Express Scripts Continues Its Assault on Community Pharmacy

By Zachary French

If the universe is a fair and just place, one day a pharmacist will land the CEO position at Express Scripts.  On that day, the practice of pharmacy will be more appropriately valued by a mega PBM CEO.  In the meantime, pharmacists and their patients will have to endure public remarks likes those recently uttered by George Paz, Express Scripts current CEO.

“At the end of the day … Nexium is Nexium, Lipitor is Lipitor, drugs are drugs, and it shouldn’t matter that much who’s counting to 30,” asserted Mr. Paz.  This quote was attributed to Paz by Tom Murphy, the AP’s business writer.

Mr. Paz is not a pharmacist, but rather he has a finance background. In 2003, he joined ESI as its CFO.  Most people with any knowledge of business understand that a CFO is not a glorified “bean counter”, and by now, Mr. Paz certainly knows that pharmacists are not pill counters.

This is why pharmacists and their patients should find Mr. Paz’s most recent assault on the value of the patient/pharmacist relationship so ominous. This latest remark is not simply an ill-informed or thoughtless throw-away line, but rather a well-considered and calculated effort to commoditize community pharmacy to serve the profit motivations of Express Scripts.

Mr. Paz’s comment was delivered during a conference call with industry analysts. This is not a venue in which CEOs usually shoot from the hip.  Quite to the contrary, CEOs typically use these meetings to clearly and carefully articulate the strategic direction of their companies and how that strategy will enhance shareholder value, drive growth and increase profits.

Make no mistake, Mr. Paz was providing insight into Express Scripts’ go-forward strategy; he is saying that pharmacists deliver minimal value and are viewed as interchangeable parts by Express Scripts.  The implications of this posture are staggering. Express Scripts will include or exclude pharmacies in its pharmacy networks based solely on their profit utility to Express Scripts.  Recent events indicate that this strategy applies to a single small business independent pharmacy as well as to a national chain with 7,000 plus stores.

Let’s be clear.  Express Scripts is seeking to deny the value that local pharmacists bring to patients.  In the brave new pharmacy world that Mr. Paz envisions where Express Scripts’ merger with Medco has been approved and Walgreens is brought to heel, patients on complex therapy regimens who are at high risk of non-adherence simply get pills counted and bottled for them rather than receiving face-to-face counseling from their local pharmacists. Patients using high-cost brands are not moved to lower cost generics when appropriate notwithstanding the impact on PBM rebate revenues as community pharmacists do every day.  Patients with long-standing relationships with their community pharmacies see these relationships disregarded and are moved to Express Scripts’ mail order and central fill pharmacies.  Of course, Express Scripts will continue to see value in creating retail pharmacy spreads that drive up its profits and reduce the available savings to health plans and employers.

Mr. Paz should explain to Congress why his recent remarks contradict previous comments he made to that body just this past fall.  At that time, the standard Express Scripts talking points acknowledged that community pharmacists were critical partners to the PBMs.

Express Scripts is seeking the support of Congress in its effort to have the FTC approve its mega merger with Medco. Just like patients, health plans and pharmacists, Congress has the right to know where Mr. Paz really stands on the value of pharmacy before the FTC rules on the proposed merger.  Will they continue to be valuable close-to-patient assets that can be leveraged to control cost and drive improved patient outcomes or does Express Scripts intend to reduce the role of pharmacists to mere pill counting? Because Express Scripts’ position on this critical question is still unknown even at this late date, NCPA continues to strongly urge the FTC to reject the proposed merger.

27 Responses to “Express Scripts Continues Its Assault on Community Pharmacy”

  1. 1 Broncofan7 February 28, 2012 at 2:28 pm

    This is very telling and it is even more imperative that ALL Pharmacists become active politically in taking BACK our profession by shining a light on deceptive and anticompetitive practices of PBM’s. This is the type of information that needs to be shared with the Dean’s of Colleges of Pharmacy all over the country….

  2. 2 john m rector February 28, 2012 at 2:53 pm

    It is naive to think that if ESI hired a pharmacist as CEO that the rhetoric would be any different
    in any case the comment is reflecting their reality of an unregulated environment when it comes to the pharmacists that they hire. one day nabp and pharmacy boards will not allow a pharmacist to practice without a license in the state of the patient/cosumer. until then little wonder someone at a pbm has the view that counting to 30 is the objective after all their interstate pharmacists have not been required to abide by the pharmacy acts in the cosumer’s states

    john m rector

  3. 3 Namron Sivad February 28, 2012 at 3:51 pm

    all the more reason that it is imperative that each of us contact our congressmen and ask that they oppose the ESI/Medco merger as well as sign on as co-sponsors of our PBM bills

  4. 4 Brian Henry February 28, 2012 at 4:36 pm

    We appreciate the opportunity to clarify what is being taken out of context.

