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Express Scripts’ Miller Discusses Loss of ‘Social Contract’ in Drug Pricing, Other Specialty Pharmacy Trends

The “social contract” that once existed among pharmaceutical companies, investors, and the public kept drug costs within reach of those who needed them. But that contract has broken down, leading to drug prices that are “entirely dissociated” with the cost of bringing them to market, Steve Miller, MD, the chief medical officer of Express Scripts, said in an interview published today.

In a wide-ranging discussion with Evidence-Based Diabetes Management, a publication of The American Journal of Managed Care, Dr. Miller describes the changed environment PBMs face as they seek to hold down drug prices for health plans and major employers, and, by extension, consumers. Express Scripts is the nation's leading PBM organization.

Among the challenges, Dr. Miller said, is the philosophy toward drug development that exists today. “Drug companies and Wall Street analysts clearly believe that if you have a unique therapy and if you have the patent, then you have almost unlimited pricing power,” he said.

“Thank goodness this line of thinking wasn’t used with the polio vaccine in the 1950s and 60s, or nobody would have been able to afford it,” Dr. Miller said. For the full interview, click here.

When Sovaldi hit the market with a 12-week course of $84,000, critics decried the “$1,000 pill,” while supporters of granting patients access said it would prevent those with hepatitis C from needing further treatment, including liver transplants (1). Competitors have come on the market since then, and Dr. Miller describes the approach Express Scripts has taken to bringing down costs, which requires buy-in from its customers. As new breakthrough therapies near FDA approval, there’s more discussion between pharmacy benefit managers and drugmakers on the front end than in the past, he said.

That approach will be tested soon. The FDA is expected to act this week on the first of two cholesterol-fighting PCKS9 inhibitors that face summer deadlines. Alirocumab, to be marketed as Pralunet by Regeneron and Sanofi, faces a deadline of Friday for FDA action.

(1) Goozner, M. Why Sovaldi shouldn't cost $84,000. Modern Healthcare. May 3, 2014.

About the Journals

The American Journal of Managed Care celebrates its 20th year in 2015 as the leading peer-reviewed journal dedicated to issues in managed care. Other titles in the franchise include The American Journal of Pharmacy Benefits, which provides pharmacy and formulary decision-makers with information to improve the efficiency and health outcomes in managing pharmaceutical care, and The American Journal of Accountable Care, which publishes research and commentary on new healthcare delivery models facilitated by the 2010 Affordable Care Act. AJMC’s news publications, the Evidence-Based series, bring together stakeholder views from payers, providers, policymakers and pharmaceutical leaders in oncology and diabetes management. To order reprints of articles appearing in AJMC publications, please call (609) 716-7777, x 131.

Nicole Beagin (609) 716-7777 x 131

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