskans deserve access to high quality health care no matter where they live.  We must look closely at all parts of the drug supply chain to ensure Alaskans living in remote or isolated regions have access to affordable medical supplies."

"It is my understanding the proposed combined PBM has the potential to control 60 percent of mail order drugs and 50 percent of the specialty prescription market.  With this high level of market concentration, it is critical for your agency to ensure that patient access and choice are preserved in Alaska."

(February 29, 2012 - Letter to Chairman Leibowitz)

Don Young - At-Large Representative  Alaska:

"The proposed merger of these two corporations would result in unparalleled market concentration in an already extremely limited PBM marketplace.  The resulting limited PBM marketplace would most likely result in reduced choices for all third party payers including the federal government, particularly with respect to the TRICARE program, Medicare Part D and the Federal employees' health benefit program.

"The combined 'synergies' of the merged entity may not lower drug costs.  It may simply create greater negotiating leverage to enable this new merged PBM to extract additional savings from other market participants, which has no guarantee of being passed on to plan sponsors and consumers." 

"Given the fact that the PBM industry is virtually unregulated at either the federal or state level, and the long list of substantial enforcement actions taken against each of the major PBMs in the past few years alleging fraudulent and deceptive conduct, I am extremely skeptical that American tax payers can trust this 'Super PBM' to look out for their best interests."

"Even today, independent community pharmacies, in particular, have extremely limited leverage when negotiating contracts with PBMs.  This proposed merger could result in even more onerous contract provisions for independent pharmacies which may drive a significant number out of business."

"The proposed merger raises significant anti-trust concerns but also may have negative effects on third-party and federal payers.  It threatens to further limit consumer choice and would unlikely result in cost savings for patients.  Given the totality of the circumstances, I feel it would be prudent for the FTC to block the proposed merger of Express Scripts and Medco."

(August 4, 2011 - Letter to Chairman Leibowitz)

John Boozman - Senator - Arkansas

"An Express Scripts/Medco merger would consolidate two of the nation's three largest pharmacy benefit managers (PBM) and provide this new entity with a dominant market share in mail order and specialty pharmacies.  Various groups and constituents in my state have expressed concern that this could substantially decrease competition in the pharmaceutical delivery market."

"Many of the alternative PBM competitors lack the economy of size and national breadth necessary to compete for many of the large health plan sponsors that compose a majority of the market."

"Others worry this proposed merger would reconfigure the market in a way that facilitates greater network exclusion leverage and drug formulary restrictions upon independent community pharmacies and drug stores.  These entities play a critical role in our healthcare economy, particularly in rural America, and I am concerned with any market transformations that might jeopardize their capacity to operate."

(February 9, 2012 - Letter to Chairman Leibowitz)

Mark Pryor - Senator - Arkansas:

"I am concerned the merger will result in one less major company competing to fulfill this function for their plans.  This type of market concentration could lead to less beneficial contracts for private insurers and federal programs like Medicare Part D, TRICARE and the Federal Employee Health Benefits Plan (FEHBP) that could significantly impact patients."

"The Companies and supporters of the merger argue that a super PBM that controls as much as one-third of the market, as in this case, would be more effective in negotiating lower prices from pharmaceutical companies. However, it is unclear whether any potential savings would be passed along to plan sponsors or consumers.  I am concerned that the merged company could have greater ability to engage in various anti-competitive tactics that threaten to drive small, local pharmacies out of business."

"There are significant concerns that with a lack of competition, a giant PBM could act to drive up drug costs, fail to significantly pass along manufacturer rebates, forcefully steer plan beneficiaries to their mail-order pharmacies and limit competition among specialty pharmacies.  Independent pharmacies serve a particularly important role in states with large rural populations by ensuring convenient access to prescription medications."

"While I believe in fair competition in the marketplace, I have concerns that approval of the Express Scripts and Medco merger could lead to market consolidation and have negative consequences for community pharmacies, employers, and other plan sponsors, federal plans, and most importantly, consumers who should have access to affordable medications."

(March 14, 2012 - Letter to Chairman Leibowitz)

Rick Crawford -  1st Congressional District - Arkansas 

"I am writing to express my concerns regarding the proposed merger of the large pharmacy benefit managers ('PBM'), Express Scripts and Medco.  The proposed merger of these two corporations could result in an unparalleled market concentration in an already limited PBM market further exacerbating an increasing problem for pharmacists and further restricting consumer choice."

"I am particularly concerned that a merger of this magnitude could have an adverse affect on community pharmacies that already have minimal leverage in negotiating contracts with PBMs.  Small independent pharmacies are prevented by antitrust laws from banding together to strengthen their negotiations with PBMs and on their own lack the resources to negotiate their best interest with these large entities."

"The proposed merger between Express Scripts and Medco has the potential to exacerbate this problem for community pharmacies widening the leverage gap which may lead to more independent pharmacies closing shop."

"The proposed merger raises anti-trust concerns as well as concerns for consumers and pharmacies."

(March 13, 2012 - Letter to Chairman Leibowitz)

Tim Griffin -  2nd Congressional District - Arkansas 

"I request that you thoroughly review the merits of this merger and the impacts it could have on pharmacies and patient's access to affordable prescription drugs."

"If merged, the Express Scripts firm would control 40 percent of the nations prescription drug industry, or 120 million Americans prescription drug customers.  With this level of market concentration, I ask you to please review this merger to ensure competition in the prescription drug industry so that consumer choice, patient access and community pharmacists are not negatively affected."

(March 20, 2012 - Letter to Chairman Leibowitz)

Joe Courtney - 2nd Congressional District - Connecticut 

"Like many of colleagues, I have concerns that the proposal will lead to further market concentration in an industry -- where there are already few choices -- without realizing cost savings for consumers.  At the same time, this concentration will squeeze community pharmacies, forcing some out of business and creating job losses.  Considering job loss and other economic consequences are at stake, I would encourage you to reject the Express Scripts-Medco merger."

"There is little evidence that increased market concentration of Express Scripts will significantly lower costs for consumers or the American taxpayer.  Rebates generated from pharmaceutical manufacturers will likely become larger.  And, the differences in negotiated reimbursement with insurance providers and pharmacies for dispensing medications will also likely increase.  However, based on empirical evidence, the exchange between price reductions and consumer savings may not be equal."

"In Connecticut and around the country, we have already seen some of the consequences of limited concentration of PBMs.  Onerous contracts with unrealistic pharmacy reimbursements have forced many community pharmacies out of business.  Further concentration will erode already limited negotiating power, create more burdensome contracts, and in the worst scenario, force more community pharmacies out of business.  At a time when our country still struggles with high unemployment, this would be another blow to our economic recovery."

