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Express Scripts, one of the largest pharmacy benefit managers in the country, overcharged U.S. Postal Service employees by a whopping $45 million for their prescription drugs during a recent five-year period, according to a federal audit.

The findings are likely to intensify scrutiny of the controversial role played by PBMs in the opaque pharmaceutical pricing system. The report, which was released in March but received little if any public attention, examined drug spending between 2016 and 2021 within the health plan that covers more than 200,000 unionized mail carriers and post office workers, as well as retirees.

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Notably, nearly half of the overcharges stemmed from drug rebates that Express Scripts negotiated with pharmaceutical companies. But instead of passing back 100% of that money to the health plan, as the contract required, the PBM skimmed millions for itself, according to the audit, which was conducted by the Office of Inspector General for the Office of Personnel Management.

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