Have I Ever Told You How Much I Hate Express Scripts?

I hate Express Scripts.  I do.  They are a pain in my ass.  Not only do they have patients by the balls because they HAVE to use them for their drugs but Express Scripts uses this leverage to destroy my day.  I have to fax EXACTLY the way they want things faxed with their form and many times that doesn’t work with my or any other doctors’ EMR.  They don’t care.  If you ignore them they alert the patient and both Express Scripts and the patient will start hounding you.  And you become the bad guy.

They lie.  They will tell patients they cannot use the medication they have been on forever without a reason and then force them to use something different.  I have seen them claim another drug is in the same class when it was not even close.

And they are raking in the money.

PBMs serve as the middlemen in drug pricing system, by making deals with manufacturers and pharmacies. Their impact on our drug pricing system is enormous, in fact the three largest PBMs control an astounding 75-85 percent of the market and have upwards of $250 billion in estimated revenues. These companies are powerful forces in prescription negotiation but their reach is often obscured by a lack of transparency.

Because PBMs are the intermediary between drug manufacturers, pharmacies, and ultimately patients these companies hold sway over everything from pharmacy reimbursements, to what drugs are covered under formularies. Their influence is notable especially considering the lack of competition in the PBM space.

The only ones who “benefit” from these Pharmacy Benefit Managers or PBMs is themselves.  I hate them all.  And I am not the only one:

In a speech at the Food and Drug Law Institute Annual conference Thursday morning, (FDA Commissioner)Gottlieb said the U.S. doesn’t have a “truly free market” when it comes to drug prices, and suggested the federal government should re-examine whether drug rebates, which manufacturers pay to pharmacy benefit managers and insurers in exchange for more favorable coverage of their products, should be exempt from an anti-kickback law.


Finally!  These middlemen are eating up any discounts meant for patients.  Please get rid of them.


Let’s give an example of their trickery:

Just this week, Regeneron and Express Scripts announced a new deal for the cholesterol drug Praluent, in which Regeneron would significantly increase the rebate it pays on the drug in exchange for fewer obstacles for doctors to prescribe it — and the exclusion of the competitor drug from Amgen from coverage on Express Scripts’ largest formulary.

What a load of crap.  Patients are pawns in this game as doctors are forced to switch medications on them because of some back room deal.  It’s disgusting.  I had to deal with it just last week with an ADD drug and an incontinence medication.

Please help me to continue to expose these crooks.  Put your stories, where you have had to change medications for patients, here and let the world know of this lunacy.

Get one our t-shirts and feel happy!


Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  4 comments for “Have I Ever Told You How Much I Hate Express Scripts?

  1. Lori Erickson
    May 10, 2018 at 9:08 am

    I’m a pharmacist and a patient forced to use Express Scripts. They are a nightmare. My stories are long so I’ll skip them but being forced to speak to their “CSR” (we take the service out of everything) is torture. I’m embarrassed on behalf of my profession and outraged as a patient at their inability to get simple things (refills) done.

  2. RSW
    May 7, 2018 at 1:23 pm

    Don’t EVER fax to Express or any other PBM.

    Give the patient a hard copy and let them mail it in with the form THEY fill out and have to argue with the PBM about.

  3. Steve O'
    May 7, 2018 at 12:49 pm

    Hey, and here it comes for the Veterans! The PBM’s are circling, trying to “save money by privatizing the VA,” i.e. tapping into VA prescriptions which are mostly filled in-house. Duck and cover, Vets!

  4. Debbie
    May 6, 2018 at 11:17 am

    My personal favorite is US Rx which covers my local hospital employees and demands patients use NPH/regular insulin VIALS! We got rid of that years ago for our hospital patients but employees are clearly second class … they harass me EVERY week asking if patients can be taken off inhalers “unless they have asthma”! What? Is that what inhalers are for? I thought they were for acne! Idiots!

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