(August 25, 2011 - Letter to Chairman Leibowitz)

James Risch - Senator - Idaho:
Michael Crapo - Senator - Idaho:

"We are writing to you regarding the proposed merger between Express Scripts and Medco.  We urge your office to conduct a thorough investigation of this merger, including examining any potential impact on consumers, patients, third party and federal payers, and independent community pharmacies."

"It is our understanding that the proposed combined entity has the potential to control 60% of mail order and 50% of the specialty prescription market.  With this level of market concentration, it is important your agency works to ensure that patient access and choice in our state, particularly in rural areas, is not restricted."

(February 13, 2012 - Letter to Chairman Leibowitz)

Janice Schakowsky - 9th Congressional District -  Illinois

"I am deeply concerned about the impacts on health care consumers if changes in the Pharmacy Benefit Management (PBM) market.  The proposed merger of Express Scripts and Medco, two of the largest PBM companies, would continue that trend, resulting in unparalleled market concentration in an already limited PBM marketplace.  I hope that you will review this proposed merger very carefully in terms of its likely effects on choices and costs for third party payers and consumers, including federal programs such as Medicare Part D, TRICARE, and the Federal Employees Health Benefit Program.  After doing so, I believe the appropriate action would be to deny the proposed merger."
(August 17, 2011)


Jesse Jackson, Jr. - 2nd Congressional District - Illinois

"I write to express my opposition to the proposed Express Scripts-Medco Health Solutions merger currently under review by the Federal Trade Commission (FTC).  If approved, I believe the merger would increase healthcare costs, adversely impacting low-income and minority community pharmacies."

"Pharmacy benefit managers (PBMs) like Express Scripts and Medco Health Solutions process drug sales between pharmacies, pharmaceutical manufacturers, insurance companies, and employers.  Through their size and purchasing power, PBMs can add economic efficiency to drug exchanges, yet the cost savings typically serve to inflate PBM's profit margins."

"A merger of Express Scripts and Medco would significantly reduce marketplace competition and diminish the purchasing power of community pharmacies."

"The merger would result in fewer choices for employers seeking a pharmacy benefit manager and fewer choices for patients who prefer - and depend on - community pharmacies for their prescription medication and other health care services.  Additionally, Medicare Part D beneficiaries who depend on competition in the drug market to keep prices low would suffer greatly from the proposed merger."

(December 8, 2011 - Letter to Chairman Leibowitz)

Danny Davis - 7th Congressional District - Illinois

"I am writing to you today to express our concerns regarding the proposed merger between two pharmacy benefit management companies (PBMs) currently before the Federal Trade Commission (FTC), Express Scripts and Medco, two of the largest PBMs would together control large segments of the prescription drug market in the United States.  The concentrated market power they would possess would lead to higher prices for consumers, impact the viability of community pharmacists and especially hit low-income and minority communities."

"The PBMs say they hope to lower costs through the merger.  However, PBMs have enjoyed huge profits - about 400% in recent years - while the rest of the economy has suffered.  At the same time, I continue to see health costs rising year after year.  This suggests the PBMs have become quite profitable at the expense of consumers."

"PBMs set the reimbursement fees for community pharmacies which will likely be significantly reduced under this merger.  This would affect their ability to provide health-care services such as immunizations and screenings in addition to filling prescriptions.  Moreover, if pharmacies are forced to reduce services or to close as a result of dwindling reimbursements people may no longer have access to other services like flu shots, blood pressure and glucose checks, and patient counseling."

"These effects will be magnified in low-income, urban communities that are feeling the brunt of the recession along with rural communities where consumers already must travel long distances to see their local pharmacists."

"On behalf of Illinois constituents, I strongly urge you to reject this merger."

(January 11, 2012 - Letter to Chairman Leibowitz)

Randy Hultgren - 14th Congressional District -  Illinois 

"Recent news reports have indicated a growing consensus that the proposed merger between Express Scripts and Medco will have a negative impact on consumers, impairing choice and potentially increasing costs."

"This union will greatly reduce the number of competitors in this already very narrow field, thus reducing overall competition; and without strong market pressures, I fear prescription prices for consumers - who are already reeling from this long sustained economic downturn - will rise."

"I am also concerned with the impact this merger may have on community pharmacies that deliver health care services in many of our small towns and cities.  During congressional testimony last year, the CEO of Express Scripts, George Paz, did not attempt to disguise the fact that this merger would result in reducing pharmacy access for Americans across the country."

"When local pharmacies close, many of my constituents may be forced to order their prescriptions through the mail and this new PBM stands to significantly profit from that development."

"This new company, if approved, would control the pharmacy benefits of some 135 million Americans, putting a substantial portion of the population under the control of one PBM.  In your investigation, please consider all implications this merger could have on patients, pharmacies, and public and private insurers."

(February 29, 2012 - Letter to Chairman Leibowitz)

Robert Dold- 10th Congressional District - Illinois 

"I write to you concerning the proposed merger between two of the largest pharmaceutical benefit managers - Medco and Express Scripts.  It is clear that such a merger would create a company that controls a majority of market share, potentially resulting in higher prices and less choice for consumers."

"While I do not believe the government should pick winners and losers in the marketplace, it is also imperative that we promote competition.  Without competition, normal market forces that foster continued innovation and keep costs down are missing."

"A Medco/Express Scripts merger would mean the new company would control the pharmacy benefits of about 135 million people.  The prescription drug industry is already concentrated and further consolidation could negatively consumers."

(March 9, 2102 - Letter to Chairman Leibowitz)

Bobby Rush - 1st Congressional District - Illinois  

"I am writing to express my concerns regarding a proposed merger between two of the nation's largest pharmacy benefit managers (PBM), Express Scripts, Inc. (ESI) and Medco Health Solutions, Inc.  This merger is likely to have negative effects on a national scale on local pharmacies, local pharmacy jobs, and affordable and available access for patients to prescription drugs and other critical pharmacy services and offerings."

"Following the merger, the combined company will have considerable market power in the pharmacy benefits market place.  The combined entity will also have strong incentives, for example to favor its own affiliate and mail-order pharmacies or not to offer reasonable reimbursement rates to unaffiliated competitors, such as smaller, local and independently-owned pharmacies.   Market clout and consolidation at such outsized levels would threaten the viability of many smaller local pharmacies and the thousands of community pharmacists and pharmacy staff they employ."

"When one company becomes dominant or attains market power concentration then typically, the most disadvantaged, needy, and price-sensitive consumers purchasing goods and services in that market stand to lose the most."

"Local pharmacies do more than just fill prescriptions - they also provide monitoring services, immunizations, and private consultations on drug interactions.  Without question, local pharmacies and pharmacists are often a community's most accessible and affordable health care provider - this is especially the case in Illinois's lower-income and minority communities."

