Buzz has it that the much anticipated, and in some corners, shunned union of PBM giants Medco and Express Scripts is almost a done deal. Shareholders have overwhelmingly approved the acquisition and ESI is raring to go!  WBC ( has opined from the initial announcement that this marriage would receive FTC blessing, and on the latest report from confidential sources, they are ready to pull the trigger.

The ESI P.R. machine has been pushing out releases over the last several months touting the benefits to consumers and health plan payors of the new mega PBM represented by this super-sized combo. This position is sharply contrasted by several community pharmacy associations who fear the negotiating club that would be wielded by “Expredco.”

Unlike the AT&T deal for T-Mobile, which received a thumbs down from the FTC,  ESI/Medco, while potent, would still only represent 30% of the prescription drug market.  Expressed (no pun intended) another way, 7 out of 10 Rxs will still be managed by competitors.

The return for investors in a combined organization looks sweet, and ESI is making a strong case that cost savings will be significant.  The question remains whether these savings generated through operational synergies and ability to negotiate with manufacturers gets passed through to plan sponsors or is simply reserved to keep a smile on stockholders faces.  We’ll see.

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