The St. Louis Post-Dispatch on Tuesday published an article titled "Express Scripts-Medco merger under fire," and Express Scripts just may feel that headline describes the coverage it has been receiving from its hometown media.

"Influence Alley" - a blog of the Capitol Hill publication National Journal - wrote about the upcoming "fly-in" of the National Association of Chain Drug Stores, and the fact that pharmacy benefit manager issues will be on the list of topics to be addressed by pharmacy advocates in hundreds of meetings with legislators.

Writing in the St. Louis Post-Dispatch, columnist Kevin Horrigan provided further evidence that the pen indeed is mightier than the sword.  It would be hard to imagine a more artful though devastating account of the proposed Express Scripts and Medco merger.  

In an opinion column, Harry C. Alford, co-founder, president and CEO of the National Black Chamber of Commerce, wrote that if the Federal Trade Commission reviews the proposed Express Scripts and Medco merger with the scrutiny that it deserves, "it is difficult to see how they could possibly allow it to move forward."

Writing in Black Voice News, Alford called the proposed merger of pharmaceutical insurance middle-men "a corporate merger that could result in great strides backward for African Americans and others suffering from economic and health ills."

The drumbeat for patient care and against the proposed Express Scripts and Medco merger continued today, as the senior advocacy group 60-Plus wrote to the Federal Trade Commission (FTC) saying the deal "will mean higher prescription prices, fewer choices in pharmacy care, and lower-quality health services than are currently available."  

60-Plus said the merger of pharmaceutical insurance middlemen "is anti-competitive, anti-consumer and anti-senior, and should not be allowed to proceed."

A Reuters newswire article distributed today continues to rock the proposed merger of Express Scripts and Meco.  The article describes a new letter sent to the Federal Trade Commission (FTC) by the Food Marketing Institute, in which the supermarket trade association asks the commission "to bring an enforcement action to enjoin the merger."  The article also describes mounting opposition to the proposed merger among consumer groups and others, highlights close scrutiny of the deal among state attorneys general, and references potentially growing skepticism about the mega-merger among some within the FTC itself.

Sen. Herb Kohl (D-WI), who as chairman of a key Senate subcommittee presided over a hearing about the proposed Express Scripts and Medco merger last December, has "outlined his concerns" about the deal in a letter to the Federal Trade Commission.

In a letter to the Federal Trade Commission, U.S. Rep. Kathleen Hochul (D-NY) has expressed concerns about the proposed merger of pharmaceutical insurance middlemen Express Scripts and Medco, warning that decreased competition could result in the merged PBM's "raising consumer prices across the country."

"Another mega deal hangs in the balance amid regulatory scrutiny.  Pharmacy benefit managers Express Scripts Inc. and Medco Health Solutions Inc. are awaiting word from the FTC on their $29 billion merger, which has faced criticism from consumer groups that the deal will increase drug costs."

- Gina Chon, "Global Regulators Proving Hard To Please On Mergers," The Wall Street Journal's "Deal Journal," February 1, 2012

Perhaps it was deception, or perhaps it was denial, when Medco CEO David Snow dismissed the relationship between patients and community pharmacists as "fiction."  In any case, his words at an October healthcare conference at Cleveland Clinic have bitten him back again, this time with a member of Congress from Wisconsin citing his rhetoric in a letter to the Federal Trade Commission.

In an op-ed column in Pennsylvania's The Morning Call, pharmacy owner Robert Frankil writes in opposition to the proposed Express Scripts and Medco merger.  The merger of pharmaceutical insurance middle-men is feared to create anti-competitive and anti-consumer consequences.

The ranking Democratic member of the U.S. House of Representatives Commerce, Manufacturing, and Trade Subcommittee has urged that panel's chairman to call a hearing on the proposed Express Scripts and Medco mega-merger.  Rep. G. K. Butterfield (D-NC) wrote to Subcommittee Chairman Mary Bono Mack (R-CA), "Given the enormity of the proposed merger and its potential to threaten fair and adequate access to health care and pharmacy services for all Americans, our Subcommittee should carefully examine its true impact on consumers.  For example, we should explore the claims that this merger will be able to generate savings for consumers.”