(March 12, 2012 - Letter to Chairman Leibowitz)

Daniel Lipinski - 3rd Congressional District - Illinois 

"I am writing to urge the Federal Trade Commission to carefully examine the proposed merger between pharmacy benefit managers (PBM) Medco Health Solutions (Medco) and Express Scripts, Inc. (ESI).  I am concerned the merger's potential negative impacts on the accessibility of medical supplies and prescription drugs, as well as consumer choice.  I ask you to consider whether this merger would create a consolidated PBM with undue control over the health care of millions of Americans, particularly with regard to the mail order and specialty drug market, and that you carefully consider the potential negative implications for patients' access to their local community pharmacies should this merger be approved."

"Community pharmacists are a vital component in the delivery of quality health care and positive outcomes."

"As both a buyer and seller of pharmacy services, a giant PBM may have incentives to impose unfavorable contract terms on local community pharmacies or to leverage its market domination to exclude pharmacies from its network.  Forcing independent pharmacies out of business would eliminate thousands of community jobs and disrupt the valuable relationships patients have with their local health providers."

"As drug spending continues to skyrocket, there is evidence that PBMs, including Medco and Express Scripts, have steered customers toward costly brand-name drugs, even when cheaper generic alternatives are available.  As such, I urge you to consider whether this merger would lead to increased prescription prices and decreased access to health care for patients, particularly those with lower incomes."

"Competition ensures that consumers receive the lowest prices and best services.  Shifting more market power to a PBM that could hold 40 percent of the country's drug volume would leave thousands of employer-based health plans with only two PBMs from which to choose.  Not only does this erode consumer choice, but a larger PBM is likely to steer patients to its own mail-order and specialty pharmacy businesses, muscling out smaller competitors."

(March 23, 2012 - Letter to Chairman Leibowitz)

Tom Harkin - Senator - Iowa:

"I am concerned that combining two of the country's three largest PBMs might lead to reduced competition, less consumer choice, decreased access to pharmaceutical services, and ultimately higher prescription drug prices for health plan sponsors and consumers"

"I also encourage you to carefully examine the impact of the merger on community pharmacists.  As both a buyer and a seller of pharmacy services, the mega-PBM may have a financial incentive to impose unfavorable contract terms on local community pharmacies, or to leverage their market domination to exclude pharmacies from their network altogether."

"Forcing independent pharmacies out of the business would eliminate thousands of community jobs and disrupt the valuable relationships patients have with their community pharmacists."

"I fear that shifting even more market power into the hands of a single PBM could lead to egregious industry abuse at the expense of community pharmacists and consumers."

(October 17, 2011 - Letter to Chairman Leibowitz)


Steve King – 5th Congressional District - Iowa

"I am writing about the proposed merger between pharmacy benefits managers Express Scripts and Medco, and I respectfully request that you carefully study this proposal.  In particular, I am concerned about the impact that this merger could have on rural populations and their local pharmacies."

"Independent pharmacies make up almost 40 percent of Iowa's pharmacies and employ over 2,000 people.  Community pharmacies are part of the rural landscape. "

"They do much more than just dispense prescription drugs.  In Iowa, people visit their local pharmacy seeking face-to-face counsel and treatments from well-trained and trusted individuals, because rural communities often have limited options when it comes to receiving basic and affordable health services.  I am concerned that this merger could further reduce the negotiating leverage of community pharmacies, leading to higher prescription prices for patients and restricted access to community pharmacies."

"As you review the proposed merger between Express Scripts and Medco, it is imperative that you consider the impacts such a move could have on the many Americans who depend on their community pharmacies for critical healthcare."

(January 18, 2012 - Letter to Chairman Leibowitz)

Tom Latham - 4th Congressional District - Iowa

"I am writing with regard to the proposed merger between pharmacy benefit management companies Express Scripts and Medco, and respectfully request that you carefully study this proposal.  In particular, I am concerned about the potential impact of this merger on rural citizens and their local pharmacies."

"Independent pharmacies make up almost 40 percent of Iowa's pharmacies and employ over 2,000 people.  Community pharmacies are an important part of the infrastructure in Iowa.  In Iowa, people visit their local pharmacy seeking medical information from well-trained health professionals, because they often have limited access to other health care services."

"I am concerned that the merger could further erode the negotiating leverage of community pharmacies for appropriate reimbursement, potentially leading to higher prescription prices for patients and restricted access to pharmacy services."

"As you review the proposed merger, it is imperative that you consider the impacts such a move could have on the many Americans who depend on their community pharmacies for critical health care."

(January 24, 2012 - Letter to Chairman Leibowitz)

John Conyers - 14th Congressional District - Michigan

"I am writing to request that the Committee hold hearings concerning the application of antitrust laws to the potential merger between Express Scripts Inc. and Medco Health Solutions, Inc.  I believe that the House Judiciary Committee should conduct a hearing to examine the impact that this merger would have on healthcare insurance, drug costs for corporations and for consumers."

"A hearing would aslso allow us to examine how the merger would affect competition, American employers, consumers, patients and pharmacists."

"Several different pharmacy groups, including the National Community Pharmacists Association (NCPA) and National Association of Chain Drug Stores (NACDS), have expressed concern, and a hearing will help us determine how this merger will affect competition within the prescription-drug-benefit and pharmacy market.  Keeping with our Committee's commitment to antitrust oversight, I urge you to hold hearings on this issue and I look forward to discussing this matter with you at your earliest convenience."

(August 5, 2011 - Letter to Chairman Lamar Smith)

Bill Huizenga - 2nd Congressional District - Michigan
Candice Miller - 10th Congressional District - Michigan

"We are writing today to share our concerns regarding the proposed merger of two of the nation's largest pharmacy benefit managers (PBM), Express Scripts and Medco Health Solutions.  We ask that the Federal Trade Commission (FTC) closely examine this merger and ensure that it truly is in the best interest of patients, employers and local pharmacies."

"It is of great concern that a consolidated PBM of such great size will simply dominate the market and will use this tremendous market power to squeeze the health care system for greater profits at the expense of the consumer."

"The independent community pharmacy is a valuable model that is incredibly popular and widely used among our constituents in Michigan.  They are easily one of the most accessible healthcare providers available to consumers today and serve as a valuable resource to patients seeking medical advice regarding prescription drugs.  Any potential for diminished choice and access to local pharmacies as a result of this merger is quite alarming."

"Please address any anti-trust concerns that may arise as well as make recommendations to avoid the potential for diluted patient care, higher costs and restricted access to critical pharmacy care."

(December 8, 2011 - Letter to Chairman Leibowitz)


Thaddeus McCotter - 11th Congressional District - Michigan

"I am writing to urge you to carefully examine the proposed merger between two pharmacy benefit managers (PBMs), Medco Health Solutions (Medco) and Express Scripts, Incorporated (ESI). "

"If this merger takes effect next year, it will combine two of the three largest PBMs in the United States leaving only one significant competitor left, CVS Caremark.  This combined company will dominate the PBM market with a share of approximately 30 percent of annual prescriptions covering 150 million Americans;  therefore, I am very concerned that this merger will have negative ramifications for consumers and community pharmacies across Michigan."

