Evidence building of PBMs' ability to control Rx costs

While policymakers in Washington, DC debate if — and how — they should address the issue of prescription drug costs, some of America’s largest pharmacy benefit managers (PBMs) are releasing data that show they may have the solution.

Earlier this month, Express Scripts — the country’s largest PBM — released a report showing prescription drug costs increased by just 2.5 percent for its beneficiaries in 2015. The company compared that to overall drug prices, which increased by 16.2 percent nationally during the same period.

Earlier today, Prime Therapeutics announced that it held drug cost increases to the same percentage (2.5 percent) for its members in 2015.

“With prescription drug prices increasing at unsustainable levels, Prime is pleased that it has played an active role in controlling drug costs for our clients,” said Jim DuCharme, Prime’s president and CEO. “We are relentless in helping our members find the right drugs for their condition, assuring their continued adherence to that regimen, and finding a most affordable cost. Every day we will aggressively negotiate the best price for our plan sponsors and members. We are thrilled to be able to report an annual drug cost in 2016 that is industry-leading and represents a responsible level of increase.”

According to Prime Therapeutics, its PBM tools generated a total of $2.2 billion in savings for its clients.

This announcement comes just a day after President Donald Trump’s nominee to head the Centers for Medicare and Medicaid Services (CMS), Seema Verma, told the Senate Finance Committee hearing that she was “thankful” for PBMs role in reducing prescription drug costs in Medicare Part D.

“I think that we need to do everything that we can to make drugs more affordable for seniors," said Verma. "I'm thankful that we have the PBMs in the Part D program that are performing that negotiation on behalf of seniors."

PBMs like Prime Therapeutics and Express Scripts negotiate drug prices on behalf of health insurance companies, employers, and Medicare Part D. In recent months, brand-name drug manufacturers have attempted to shift blame for rising drug costs to PBMs. These drug makers claim PBMs drive higher prices by offering rebates and discounts.

In an interview with American Pharmacy News last week, Jennifer Luddy, senior manager of corporate communications for Express Scripts, said that blame is misplaced.

“Drug makers set the prices for their medications. They can lower those prices at any time,” she said. “Our job is to put medicine within reach for payers and patients. We still have more work to do to get costs lower for more patients and more payers, but as demonstrated in our report, we are doing our job effectively.”