A secretive board controls access to prescription drugs for millions of Americans

Each year, Express Scripts releases a list of prescription drugs it will exclude from coverage for the upcoming year, and that list is determined by a secretive board of doctors and a pharmacist.

The nation’s largest pharmacy benefit manager, which is based in St. Louis County, does not disclose the names of the board members or any actual or potential conflicts of interest they may have.

Express Scripts is not alone. Its rivals also exclude drugs from their own annual drug formularies — the list of drugs they will cover — based on the recommendations of unidentified experts.

The reason behind the secrecy is to shield experts from the “tremendous” influences of lobbyists, Express Scripts executives say. But some critics say the process should be more transparent, as it is in many other countries.

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