Sadly, this is business as usual. Take for example Valeant Pharmaceuticals, a company that spends almost nothing for research and development but acquires mature products for marketing and sales. On the day that Valeant acquired two heart medications Nitropress and Isuprel, they raised the price for one by three times and the other by six times. A company spokesperson claimed that Valeant was beholding to their stockholders and would price their products accordingly.
From a survey of drug prices by Express Scripts, brand drug prices have increased by 127% since 2008 while the consumer price index has gone up by 11%.
Since we are dependent on the questionable benevolence of the pharmaceutical industry to hold drug prices down, what is the role of the PBM to help maintain a reasonable drug spend for contracted plans? PBMs are not fiduciaries and are not in place to save your plan money. They are the ATMs of the pharmacy transaction. Their role in your plan’s management is how you design your benefit. Being a knowledgeable consumer of pharmacy benefit transactions is the best way to protect yourself.
Can you insert protection between rising manufacturer drug costs and best outcomes for your members’ health? It is important to be aware of fluctuating market conditions that impact your pharmacy dollar. APC can help design your plan to best protect you from wildly impactful pricing by enabling you to direct the PBM through contracting and monitored performance.
Article Written By:
Article Written By:
Galen Davidson is a Pharmacy Benefit Consultant with more than 36 years’ experience in the pharmaceutical industry. His expertise includes knowledge in the process of analysis and negotiation of contract terms for best competitive pricing for rebates, admin fees, discount rates, and disease state management program fees.