"If this new company excludes community pharmacies from its network or imposes unfavorable contract terms, this merger could leads to severely restricted consumer choice and access to qualified health care professionals.  Additionally, there is no evidence to suggest that any savings will be passed on to consumers as a result of greater price negotiating power between this new PBM and pharmaceutical companies.  In fact PBMs have been accused of steering consumers to more expensive drugs or their own mail-order businesses despite the fact that most consumers favor the personalized service they receive from their community pharmacies.  Consumers and patients do not want restrictions on the availability of certain medications or on which pharmacy to use to fill their prescriptions."

"Dozens of states have now voiced their concerns about this proposed merger.  I implore the Federal Trade Commission to comprehensively investigate it and consider its impact on competition, health care consumers, and community pharmacies."

(December 14, 2011 - Letter to Chairman Leibowitz)

Collin Peterson - 7th Congressional District - Minnesota

"As the Federal Trade Commission (FTC) considers issues related to the proposed merger between Express Scripts Inc. (ESI) and Medco Health Solutions, I ask that you give special attention to the likely impact of the merger on consumers in rural areas."

"Residents of my district are concerned that the merger of these two pharmacy benefit managers (PBMs) will result in the loss of these small pharmacies from the increasingly concentrated PBM market and that health insurance beneficiaries may be forced to use mail-order pharmacies instead."

"I have heard many concerns that such concentration will likely lead to higher prices for consumers, and fewer choices, as the new, more powerful PBM reduces reimbursement fees to retail pharmacies so that they are unable to compete with the mail-order services of the PBMs, or worse, forced out of business."

"During this difficult economic time, we cannot afford to lose jobs and the small businesses that serve the very important health-care needs of American consumers.  This is especially true in rural areas, where there are often fewer choices to begin with."

(January 3, 2012 - Letter to Chairman Leibowitz)

Timothy Walz - 1st Congressional District - Minnesota

"As the Federal Trade Commission (FTC) considers the potential merger of two of the three major pharmacy benefit managers (PBMs), Express Scripts and Medco, I ask that you please take into account potential implications for small businesses and patients in rural areas."

"In Minnesota, community pharmacies are extremely important patient resources and support the local economy of rural areas.  For many chronically ill patients, one-on-one interaction with their local pharmacist often serves a variety of purposes.  Pharmacists are sometimes the only medical professional these patients interact with on a consistent basis, they take the time to ensure patients understand their complicated medication regimens, and are available to answer questions.  The New England Health Institute estimated that the improper use of medicine adds $209 billion a year to unnecessary health care expenses.  Our community pharmacists can help bridge this gap."

"I am concerned the Express Scripts-Medco merger could force many small pharmacies to go out of business, leaving a void of services in many rural communities.  Small pharmacies operate on very thin margins and often do not have the bargaining power to negotiate with their PBM.  I fear a consolidation of these two PBMs could further exacerbate this problem."

"The closure of local pharmacies means a loss to rural economies, and a greater reliance on mail-order or long distance travel to fill badly needed prescriptions.   While mail-order may seem to have many conveniences and efficiencies, it has many draw-backs as well.  There is much anecdotal evidence of expensive prescription drugs being sent to deceased individuals.  This simply adds to the waste, fraud, and abuse that can occur in our health care system."

"This merger has the potential to negatively impact patients, consumer choice, and local economies."

(January 9, 2012 -  Letter to Chairman Leibowitz)

Kathy Hochul -  26th Congressional District - New York

"I am deeply concerned that this concentration of prescription drug processing into one company would limit consumer choice, and I hope the FTC will carefully assess the potential impacts of this merger on consumer access - especially for seniors - to local pharmacies and face-to-face consultations with pharmacists.  In addition, I fear that decreasing competition in an industry that is already largely unregulated would allow the merged ESI-Medco PBM to manipulate prescription drug costs for their own benefit, raising consumer prices across the country."

"Already, these pharmacies posses little leverage when negotiating contracts with PBMs.  A merger between Express Scripts and Medco would only increase the PBm's ability to strike deals with independent and chain pharmacies that disproportionately benefit the PBM and place greater burdens on pharmacies."

"Again, I ask that you take a close and careful look at this proposed merger.  If there is any evidence at all that this new PBM may increase health care costs, decrease consumer choice and quality service, or harm our nation's independent and chain pharmacies, I urge you to reject the merger."

(January 31, 2012 - Letter to Chairman Leibowitz)

Louise Slaughter - 28th Congressional District - New York

"I write to express my concern about the proposed merger of Express Scripts, Inc., and Medco Health Solutions, Inc.  The proposal combines two of the largest pharmacy benefit managers (PBMs) into a single entity over twice as large as the next biggest competitor."

"The newly merged PBM would control one-third of the total 2011 PBM market share and 60% of the market share for mail-order drugs.  This centralization raises the possibility of higher prices for prescription drugs and reduced choice for consumers."

"My primary concern is the impact that the merger could have on community pharmacies and patients who rely on them not only for their medicine, but also for counseling and other specialized services and products."

"The proposed merger would also affect hundreds of millions of Americans with private health insurance and have a potentially significant impact on drug cost for government programs such as Medicare Part D, Medicaid, the Federal Employee Health Benefits Plan, and TriCare.  With such serious implications, this merger deserves close scrutiny and careful consideration."

(February 6, 2012 - Letter to Chairman Leibowitz)


Carolyn Maloney - 14th Congressional District - New York

"The proposed merger would combine the largest and third largest pharmacy benefit mangers (PBMs) to create a single entity that would be over twice as large as the next biggest competitor."

"If this merger is allowed to go through, it would consolidate 40 percent of the country's drug volume and 60% of the country's-mail order prescription drug business into one single PBM.  I have serious concerns that this consolidation would give one company too much control over American's health care and could lead to higher costs for prescription drugs and fewer choices for consumers."

"Given the current practices of both Express Scripts and Medco, I am concerned that the new company will eliminate certain pharmacies from their networks and require some drugs to be purchased by mail-order, thereby eliminating the role of the community pharmacy.  If this happens, both patients and pharmacies will suffer."

"I urge you to carefully review this proposed merger , consistent with all applicable rules and regulation, and hope that you will rule in favor of fair market competition and quality health care for all Americans."

(February 8, 2012 - Letter to Chairman Leibowitz)


George Butterfield - 1st Congressional District - North Carolina

"I write to express my concerns about the proposed merger between Express Scripts, Inc. (ESI) and Medco Health Solutions, Inc., two pharmacy benefit management (PBM) companies.  The proposed merger could have potentially far-reaching impacts on all aspects of the delivery of drug care nationwide."