    During our earnings call, we were asked about the potential savings seen from offering a narrower network to our clients. As you know, Walgreens unilaterally announced in June 2011 its plans to leave our network on January 1, 2012. We worked with our clients and members to let them know about the many other convenient, lower-cost pharmacy choices they had available. Overwhelmingly, and with minimal disruption, clients and members have moved on to other pharmacies ready, willing and able to serve them.

    We are making two points, which are borne out by our experience over the past few months following Walgreens’ departure from our network:

    — Our clients expect a low-cost, high-quality pharmacy benefit. We are expected to help make the use of prescription medications safer and more affordable. Paying one pharmacy chain a premium over all others does not align with our clients’ best interests.

    — The experience provided by community pharmacies, chain pharmacies, grocery-store pharmacies and “big-box” store pharmacies is just as good at as it is at Walgreens.

    As we’ve said on many occasions, and did so during that call, pharmacies of all sizes and locations remain important partners to Express Scripts.

    Thanks for considering the additional context.

    Brian Henry
    Express Scripts

    • 5 Concerned Student February 29, 2012 at 3:35 am

      Can you tell us all what Express Scripts was going to pay Walgreens to process a prescription? Is it what they pay the other pharmacies that are taking in all of your “clients”? Also, please refer to customers as patients, not “clients”, healthcare is not all about business Mr. Henry.

      • 6 Martin February 29, 2012 at 1:11 pm

        A servey taken a few years back indicated that the public thought of themselvs as patients when treated by physicians, dentists and nurses, and clients when dealing with lawyers, accountants and pharmacists. The key difference is that patients are physically touched by the health care provider and clients are not. So a customer of a pharmacist is a client regardless of what the concerned student is taught in school

      • 7 Kathy Elliott February 29, 2012 at 3:13 pm


        Obviously you haven’t noticed, but things have changed drastically in the last few years. We DO touch our PATIENTS- do BP screens, show them how to inject insulin and use the devices, give vaccinations, etc. Maybe it’s time you go to a community pharmacy and see what we really do!

      • 8 Mary February 29, 2012 at 2:58 pm

        As a pharmacist I provide immunizations, blood pressure screenings, as well as cholesterol and blood glucose screenings. My patients are my patients and NOT clients.

      • 9 Concerned Student February 29, 2012 at 6:04 pm

        Martin, upon further review of your post it appears you did not attend school long enough to spell survey, so how do you know what I am taught in school? Also, today is not a few years back. TODAY pharmacists provide immunizations, take blood pressures, measure cholesterol, and test A1c. I’m fairly certain physical contact is made during these encounters. Pharmacists roles are expanding daily and soon will be looked on as a form of primary care. Welcome to the future Martin, our Patients are already here, maybe you should take another “servey”.

    • 10 Bradley Stanford February 29, 2012 at 5:05 am

      What he fails to mention is that upon review of the reimbursements Walgreens receives, Express Scripts was at the bottom of the list before negations. Furthermore, upon review of the buyouts Walgreens acquired over the past few years, it was noticed that about 75% of the independent pharmacies were getting reimbursed more than Walgreens. I have seen the numbers first hand and can tell you that Walgreens would loose $2-3 on every script filled. They can blame Walgreens, but other major chains will not accept this unprofitable offer when their contracts come up for renewal. No company is in the business to loose money. Patient’s were not willing to go to other pharmacies, as I have about 20 who pay cash and another 75 who signed up for the prescription savings club rather than go somewhere else. Patients build a relationship with pharmacy staff and rely on them to be there to address their concerns with medications and health conditions. If the CEO thinks every pharmacy is the same, then he should look at the thousands of “I Choose Walgreens” signatures that were collected over November and December. No one knows if an agreement will be reached but in Louisiana, Blue Cross is up for renewal with Express Scripts in March. I have had many previous customers call the pharmacy saying that Blue Cross is calling them and asking if Walgreens returned to their network if they would switch back, with all who called stating that they would. Sounds to me like insurance companies are listening to consumers before making a decision to renew contracts for PBM’s that only include “cost efficient pharmacies”. Companies like CVS and Walmart can benefit from Walgreens loss but when their contracts with Express Scripts are up for renewal, I doubt that they would be willing to loose money to fill a prescription.

    • 11 Community Pharmacy Owner Tired of Deceptive PBM's March 2, 2012 at 7:48 pm

      You are right Brian, We (Community Pharmacies contracted with Express Scripts) are very important to you (Express Scripts) because we provide you the information that you need to go behind our backs and solicit our patients to your mail-order facility using various price/copay fixing tactics!! As a matter of fact I had someone in here yesterday that said as soon as I fill a prescription for them they receive an email claiming that (Medco) can fill that prescription cheaper. Not only is this a violation of HIPAA, it is dirty business.

