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What killed mail-order drug jobs in Bucks? Automation? Overseas workers?

The company said automation was the cause. The union says blamed it on call centers in the Philippines. In any event, 200 are losing their jobs.

Why are 200 Express Scripts pharmacists and pharmacy techs losing their jobs in Trevose?

Automation and more efficient software, says the St. Louis-based pharmacy management and mail-order drug company, one of the nation's largest.

"Increased automation and the market adoption of electronic tools as well as the adoption of member digital tools ... have streamlined processing of our prescriptions," wrote Brian Henry, an Express Scripts Holding Co. spokesman.

Call centers in the Philippines and temp workers in Indiana, says the union representing about 180 of the workers.

"We know for a fact that a trainer from Trevose went to the Philippines to train them. We know these workers are performing the same work," said Neal Manning, an SEIU Healthcare official.

"Express Scripts does have some call center work that is managed overseas to complement call centers managed elsewhere in the U.S.," Henry responded. "We are not moving jobs from Trevose to the Philippines."

Manning said employees at Express Scripts' office in the Bucks County Technology Park on Street Road in Trevose in Bensalem Township make calls verifying prescriptions, checking eligibility, and contacting doctors, all under the direction of pharmacists. Top technicians earn $17.50 an hour, plus benefits.

Outraged by the closing, State Rep. Gene DiGirolamo (R., Bucks) was hosting a gathering Wednesday of Express Script workers at his office in the Neshaminy Valley Commons on Bristol Road in Bensalem.

"When a multibillion-dollar corporation posting enormous profits shuts down a facility and puts hardworking Pennsylvanians out of work just to make even more money, that's greed," he said in a statement last month.

Henry had no comment on whether Express Scripts uses call centers in the Philippines.

Express Scripts' 2016 profit grew to $3.4 billion, up from $2.5 billion in 2015, even as revenue declined slightly to $100.3 billion in 2016 from $101.8 billion, the company reported.

Increased automation and call centers in the Philippines are both likely to be true, said Albert Wertheimer, a Temple University professor emeritus specializing in the pharmacy economics, now at Nova Southeastern University in Florida.

"They like to tie people up," Wertheimer said, explaining that pharmacy benefit management companies such as Express Scripts strive to get individual patients, perhaps through their health insurers, to enroll and have their prescriptions refilled automatically and delivered by mail. That requires fewer workers at all points along the supply chain.

Also, he said, drug companies are increasingly turning to pharmacy benefit management companies to market their products. Benefit management companies know which doctors are prescribing what types of drugs and can call them to tout an alternative.

"That work can be done from anywhere," including the Philippines, he said.

Jacqueline Dixon, 52, a mother of four who lives in Willingboro, says she thinks at least some of the work she's doing inputting prescriptions into the computer system will go to 150 temporary employees hired in Indiana.

"I'm devastated," she said. "I'm without a job after 13 years of service. We've been fighting to stay here. We've given concession after concession, but it's never enough."

Express Scripts has been cutting jobs in the region. It told the State of New Jersey that it would be laying off 66 workers in Franklin Lakes, effective April 21. It had previously laid off 200 workers in New Jersey in 2013 and 2014.

The company has been trimming its workforce in Lower Bucks County since 2010 when it and the union negotiated a bittersweet deal to save 400 jobs while negotiating severance for 500 workers. They included 350 at its Marshall Lane plant in Bensalem, which was shuttered, and 150 at the Street Road office. Since then, primarily through attrition, the number of employees has dwindled to about 220 from 400.

The company's lease on the 53,000-square-foot space is up at the end of June. Operations will end there on May 28.

About 50 workers at the Trevose office are being given the opportunity to work from home or at another site, Henry said. Express Scripts employs about 2,000 people statewide, with offices in Blue Bell, North Huntingdon, and Warrendale, he said.