"ESI and Medco are two of the nation's largest PBMs.  Their merger agreement proposes to create one giant PBM with a combined market that would cover more than 200 million U.S. citizens, or close to two-thirds of our population."

"I am concerned that this market dominance could force community pharmacies in my district, and across the country, out of business.  In addition, because the consolidated PBM will have the largest piece of a market that is already highly concentrated, there is a possibility that prescription prices would increase.  Ultimately this market consolidation and price increase will be disproportionately felt by elderly, poor and rural populations.  As the representative of a rural, low -income district, I am especially sensitive to this prospect."

"Pharmacy Benefit Managers have long touted their ability to generate savings for consumers.  However, I question the savings alleged by ESI and Medco, and have only heard anecdotal evidence of the decrease in prescriptions or health care premiums.  In fact, many have expressed that the opposite is true.  I fear that giving a consolidated PBM even greater market power could potentially worsen this already troubled situation."

"Already, community pharmacists have little power to negotiate with their PBM and are essentially offered 'take it or leave it' deals with below market reimbursement rates.  A consolidated PBM would have even greater power to dictate contract terms and would likely result in small pharmacies being forced to close their doors."

"Local pharmacists play an integral and important role in Eastern North Carolina, where they are often intimately connected with the health care of their customers and my constituents.  I would be troubled if this merger impacted the level of service or damaged the current system of pharmacy delivery of drug and drug care services."

"The pharmacies throughout Eastern North Carolina are not only trusted health care providers, but also generators of jobs and contributors to the community and the tax base.  If they are pushed out of the health care system, my district will lose pharmacists, jobs and tax dollars.  My community, and countless others across the country, cannot afford these results."

(December 19, 2011- Letter to Chairman Leibowitz)


Kent Conrad - Senator - North Dakota:

"North Dakota Pharmacists have raised serious concerns about the impact of this proposed merger on health care consumers in my state."   

"North Dakota pharmacists tell me the proposed merger will result in a single firm controlling more than 60% of the mail order market and will likely increase overall drug prices.  They also point out that community pharmacists help control costs by ensuring that patients adhere to the prescribed drug regimen, and that in North Dakota local pharmacists dispense generic drugs 72 percent of the time, compared to a 59 percent rate for mail order pharmacies."

"It is my hope that the FTC will carefully look into the concerns raised by North Dakota's pharmacists.  A merger of this size has the potential to dramatically impact the pharmaceutical market, and it is important to ensure that North Dakotans have access to quality and affordable health care."

(September 9, 2011 - Letter to Chairman Leibowitz)

James Inhofe - Senator - Oklahoma:

"I am writing regarding the proposed merger between pharmacy benefits managers Express Scripts and Medco.  I respectfully request that you carefully consider the impact this merger could have on consumers, taxpayers, pharmacies and patients' access to health care."

"The combined entity that results from this merger may control as much as 50% of the specialty market and 60% of mail order.  With that type of potential control, it is essential that your agency conducts a thorough investigation of the proposal to ensure that access to care and consumer choice is preserved."

(February 10, 2012 - Letter to Chairman Leibowitz)

Dan Boren  - 2nd Congressional District - Oklahoma

"I am writing to express my concerns with the recent announcement of the merger of Express Scripts and Medco, and to request that your office conduct a full and thorough investigation, including examining the impact that the merger will have on consumers, patients, third parties and federal payers."

"The consolidation of PBM industry would force some community pharmacies out of business because they already have little leverage to negotiate with the new entity. Pharmacy closures would restrict patient access and cost the state local jobs an revenue."

"A recent study conducted by the Department of Health and Human Services's Office of the Inspector General has already documented issues within the pharmacy benefit manager market.  The report revealed that 'pharmacy discounts were not always passed on to the beneficiaries and the Government.'  This report is disturbing and raises questions about the probability of continued anti-consumer/patient practices in the future under dominant entity."

(February 21, 2012 - Letter to Chairman Leibowitz)

Robert Brady - 1st Congressional District - Pennsylvania 

"There is significant concern that, if approved, the merger between Medco Health Solutions and Express Scripts Inc. (ESI) would have a number of adverse effects on patients and consumers."

"Pharmacy benefit managers (PBM) are already a very very highly concentrated industry, and ESI and Medco are two of the largest players.  Many are concerned that should this merger be approved, it will further concentrate this industry and put the pharmacy benefits of nearly 135 million Americans in the hands of one single company.  The creation of such a mega-company could potentially hold retail chain pharmacies hostage by dictating low reimbursement rates and limiting competition."

"PBMs are expanding their role in an attempt to increase profit by reimbursing pharmacies at well below the industry average, making it impossible for a normal pharmacy to refill a prescription."

"The long-term consequences of this merger could be the closure of many small and even some chain pharmacies throughout the U.S.  These community pharmacies are not only the source of convenient and timely prescription medications and refills, but are also used by many Americans for their health monitoring services, immunizations, and the occasional face-to-face consultation with the pharmacist or pharmacy staff.  Mail-order prescriptions are nice to have as an option, but they certainly cannot fill all of these important roles."

(February 1, 2012 - Letter to Chairman Leibowitz)

Lou Barletta - 11th Congressional District -  Pennsylvania

"I respectfully urge you to oppose the proposed merger between two of the largest companies in the pharmaceutical industry, Express Scripts and Medco.  I am very concerned that combining these two companies would distort the pharmacy benefit management (PBM) industry by allowing a single company to control the pharmaceutical market, harming prescription drug consumers, distributors, and manufacturers."

"Already, PBMs have too much control within the prescription drug supply and payment system."

"These companies have the ability to dictate prices to independent and community pharmacies."

"If the proposed merger between Express Scripts and Medco occurs, this mega-company could decrease reimbursement rates for pharmacies; filling prescription drugs to levels that drive traditional pharmacies out of business.  This would direct more consumers to the PBM's own mail-order pharmacies - a direct move against competition and the free market."

"An inherent conflict of interest exists in the PBM itself - a PBM must offer consumers the lowest possible price, but it must also make a profit on the margin between the price it paid the manufacturer and the price it offers to the PBM consumer."

"Additionally, there are minimal regulations and oversight from federal and state authorities regarding PBMs.  This lack of oversight, combined with an unlawful share of market power, could require ever-larger rebates and discounts from drug companies.  With less profit to reinvest in research and development, drug companies could reduce efforts to bring important new drugs and orphan drugs to market."

"I again urge you to prevent creating an anti-competitive prescription drug market by opposing the pending merger between Express Scripts and Medco."

(March 5, 2012 - Letter to Chairman Leibowitz)

Glenn Thompson – 5th Congressional District  – Pennsylvania

“The planned merger of Express Scripts, Inc. and Medco Health Solutions, currently under review by the Federal Trade Commission (FTC), has the very real potential to harm residents in rural areas, including much of the Commonwealth of Pennsylvania, which I have the pleasure of serving in Congress.”