The editorial board of the TIMESLedger in Queens, New York, today urged the Federal Trade Commission to "draw the line between free enterprise and monopolies," and to "come down on the side of the consumer" by blocking the proposed Express Scripts and Medco merger.

The American Consumer Institute Center for Citizen Research (ACI) has added its voice to the mounting concerns about the proposed Express Scripts and Medco merger.  In a letter to the Federal Trade Commission (FTC), ACI wrote, "Approving this mega-PBM [pharmacy benefit manager] merger would only exacerbate the conflicts of interest and concentration of market power that already exist in the PBM industry, and would in no way benefit consumers.  For these reasons, the Institute is strongly opposed to the Express Scripts-Medco merger, and we urge the commission to dedicate adequate resources to thoroughly review the merger."

High profile national organizations have written again to the Federal Trade Commission to debunk arguments that - while dubious - have been utilized to allay fears about the potential ramifications of the proposed Express Scripts and Medco merger.  The organizations that wrote the letter to help prevent the proposed merger from slithering through the antitrust review process include National Consumers League; Consumer Federation of America; American Antitrust Institute; Community Catalyst; U.S. PIRG; and the National Legislative Association on Prescription Drug Prices (NLARx).

Regarding the proposed merger of Express Scripts and Medco, U.S. Rep. Ralph M. Hall (R-TX) today wrote to the Federal Trade Commission (FTC), saying "I urge the FTC to take a close look at this proposed merger, at which point I am confident that it will be denied." 

As reported in the Queens Campaigner, a rally led by New York State Assemblywoman Aravella Simotas (D-Astoria) raised awareness of the feared anti-competitive and anti-consumer consequences of the proposed Express Scripts and Medco merger.

Sally Greenberg, executive director of the National Consumers League, did not come right out and call the proposed merger of Express Scripts and Medco a "hound dog."  She did, however, come very close to saying a merged Express Scripts and Medco mega-PBM "ain't no friend of mine."

In a letter-to-the-editor published on The Hill's Congress Blog with the headline "PBMs NOT the friend of consumers," Greenberg took issue with a prior opinion piece by Jonathan Orszag.  Greenberg said that Orszag "portrays pharmacy benefit managers as the best friend of consumers," but "seems to lose sight of the interests of the ultimate consumer here  - the patient."

Rep. G.K. Butterfield (D-NC) wrote to Federal Trade Commission Chairman Jon Leibowitz yesterday, expressing "great concern" over the proposed Express Scripts and Medco merger.  In his letter, Rep. Butterfield conveyed skepticism over the pharamacy benefit managers' (PBM) claim that a merger would result in healthcare cost savings - strong skepticism that has been shared by consumer groups, members of Congress, and many others.  

The Pennsylvania newspaper Pottsville Republican has editorialized that the Federal Trade Commission should reject the proposed Express Scripts and Medco merger.  The Editorial Board said that the merger "would create less competition not just for price, but for service and convenience, all at the expense of consumers who are not one-size-fits-all."

Says PBMs’ flawed claims are “illustrative” of current practices and of future actions if anti-competitive and anti-consumer merger is allowed

The National Association of Chain Drug Stores submitted comments to U.S. Senator Herb Kohl (D-WI), clarifying misleading statements made by Express Scripts Chief Executive Officer George Paz and Medco Chief Executive Officer David Snow at a recent congressional hearing.

Consumer groups, anti-trust watchdogs, public officials and pharmacy groups have expressed serious skepticism that an Express Scripts and Medco merger would result in cost savings for consumers, employers and the health plan clients of the drug benefit middlemen.  Now, add Washington Post columnist Steven Pearlstein to the list of those voicing caution about believing the claims of Express Scripts and Medco.

The Minnesota Pharmacists Association (MPhA) has formally announced its opposition to the proposed Express Scripts and Medco merger. 

“This merger is bad news for patients who have built trusting relationships with their neighborhood pharmacies,” said Julie K. Johnson, Pharm.D., MPhA executive vice president.

