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As the cost of prescription drugs generates increased controversy, Express Scripts (ESRX), the nation’s largest pharmacy benefit manager, will be removing still more medicines from its list of drugs covered by insurance, known as formularies.

In 2019, the PBM will exclude 242 medicines, compared with 196 this year, and the changes are forecast to save about $3.2 billion for its clients, such as health plans. The formulary covers approximately 25 million people, and about 0.2 percent of them are forecast to be affected by the changes.

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