“The FTC should acknowledge that the proposed merger will lead to increased prescription costs and limit the ability of Pennsylvanians to access vital medications through their local community pharmacies.”

“Local community pharmacies are on the front lines of healthcare.  These small businesses provide critical services that help to ensure the vitality of their communities.”

“Given all that is at stake for families and rural communities, I respectfully request you weigh the serious implications this merger has for the health and well being of our communities.  Thank you for your consideration.”

(March 23, 2012 – Letter to Chairman Leibowitz)

 Jeff Duncan - 3rd Congressional District  - South Carolina

"Forcing consumers to mail order companies would disrupt the relationships many of these folks have with their local pharmacists, to the detriment of public health.  Resulting pharmacy closures and related job losses would also prove harmful to local economies."

"I am not asking you to pick winners and losers in the marketplace; that isn't government's job.  I am asking you to protect competition, the greatest market force to keep costs contained and innovation thriving."

(February 7, 2012 - Letter to Chairman Leibowitz)




Mick Mulvaney - 5th Congressional District - South Carolina

"This proposed merger may have a significant impact on the prescription drug market in the United States by combining two of the three largest Pharmacy Benefit Managers.  In particular my constituents are concerned this merger would have an impact on prescription drug prices and availability, as well as on small community pharmacies."

(March 1, 2012 - Letter to Chairman Leibowitz)



Tim Johnson - Senator - South Dakota:
John Thune - Senator - South Dakota:
Kristi Noem - At-Large Representative - South Dakota:

"We write regarding the proposed merger of the pharmacy benefit managers, Express Scripts and Medco, and to relay concerns of our constituents about how it could affect consumers and patients, particularly in rural areas with a high proportion of community and independent pharmacies."

"There is no question that this merger is complex due to the market concentration it could present.  We are aware the proposed combined entity would stand to control 60% of the mail order market and 50% of the specialty prescription drug market."

"Preserving access to care and consumer choice should not be overlooked."

(December 22, 2011 - Letter to Chairman Leibowitz)



Ralph Hall - 4th Congressional District - Texas

"Americans deserve a health care delivery system that reduces cost, expands access, and increases the quality of care available to all citizens.  If Washington has any role in deciding the type of care patients receive, it is to create and ensure a vibrant marketplace for insurance."

"Your Commission is currently being asked to approve a merger that could dramatically and devastatingly affect competition in the health care marketplace, and could therefore increase costs, reduce access, and degrade the quality of care available to hundreds of millions of American consumers."

"The FTC should reject the proposed merger between Express Scripts and Medco Health Solutions immediately."

"If allowed to merge, the combined PBM would, according to a U.S. Senate subcommittee that examines antitrust issues, administer 1.14 billion prescriptions annually, handle 41% of all prescriptions administered by PBMs, and be nearly twice as large as its nearest competitor.  This scenario would allow the company to dominate the market and enable them to squeeze the health care system a the expense of patient choice, access and service."

"I believe those who are happy with their health care coverage should be allowed to keep it, and that all citizens ought to have the freedom to choose the health plan that best meets their needs.  Medical decisions should be made by patients and their doctors, not by middlemen.  In each of these cases, the merger between Express Scripts and Medco would further damage the health care delivery system."

"It would threaten jobs, increase costs, and diminish patient health - the last thing our economy needs at this time."

"I urge the FTC to take a close look at this proposed merger, at which point I am confident that it will be denied."

(January 5, 2012 - Letter to Chairman Leibowitz)



Ted Poe - 2nd Congressional District - Texas

"Many of my constituents in Texas' Second Congressional District have called, written, and visited me about their concerns over the merger. I hope that you will be especially diligent in your review of this proposal and fully assess the negative impacts it could have on our citizens' affordable healthcare choices."

"It is my understanding that each of these companies already places limits on where and how patients can fill their prescriptions; they eliminate certain pharmacies from their networks; and require certain drugs be purchased by mail-order.  I am concerned that these requirements could reduce or diminish the pharmacist-patient relationship."

"Consumers often rate their community pharmacists high for providing in-person advice on the side effects of medications and drug interactions.  This system works because it is accountable and accessible.  This system should not be broken."

(January 24, 2012 - Letter to Chairman Leibowitz)




Blake Farenthold - 27th Congressional District - Texas

"I hope that you will be especially diligent in your review of this proposal and fully asses the negative impacts it could have on our citizens' affordable health care choices."

"While many companies defend their decision to merge by citing cost reductions, I remain concerned that American families and small businesses may not receive a cost savings.  It is my understanding that each of these companies already places limits on where and how patients can fill their prescriptions; they eliminate certain pharmacies from their networks; and require certain drugs be purchased by mail-order.  I am concerned that these requirements could reduce or diminish the pharmacist-patient relationship."

(March 20, 2012 - Letter to Chairman Leibowitz)

John Carter - 31st Congressional District - Texas

"As you know, the merger could create a combined entity which has the potential to control more than 40 percent of annual prescriptions and more than 80 percent of private plans.  This is particularly concerning in light of a study conducted last year by the Office of the Inspector General for the Department of Health and Human Services which found that within the pharmacy benefit manager market 'pharmacy discounts were not always passed on to the beneficiaries and the Government."

"I am particularly concerned about the potential negative impacts of this merger on small independent pharmacies around the country.  Pharmacy benefit managers, such as Express Scripts and Medco, dictate reimbursement terms to pharmacies and control which prescription providers insurance plans will cover.  In January, when Walgreen's stopped accepting Scripts as a result of a long cost negotiations process it instantly lost scores of customers.  Independent pharmacies operate on much narrower cost margins than do giants like Walgreen's would suffer far greater consequences as a result."

"They lack the negotiating power to go up against giant pharmacy benefit managers, and the potential loss of business as a result of this merger could result in staff layoffs, reduction in patient services, or even pharmacy closings.  Independent pharmacy closings would have a negative affect not only on patients, but on our economy which depends on small businesses to thrive."

(March 20, 2015 - Letter to Chairman Leibowitz)



Robert J Wittman - 1st Congressional District - Virginia

"This proposed merger would likely have a significant impact on the prescription drug market in the United States, combining two of the three largest Pharmacy Benefit Managers which would then control approximately 60 percent of the mail-order pharmacy market and a majority of the specialty pharmacy market.  In particular, my constituents are concerned about the impact this merger would have on prescription drug prices and availability as well as on small community pharmacies."

(January 31, 2012 - Letter to Chairman Leibowitz)



Maria Cantwell - Senator - Washington:

"I am writing to urge you to carefully investigate the merger of these two companies and consider all of the implications it could have on patients, pharmacies, and insurers."

