Express Scripts announced adrastic departure from business as usual: a new drug list forclients that favors drugs with lower sticker prices over those thatprovide huge secret discounts.

Express Scripts Holding Co. and other pharmacy-benefit managers make money bynegotiating drug prices on behalf of health-plan providers. Thelist prices that pharmaceutical companies setfor their drugs diverge wildly from their real cost, and PBMs widenand feast on the gap, which helps make them some of the principalbeneficiaries of America's byzantine pricing system.

But on Tuesday, ahead of its acquisition by Cigna Inc. and possibleregulation, Express Scripts announced a drastic departure frombusiness as usual: a new drug list for clients that favors drugswith lower sticker prices over those that provide huge secretdiscounts. While unlikely to replace the current system any timesoon, it's a substantial shift for a major PBM, and anacknowledgment of tough political and business realities that couldboost a nascent and positive trend in drug prices.

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