"One of the main arguments, Mr. Paz, for the merger, is that, combined, you'll be able to develop more innovation and new clinical tools and strategies for cutting costs.  And yet, we all know that innovation is the fruit of competition and that the more competitors, the more innovation and the better the consumer is served.  You seem to be making an argument to the contrary.  Have you come up with a new concept for how capitalism works?"

- Sen. Herb Kohl (D-WI), chairman of the Senate Judiciary Subcommittee on Antitrust, Competition Policy and Consumer Rights, at a hearing today on the proposed merger of Express Scripts and Medco.  Chairman Kohl asked the question of George Paz, chairman and CEO, Express Scripts, Inc.

"It is notable that no large employer who privately expressed concerns to us wished to testify at today's hearing, often telling us that they feared retaliation from the large PBMs with whom they must do business," stated Chairman Herb Kohl (D-WI) at a hearing of the Senate Judiciary Subcommittee on Antitrust, Competition Policy and Consumer Rights today.

Emphasizes lack of evidence that PBMs pass on savings to consumers, employers and health plans; notes abundance of skepticism among consumer groups and public officials

Mike Bettiga, chief operating officer of NACDS-member Shopko Stores Operating Company, LLC, testified before the U.S. Senate Judiciary Subcommittee on Antitrust, Competition Policy and Consumer Rights on the proposed mega-merger of Express Scripts and Medco and its feared negative effects on health outcomes and patient and prescription drug costs. The subcommittee held a hearing on the controversial proposed acquisition in the pharmacy benefit manager (PBM) industry, titled “The Express Scripts/Medco Merger: Cost Savings for Consumers or More Profits for the Middlemen?”

Consumers Union and NACDS are among those quoted in a New York Times article published on the day of a Senate Judiciary subcommittee hearing on the proposed Express Scripts and Medco merger.  "Our concern is that a mega PBM would have tremendous power and control over what prescription drugs Americans can get, where they get them, and how much the drugs cost," said Don Bell, senior vice president and general counsel for NACDS.

In a letter to the Federal Trade Commission (FTC), three more Senators have communicated concerns about the proposed Express Scripts and Medco merger and have urged a "thorough and complete investigation, including examining any potential impact on consumers, patients, third party and federal payers."

"On a scale thousands of times larger, the lemonade stand example illustrates the sort of anti-competitive, monopolistic behavior that could result from a proposed $29 billion merger between two pharmacy benefit managers (PBMs), Express Scripts and Medco," writes LegitScript President John Horton in a column published today on Huffingtonpost.com.

"Beyond outrageous" was among the hard-hitting descriptions used by New Jersey Assemblywoman Linda Stender (D) in issuing a statement and announcing plans for a hearing regarding the proposed Express Scripts and Medco merger. 

In a simple and powerful statement, the American Antitrust Institute (AAI) wrote in a letter to the Federal Trade Commission:  "Express Scripts' acquisition of Medco poss a threat to substantially lessen competition in the provision of pharmacy benefit manager services throughout the United States."

Citing concerns about the potentially devastating impact on community pharmacies and patient care, the Pennsylvania Pharmacy Councl (PPC) announced opposition to the proposed Express Scripts and Medco merger.

U.S. Sens. Mark Pryor (D-AR) and John Boozman (R-AR) today questioned Federal Trade Commission (FTC) nominees about scrutiny of the proposed Express Scripts and Medco merger.  The Senators asked their questions as part of a Senate Commerce, Science & Transportation Committee hearing on the re-nomination of FTC Chairman Jon Leibowitz and the nomination of Maureen Ohlhausen to become a Commissioner. 

Medco CEO David Snow's "Robots vs. Pharmacists" remarks sent the pharmacy blogging community into orbit in October, where it has understandably remained since that time.

David Balto, who previously served as policy director at the Federal Trade Commission (FTC) and who now represents opponents of the proposed Express Scripts and Medco merger, made a compelling case in a leading Capitol Hill newspaper against the emergence of a mega-pharmacy-benefit-manager (PBM).