"Various groups and constituents in my state, especially small community pharmacies, have expressed concerns that the merger would create a consolidated PBM that could have a negative impact on consumers by impairing choice and potentially increasing prescription drug costs."

"Competition helps to ensure that consumers have access to high quality services, more choices, and lower prices.  I want to ensure that this union will not create excessive industry consolidation and reduce the number of competitors in this field and, therefore, harm consumers."

(March 27, 2012 - Letter to Chairman Leibowitz)



Herb Kohl - Senator - Wisconsin:

"In brief, without reaching any final judgement as to the legality of this proposed merger under the antitrust laws, I believe this proposed merger presents serious competition concerns which should be examined carefully by the FTC."

"Reducing the number of PBM competitors that are able to meet the unique needs of large health plan sponsors from three to two raises significant competition concerns.  Serious questions have been raised as to whether such a reduction in competitive alternatives will lead to higher fees charged by PBMs to large plan sponsors.  The merger's critics also contend that the remaining PBMs will have substantially less incentive and competitive pressure to pass through to the plan sponsors a substantial part of the negotiated savings and rebates the PBMs obtain from drug manufacturers."

"In sum, it seems unlikely that there are significant competitive alternatives to the big three PBMs for large plan sponsors.  Indeed, even Medco's CEO admitted as much in an investor phone conference in July 2010.  When asked if 'everyone's always focused on your two primary competitors [that is, Express Scripts and CVS/Caremark,' Mr. Snow replied that '[at] the best and finals I go to, I'm not seeing a lot of secondary PBMs in the mix at all.  I'm really not.  You may see a name pop up here and there, but that's not really common at all.'"

"One of the principal benefits that the PBMs contend they bring to the health care system is that, by representing numerous health plans, they are able to gain increased buying power with drug companies to drive drug prices down.  However, given the already massive buying power of Express Scripts and Medco (with Express Scripts covering 90 million lives and Medco 65 million), it seems highly unlikely that the merger will result in any substantial increase in buying power to attain such cost savings."

"It is clear that obtaining greater drug price discounts from manufacturers cannot be an argument to justify this merger."

[On dangers to the Specialty Pharmacy market] "The merger's critics have alleged that PBMs have engaged in exclusive distribution arrangements designed to exclude rivals.  They argue that it is 'a common business practice for these PBMs to prevent other pharmacies ffrom dispensing specialty drugs and to force patients to use the PBM's mail order facility, thereby foreclosing competition from rival pharmacies.'  This merger may give the combined PBM increased market power to demand exclusive distribution arrangements with large manufacturers, freezing out other competitiors."

"The merger's critics also argue that the combined company's dominance in mail order could give it the market power to force consumers into using mail order services for their prescriptions.  The Subcommittee received substantial testimony from the merger's critics that mail order may be more costly, may result in significant waste, and cause consumers to lose the service and counseling they obtain from traditional pharmacies.

"The Subcommittee received extensive testimony from pharmacies - both independently owned commmunity pharmacies and chain drug stores - regarding what they believe to be the dangers to competition from this merger.  PBMs set the reimbursement rates that pharmacies receive when they dispense drugs to patients covered by health plans administered by those PBMs.  Pharmacies believe this deal will increase the bargaining leverage of the combined Express Scripts/Medco PBM so that the combined PBM will be able to significantly reduce their reimbursement.  Given that the combined PBM will have 155 million covered lives, pharmacies will be in no position to decline to do business with Express Scripts/Medco patients, but will, they argue, be left in a 'take it or leave it' position."

"Substantial doubt exists as to whether any declines in reimbursement rates would in fact be passed on to plan sponsors."

(February 2, 2012 - Letter to Chairman Leibowitz)



Tammy Baldwin - 2nd Congressional District - Wisconsin

"I write regarding the proposed merger between Express Scripts, Inc. and Medco Health Solutions, Inc.  I strongly encourage you to look critically at the request for the Express-Scripts-Medco merger."

"If approved by the FTC, the combined company would control more than 50 percent of the prescription drug supply line to retail pharmacies.  I am concerned that the excessive market dominance of this combined company could lead to higher costs for prescription medications or fewer choices for consumers."

"I am concerned that this merger could directly threaten the services and value that neighborhood pharmacies provide.  As you know, many individuals in Wisconsin and across the country rely on their trusted relationship with pharmacists for a reliable, cost-effective source of health care advice and counsel."

"As separate companies, Medco and Express Scripts are already placing limits on where and how patients can fill their prescriptions, and they are eliminating certain pharmacies from their networks and requiring some drugs be purchased by mail order."

"I encourage you to ensure that patients continue to have access to affordable prescription drugs and the valuable patient-pharmacist relationship."

(December 22, 2011 - Letter to Chairman Leibowitz)



Reid Ribble - 8th Congressional District - Wisconsin

"I'm writing to express some concerns I have with the proposed merger currently under consideration at the Federal Trade Commission between Medco Health Solutions and Express Scripts Inc. (ESI).  Should this merger be approved, I believe it could have some adverse consequences for consumers and patients throughout Wisconsin."

"I've heard from many constituents who are very concerned that the merger of these two pharmacy benefit managers (PBM) will result in the creation of a company that will have excessive market share, cover roughly one-third of the population of the country, and force many small pharmacies out of business while driving up prices for consumers."

"The new combined PBM will use their market share to push pharmacies out of their network and eventually out of business.  These pharmacies represent a life-line to health care access, not only providing much needed medications, but also health monitoring services, immunizations and even private consultations with pharmacists.  They are truly on the frontline of the health care delivery system in my state."

"This merger will drive up prices for patients, as the new PBM will operate without significant competition, the only mechanism that keeps prices in check.  Given the current economic climate, higher prices and less access for patients and consumers is more bad news than the people of Wisconsin can take."

"I urge you to take a hard look at this proposal and the long-term consequences it could pose for consumers and patients."

(January 24, 2012 - Letter to Chairman Leibowitz)



Ron Kind - Wisconsin - Wisconsin - 3rd Congressional District

Robust competition among pharmaceutical benefits managers (PBMs) plays an important role in helping consumers secure the best price for prescription drugs.  I therefore encourage you to fully consider the impact the merger of these two companies will have on consumers, including both price and access to care."

"The combined Express Scripts/Medco would account for over 40 percent of all prescription drugs administered by PBMs.  In addition, the merged company would handle nearly 60 percent of all mail order sales and more than 50 percent of the specialty pharmacy business."

"While this merger raises important market competition issues that could increase prescription drug prices for consumers, I am equally concerned about patient access to local pharmacies in Wisconsin and throughout the country.  As you know, many retail pharmacies assert the increased leverage of a combined Express Scripts/Medco would present a threat to their continued survival.  Without any assurance that the decreased retail pharmacy reimbursement rates likely to result from the larger PBM would be passed on to consumers, patients could be faced with higher prices and reduced access to care if pharmacies close or are removed from local provider networks."