  5. 12 Nancy Cantor February 28, 2012 at 6:15 pm

    If indeed Mr. Henry believes the statement above, then he needs to muzzle George Paz, pronto.

    One would also suggest that Mr. Henry and Express Scripts take more than a few months to research the attitudes of customers/patients regarding their experiences and choices under the Express Scripts program, as well as other similar companies like Caremark. Then again such enlightenment might get in the way of all their efforts to increase their profits at the expense of patient health care.

  6. 13 Kathy Elliott February 28, 2012 at 6:27 pm

    If pharmacies of all sizes are of equal importance to Express Scripts, then I know how UN-important we really are- their lack of reimbursement speaks volumes, regardless of what they say.

  7. 14 Jean Keating February 28, 2012 at 7:17 pm

    Brian Henry who do you think you’re trying to kid posting on a community pharmacy board? We know it’s all about the money for the PBMs and certainly not about the patients. Why don’t you reimburse at a fair rate to ALL pharmacies and let the patients decide? We know where they would choose and I suspect so do you.

  8. 15 Donald Blank February 28, 2012 at 7:23 pm

    This assault on the profession of Pharmacy by the insurers began in the 80’s and has progressed over the years. Until Pharmacists organize it will be the way it is.

  9. 16 Robert Frankil February 29, 2012 at 3:33 am

    Mr Henry,

    Thanks for chiming in and trying to explain your side in public. At least you will put something out there that attempts to make sense, unlike you multi-million dollar earning boss, Mr Paz.

    However, you must show us how Express Scripts treats pharmacies of all sizes and locations as valuable partners. How can that be when you require mail order after 2 or 3 fills at the local community pharmacy? This is clearly not an example of how all pharmacies are treated as valuable partners. And MAC prices that come out of nowhere at below our cost? If this is how important partners are treated, then I shudder at the thought of how UN-important partners are treated by Express Scripts.

  10. 17 JBird February 29, 2012 at 6:15 am

    Express scripts is a joke, just like everything else these days. Cut cut cut, make money, drive everyone else into the ground. I speak to these imbeciles on a daily basis, even had opportunity to speak to a express scripts board member who stated that “Walgreens left because they think their brand deserved better reimbursement”. Don’t get me wrong, I hate Wag just as much as ESI, but this whole healthcare ordeal is an utter joke right now, and Mr. Paz is just another undereducated puppet master in the whole ordeal. God be with us if the ESI/MEDCO merger ever happens, community pharms can take a look to the left, then to the right and say goodbye to each, and send their CV to the local mail order pharmacy. Quite a pitiful society, but tis’ the way of the world I guess…..just wish I would have had the opportunity to choose a different profession before these worthless businessmen ruined what used to be a respectful profession.

  11. 18 Congresswoman Eva M. Clayton (Ret.), PCPAN Chair February 29, 2012 at 7:25 pm

    One of the things that stands out most to me about Mr. Henry’s comment, is that he does not deny that George Paz said what he said. He says the line was taken out of context, but the words pretty much speak for themselves. Especially when you consider that this is not the first time Mr. Paz – or Medco CEO David Snow, for that matter – has made comments along these lines. ESI and Medco’s own words clearly show how they really feel about pharmacists:

    “At the end of day, as I said earlier, NEXIUM is NEXIUM, LIPITOR is LIPITOR, drugs are drugs and it shouldn’t matter that much [who is] counting to 30.” – Express Scripts CEO George Paz (02/23/2012)*

    “I can’t stop certain pharmacies from going out of business…” – Express Scripts CEO George Paz (12/06/2011)**

    “I’m not dissing retail [pharmacy], but…there’s a fiction that a pharmacist comes out and dialogues with you … In reality, a high school student hands you a script from the shelf.” – Medco CEO David Snow (10/11/2011)***

    “Medco’s ‘robots’ are ‘twenty-three times more accurate’ than human pharmacists, in terms of errors in dispensing prescriptions.” – Medco CEO David Snow (10/11/2011)****

    The idea of combining two companies that do not value pharmacies that provide critical services and look at pharmacies as mere, ‘dots on the map,’ is downright scary.

    These comments are offensive should be of great concern given that PBM’s and pharmacists should have a respectful relationship if they are to serve the consumers well. I think pharmacists should contact Mr. Paz directly to demand an apology.

