A front-row seat for the drug pric­ing bat­tle

Daily Local News (West Chester, PA) - - WEATHER - By Tom Mur­phy AP Health Writer

Dr. Steve Miller, the chief med­i­cal of­fi­cer of Ex­press Scripts, sits at the cen­ter of the storm over ris­ing drug prices.

His com­pany runs pre­scrip­tion plans for em­ploy­ers and in­sur­ers that cover around 85 mil­lion peo­ple. It buys enough drugs to fill more than 1 bil­lion pre­scrip­tions a year.

Miller has watched su­per-sized drug prices in­fu­ri­ate pa­tients and strain the health care sys­tem with growing fre­quency, start­ing when a new hep­ati­tis C drug hit the mar­ket at $84,000 for a course of treat­ment and con­tin­u­ing through the re­cent rev­e­la­tion that the price of My­lan’s EpiPen rose more than 500 per­cent since 2007.

The com­pany uses its buy­ing power to push drug­mak­ers for dis­counts, and Miller fre­quently crit­i­cizes both the amounts drug­mak­ers charge and the pa­tient as­sis­tance pro­grams they of­fer.

Drug­mak­ers, on the other hand, say these phar­macy ben­e­fits man­agers, or PBMs, are among the lay­ers of mid­dle­men in­flat­ing costs.

Miller spoke re­cently with The As­so­ci­ated Press. His com­ments have been edited for clar­ity and length.

Q

: Why do you op­pose the coupons that My­lan and oth­ers of­fer to cus­tomers?

A

: The pa­tient pays only a small part of the drug cost. It’s their em­ployer or their in­surance com­pany that pays the vast ma­jor­ity. So giv­ing that co-pay as­sis­tance does noth­ing to lower the price for the U.S. health care sys­tem, and ev­ery pa­tient pays for it in the form of their (in­surance) pre­mium.

Q

: Em­ploy­ers and in­sur­ers pay you to process pre­scrip­tions. Isn’t your com­pany part of the pric­ing prob­lem?

A

: We are part of the pric­ing so­lu­tion. If you did not have PBMs you’d in­vent a PBM, be­cause what we do is we ag­gre­gate a huge num­ber of pa­tients, and we can drive enor­mous dis­counts.

Q

: What ul­ti­mately stops this pat­tern of steep price hikes for pre­scrip­tion drugs?

A

: His­tor­i­cally, providers of health care never took ad­van­tage of the times they had their mo­nop­o­lies. Over the last decade or two, we’ve seen the tat­ter­ing of that so­cial con­tract.

We have re­ally been en­cour­ag­ing the lead­ers of the phar­ma­ceu­ti­cal in­dus­try to ad­here to that so­cial con­tract, and we’re see­ing some progress.

Q

: Will profit-hun­gry in­vestors buy into that con­tract?

A

: If a phar­ma­ceu­ti­cal man­u­fac­turer demon­strates sci­en­tific in­no­va­tion, brings new prod­ucts to the mar­ket, we’re go­ing to work with them to make sure pa­tients have ac­cess to the prod­ucts. They’re go­ing to be suc­cess­ful, pa­tients are go­ing to health­ier and so­ci­ety’s go­ing to be bet­ter for it.

Q

: These price hikes seem to be pop­ping up all the time now. What are the chances the aver­age con­sumer’s go­ing to run into sticker shock at the phar­macy counter?

A

: The ad­vent of health plans with high de­ductibles is mak­ing it more com­mon. In the past, peo­ple had flat (co-pay­ments), which means that you paid ei­ther $10 or some­thing sim­i­lar. Now these plans have gone to per­cent co­pays. Even if your per­cent is low, if you have a $10,000 drug, that means a high co-pay.

We’re see­ing high drug prices, and we’re see­ing more and more pa­tients with high-de­ductible health plans.

Q

: What is the next area of treat­ment where we may see some soar­ing drug prices?

A

: Con­sider how dev­as­tat­ing Alzheimer’s is, any­one who comes to the mar­ket with a treat­ment would have un­lim­ited pric­ing power. How much would you be will­ing to pay for your spouse who is suf­fer­ing with Alzheimer’s? Any­thing.

Ex­press Scripts Chief Med­i­cal Of­fi­cer Dr. Steve Miller

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