(March 14, 2012 - Letter to Chairman Leibowitz)



Charles Gonzalez - 20th Congressional District  - Texas
Lucille Roybal-Allard - 34th Congressional District  - California
Luis Gutierrez - 4th Congressional District - Illinois
Ruben Hinojosa - 15th Congressional District - Texas
Ed Pastor - 4th Congressional District - Arizona
Pedro Pierluisi - Puerto Rico
Silvestre Reyes -  16th Congressional District - Texas

"We are concerned that an approved merger between two of the largest pharmacy benefit management (PBM) companies will result in reduced access to local community pharmacies and increased prescription prices."

"The CEO of Medco, David Snow, has challenged the role that community pharmacies play in the delivery of health care services.  He recently said that the relationship between a pharmacist and a patient is 'fiction.'  This position blatantly ignores the important and increasing role that pharmacies play in our communities.  These pharmacies don't just fill prescriptions, they also offer health monitoring, immunizations, private consultations, and other important services - at convenient times and for affordable prices.  And in many communities, these pharmacies are the most accessible and affordable health care provider."

"In these tough economic times, we can't afford to push policies or plans that will make access to health care even more difficult for our citizens, particularly those already at a disadvantage.  Please keep this concern in mind as you carefully and thoroughly examine this merger proposal."

(February 2, 2012 - Letter to Chairman Leibowitz)



Jerry Moran - Senator - Kansas:
Saxby Chambliss - Senator - Georgia:
Johnny Isakson - Senator - Georgia:

"We are writing to you regarding the recent merger announcement between Express Scripts and Medco and to request that your office conduct a thorough and complete investigation, including examining any potential impact on consumers, patients, third party and federal payers."

"We understand that a combined entity has the potential to control 60% of mail order and 50% of the specialty market.  With that type of market concentration, it is important that your agency works to see that access to health care is not limited."

(December 2, 2011 - Letter to Chairman Leibowitz)



Joe Courtney - 2nd Congressional District - Connecticut
Walter Jones - 3rd Congressional District - North Carolina
Mo Brooks - 5th Congressional District - Alabama
William Owns - 23rd Congressional District  - New York
Martha Roby - 2nd Congressional District  - Alabama
Mike Rogers - 3rd Congressional District - Alabama
Austin Scott - 8th Congressional District  - Georgia

"We write to raise concern about the potential impact of the proposed merger between Express Scripts, Inc. (ESI) and Medco on TRICARE and its beneficiaries."

"As the FTC continues to investigate the proposed merger, we believe it necessary to highlight potential consequences to the TRICARE program and its beneficiaries should it go through."

"Many of us have already expressed concern to the FTC about the consequences of the merger on market concentration in the pharmacy benefit manager (PBM) industry and what it will mean for small businesses as well as patients and patients' access to their local pharmacies.  If approved, a merged Express Scripts-Medco would create a PBM with more than 135 million covered lives and with control of more than 30 percent of all prescriptions in the United States.  It is also estimated that the company would hold 60 percent of the total mail order market."

"There is little evidence that increased PBM market concentration will significantly lower costs for consumers or the American taxpayer.  And, instead of realizing costs savings, there will be even less market competition during the next TRICARE contract bid."

"We are also concerned that this merger would result in only two viable PBM choices with the capacity to administer benefits for the 9 million Americans who depend on TRICARE.  We are concerned these limitations would undermine TRICARE's negotiating leverage and limit TRICARE's ability to demand a quality prescription drug benefit."

"We share your commitment and are concerned about the potential consequences of this merger for TRICARE patients, small businesses, and the American taxpayer." 

(January 26, 2012 - Letter to Assistant Secretary of Defense Woodson)



Henry Waxman - 30th Congressional District - California
Frank Pallone, Jr. - 6th Congressional District - New Jersey
Diana DeGette - 1st Congressional District - Colorado 

"We are writing to ask you to give close scrutiny to the proposed merger of Express Scripts, Inc., and Medco Health Solutions, Inc.  The proposed merger would combine the largest and third largest pharmacy benefit managers (PBMs) to create a single entity that would be over twice as large as the next biggest competitor."

"Changing industry dynamics raise additional questions about this merger and its impact on consumers and health care costs.  Expensive specialty drugs are the fastest-growing areas of the pharmaceutical market."

"The proposed merger would affect hundreds of millions of Americans with private health insurance and have a potentially significant impact on drug cost for government programs including Medicare Part D, Medicaid, the Federal Employee Health Benefits Plan, and TriCare.  The market for prescription drugs, which involves often opaque interactions between insurance companies, pharmaceutical manufacturers, pharmacies, and PBMs, is complex and rapidly changing, and the impacts of this merger could be significant.  We are therefore asking that you carefully examine the impacts on healthcare cost and access as a result of the proposed Express Scripts-Medco merger."

(September 9, 2011 - Letter to Chairman Leibowitz)



Cathy McMorris Rodgers - 5th Congressional District - Washington
Robert Aderholt - 4th Congressional District - Alabama
Spencer Bachus - 6th Congressional District - Alabama
Jo Bonner - 1st Congressional District - Alabama
Mo Brooks - 5th Congressional District - Alabama
Mike Rodgers - 3rd Congressional District - Alabama
Terri Sewell - 7th Congressional District - Alabama
Martha Roby - 2nd Congressional District - Alabama
Judy Chu - 32nd Congressional District - California
Maurice Hinchey - 22nd Congressional District - New York
Ruben Hinojosa - 15th Congressional District - Texas
Thomas Marino - 10th Congressional District - Pennsylvania
Peter Welch - At-Large Representative -  Vermont
Don Young -  At-Large Representative - Alaska

"We are writing to express our concerns with the recent merger announcement between Express Scripts and Medco and to request that your office conduct a full and thorough investigation, including examining the impact that the merger will have on consumers, patients, third party and federal payers."

"On its face, the merger demonstrates the potential for a combined entity to dominate an already heavily concentrated market.  We understand that this combined entity has the potential to control more than 40 percent of annual prescriptions and more than 80 percent of private plans.  And, if unregulated would have the ability to raise prices and/or block pass through pricing for plans and patients - ultimately limiting critical access."

"A recent study conducted by the Department of Health and Human Services's Office of the Inspector General has already documented issues within the pharmacy benefit manager market.  The report revealed that 'pharmacy discounts were not always passed on to the beneficiaries and the Government.'  This report is troubling and raises questions about the probability of continued anti-consumer/patient practices in the future under one dominant entity."

"We ask that your office closely examine this proposed merger and make recommendations that ensure a competitive marketplace exists for consumers, beneficiaries, and pharmacies.  We appreciate your attention to this matter."

(October 20th, 2011 - Letter to Chairman Leibowitz)