  12. 19 Concerned Pharmacy Tech March 1, 2012 at 3:54 pm

    Unfortunately, Walgreens was asked to take a profit loss to keep ESI on as a PBM. There is no finger pointing needed here, what needs to happen is to make the patient the top priority instead of money.
    Do you think it is fair for the 90 year old to have to leave the pharmacy she has used for 10 years, go to a different pharmacy then actually pass away due to the fact that they got her insulin mixed up? Or the other patient we had that moved and had a severe allergic reaction to a medication that she was allergic to, but the pharmacy she moved too didn’t document all of her allergies? If the patient was important to ESI then these senarios would never have happened.
    I still have my job, others have lost theirs due to the ESI move. We form bonds with our patients over the years, we know them by their first name, and they know ours. Sometimes they just come in to chat. Do you think moving them to a different pharmacy makes this easier on them? The unfamiliar, and the more expensive in the long run.
    I have had many people tell me that when the contract with their PBM comes back around they are choosing the plan that does not include ESI.
    I’m going to e-mail my congressman and ask him to please veto this merger, as it is only going to cause more harm.

  13. 20 Kathy Elliott March 1, 2012 at 8:15 pm

    HA HA HA HA HA HA !!!!!!!!!!!!!!!! You tell ’em George!!! Your comment made my day!

  14. 21 John March 2, 2012 at 8:13 pm

    Mr. Henry,
    It seems peculiar that you highlight the fact that this was brought up in an earnings call. Typically a call like this would highlight moves to save the company money not “clients and members”, I believe your second sentence pretty much sums that up.
    As far as minimal disruption to your “members and clients” I believe you are delusional, this was a HUGE disruption to your “members and clients”. Your “members and clients” are our patients, people we have personal relationships with, a vested interest in, and that trust us with an important part of their healthcare. You and Mr. Paz are missing an important point, these people are not getting a commodity they are getting healthcare and they deserve to be able to go to a pharmacy they trust.
    If you really want to save your “members and clients” money do away with spread pricing, but I bet you don’t want to discuss that topic!

    • 22 Kathy Elliott March 6, 2012 at 5:18 pm

      I’m with you John! Let’s discuss SPREAD PRICING!!!!!!!!!!!

  15. 23 Van G. Coble Dph, CDM, FASCP March 5, 2012 at 3:56 am

    Brian: Are you a pharmacist? We know Mr. Paz is not. So what makes the both of you think you know what happens in a community retail pharmacy? My suggestion is to get out from behind your desks and work in an actual pharmacy for 30 days. Then you may be slightly qualified to comment what happens in a community retail pharmacy.

  16. 24 Concerned pharmacist March 11, 2012 at 3:33 pm

    Brian, who do you think we are? We are informed pharmacists that care about our profession. We realize that you are asking Walgreens to take a loss on each and every Rx(that means prescription) that they fill in order to participate in your network. We also know that Target, Walmart, CVS, Kroger,etc. will participate or take a loss in order to get the patient in the store to buy other items. Walgreens is becoming the PharmD’s best friend. Finally, a company that is standing up for the dignity of pharmacy. We should all applaud Walgreens.

  17. 25 Robert December 20, 2012 at 4:31 pm

    I am a liver transplant patient, and, until now, had a few minor issues when it was Medco over getting my anti-rejection pills filled. Enter EXPRESS SCRIPT. On Dec 10, 2012 I informed my transplant center I was almost out of my med. Starting on Dec 17, both myself and transplant center have been on the phone daily, being assured my med is filled going out overnight delivery. After I have spoken with 2 pharmacist, 6 customer service reps, and 5 Mgr’s in C.S., Escalation, and Complaint depts., NO ONE can tell me what is happening with my medication. They show it on the “screen” and there’s ‘Lot’s of notations” but NO answers! EXPRESS SCRIPT IS AN INSULT TO THE PHARMACEUTICAL COMMUNITY – as well asa the people who have to depend on this group for vital medication. AVOID THIS COMPANY AT ALL COST IF YOU VALUE A LOVED ONE!

    • 26 ncpa1 December 20, 2012 at 5:38 pm

      We’re very sorry to hear about this stress and trouble that you are having. If you haven’t already, consider talking to a local community pharmacist (a searchable database is available at for help. They may be able to help provide a short-term supply of your medication if needed.

      It is especially wrong-headed when patients are mandated to use mail order and have no option of switching to another pharmacy, such as a community pharmacy. Your experience underscores why NCPA advocates so strongly for robust patient choice of pharmacy.

  18. 27 minion March 9, 2013 at 12:48 am

    I work for ESI as a temp worker. I desperately need the money they are paying or I never would have found myself there. I am nervous sharing this because they keep their lowly worker bees so stressed and pressured. I go home with jitters and at times get angry with my family for stupid things. If you have a heart or a brain, the job gets to you.. i am a kind hearted person and cannot help but feel for the sick, the elderly and less empowered. I work ten hr shift listening to their stories and when not asking if failed once day dosing, i am hammering out faxes. Since I am temp, I have no health insurance. How ironic.

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