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Front Immunol (2019) 10:796

and metabolism 14 (10), 910917

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While a number of mechanistic studies have found that metformin lowers fasting blood glucose levels by suppressing hepatic glucose production [1,2,3], a substantial body of in vivo data suggest that much of the glucose-lowering action occurs at the level of the gastrointestinal tract, irrespective of its systemic bioavailability [3, 4]

The Express Scripts/Medco merger in 2012 ($29.1 billion) and the CVS/Aetna and Cigna/Express Scripts deals in 2018 ($69 billion and $67 billion, respectively) were the structural events that locked in the current oligopoly