The Senate Judiciary Committee's Subcommittee on Antitrust, Competition Policy and Consumer Rights has announced a hearing on the proposed Express Scripts and Medco merger.  The hearing - titled "The Express Scripts/Medco Merger: Cost Savings for Consumers or More Profits for the Middlemen?" - will be held December 6, 2011, at 2:30 p.m.

The Wall Street Journal reported first that the advocacy group Small Business Majority has written to the Federal Trade Commission to oppose the proposed Express Scripts and Medco merger.

Nine Republicans and 5 Democratic members of the U.S. House of Representatives have joined forces to urge the Federal Trade Commission (FTC) to "conduct a full and thorough investigation" of the proposed Express Scripts and Medco merger, "including examining the impact that the merger will have on consumers, patients, third party and federal payers."  In a letter to the FTC, the members of Congress cited a Department of Health and Human Services Office of the Inspector General Report that said of pharmacy benefit manager practices, "pharmacy discounts were not always passed on to the beneficiaries and the Government."

With news breaking that a Senate subcommittee is planning a hearing to further scrutinize the proposed Express Scripts and Medco merger, NACDS told Modern Healthcare: “We are very receptive and appreciative of the news that another hearing will be forthcoming, because we believe that the continued scrutiny of this mega-merger is appropriate and certainly in the best of consumers.” 

Pharmacy Times is the most recent publication to report on the revealing remarks by Medco CEO David Snow at a Cleveland Clinic healthcare conference earlier this month. NACDS says the remarks provide insights into the thinking of Express Scripts and Medco that relate directly to fears surrounding the proposed mega-merger of the two companies.

Bloomberg reports that U.S. Sen. Herb Kohl (D-WI), chairman of the Senate Judiciary Committee's Subcommittee on Antitrust, Competition Policy and Consumer Rights, is planning a hearing on the proposed Express Scripts and Medco mega-merger.

A trade publication reporter contacted NACDS to request a comment about recent remarks by Medco Chairman and CEO David Snow regarding community pharmacy.  NACDS responded by saying that the remarks “are a window into the true thinking of the companies [Medco and Express Scripts] that are seeking to merge.”

Representatives of the Louisiana Lupus Foundation and the Louisiana Academy of Medical Psychologists are quoted in an opinion piece posted on Louisiana’s BayouBuzz.com, describing the flaws of reducing or eliminating the ability of patients to choose to obtain their prescriptions from community pharmacies – a feared potential consequence of the proposed Express Scripts and Medco merger.

"Over two dozen states are scrutinizing Express Scripts' proposed acquisition of Medco Health Solutions," writes Reuters' Diane Bartz.  "The states do not have a direct say in the review by the Federal Trade Commission, whose role is to make sure the deal complies with antitrust law.  But they will likely add pressure on the FTC to give tough scrutiny to the merger, and could hand the agency evidence that would potentially serve as ammunition to challenge it.  The states could also challenge the deal on their own."

In an op-ed column published in today's edition of The Hill, former U.S. Rep. Eva M. Clayton (D-NC) said of the proposed Express Scripts and Medco mega-merger: "Not all mergers are bad - and there are certainly cases where merging two industry leaders would be a good thing.  However, in this particular case with these two specific companies, the consequences greatly outweigh any potential good."

New ad asks, “What will stop Express Scripts and Medco from putting profits ahead of patients?” 

NACDS today unveiled the print advertising component of its campaign to emphasize the anti-competitive and anti-consumer effects of the proposed merger of Express Scripts and Medco. The new print ad was published in today’s Washington Post.  The new print ad was published in today’s Washington Post.  The print ad can be seen by clicking here.  NACDS’ previously announced radio ad can be heard be clicking here.

In a letter to the Federal Trade Commission today, U.S. Rep. Joe Courtney (D-CT) expressed opposition to the proposed Express Scripts and Medco merger.  "There is little evidence that increased market concentration of Express Scripts will significantly lower costs for consumers or the American taxpayer," Rep. Courtney wrote. 

Pharmacist, 40-year community pharmacy veteran: Express Scripts-Medco merger would be a “tipping point in PBM market consolidation”

Dennis Wiesner, senior director of privacy, pharmacy and government affairs for National Association of Chain Drug Stores (NACDS) member H-E-B (San Antonio, Texas), testified before a House panel today about the negative effects – ultimately on consumers – if the proposed merger between pharmacy benefit managers (PBM) Express Scripts and Medco were approved. The Judiciary Subcommittee on Intellectual Property, Competition and the Internet held a hearing today titled “The Proposed Merger between Express Scripts and Medco.”

Today, the following organizations sent a letter to the Federal Trade Commission to oppose the Express Scripts and Medco merger:  National Consumers League, Consumer Federation of America, Consumers Union - Nonprofit Publisher of Consumer Reports, U.S. PIRG and National Legislative Association on Prescription Drug Prices.

On creation of huge new industry middleman: “Too big. Too much power. That’s not healthy.”

Amid a hearing in Congress this week on the controversial Express Scripts-Medco proposed merger, and with rising consumer- and Congressional voices of opposition to the merger, the National Association of Chain Drug Stores (NACDS) today launched advertising to warn further of the mega-deal’s feared anti-competitive and anti-consumer consequences.

Emphasizes unsurpassed value of community pharmacy in improving patient health, lowering healthcare costs across the board

The National Association of Chain Drug Stores (NACDS) today sent letters to U.S. Senator Mark Pryor (D-AR) and U.S. Representative Cathy McMorris Rodgers (R-WA) applauding their sponsorship of companion legislation that seeks to preserve pharmacy choice for patients and takes additional steps to prevent threats to pharmacy patient care.

A Reuters article describes a letter to the Federal Trade Commission from U.S. Reps. Henry Waxman (D-CA), Frank Pallone (D-NJ) and Diana DeGette (D-CO).

Urges opposition to merger in comments to Ways and Means Subcommittee on Health

Questions whether huge PBM would live up to claims of passing along any cost-savings

Calling on Congress to scrutinize the controversial proposed merger of two large pharmacy benefit management (PBM) companies, today the National Association of Chain Drug Stores (NACDS) submitted comments to the U.S. House of Representatives Ways and Means Subcommittee on Health emphasizing its opposition to the proposed Express Scripts and Medco. The House panel held a hearing today titled “Health Care Industry Consolidation.”

Emphasize Merger’s Anticompetitive Consequences & Potential Harm to Consumers

The National Association of Chain Drug Stores (NACDS) and National Community Pharmacists Association (NCPA) – who represent a near totality of the nation’s pharmacy community – today commended the U.S. Federal Trade Commission (FTC) for issuing a "second request" - further investigation of the proposed merger of Express Scripts, Inc. and Medco Health Solutions, Inc.

Saying that the proposed Express Scripts and Medco merger "would reduce competition resulting in a decrease of pharmacy patient care and an increase in healthcare costs to both consumers and to FMI [Food Marketing Institute] members as employers," FMI urged careful evaluation of the potential merger's effects.

Click here to read the FMI news release.

An Associated Press article reports on a letter to the Federal Trade Commission by U.S. Rep. Don Young (R-AK).

The Editorial Board of the St. Louis Post-Dispatch writes of the proposed Express Scripts and Medco merger:  "the antitrust issues are real."

Drug Store News reports on the Chain Drug Consortium's opposition to the Express Scripts and Medco merger.

In a letter to House of Representatives Judiciary Committee Chairman Lamar Smith (R-TX), U.S. Rep. John Conyers (D-MI) urged a Congressional hearing to review the proposed merger of Express Scripts and Medco.

Emphasize Merger’s Anticompetitive Consequences & Potential Harm to Consumers

The National Association of Chain Drug Stores (NACDS) and National Community Pharmacists Association (NCPA) – who represent a near totality of the nation’s pharmacy community – sent their first formal letter to the U.S. Federal Trade Commission (FTC) in shared opposition to the proposed merger of Express Scripts, Inc. and Medco Health Solutions, Inc.