PBM Sees New Cancer and Cholesterol Drugs as Cost Savings Opportunity

Express Scripts, the nation’s largest pharmacy benefit manager (PBM), is looking for savings from new treatments for cancer and high cholesterol.

Now that Express Scripts and CVS Health, the nation’s second largest PBM, have negotiated discounts for new hepatitis C drugs, Express Scripts’ CEO said that new cholesterol and cancer drugs may be its next focus for negotiating discounts.

In December, Express Scripts announced that it would stop covering Gilead Sciences’ hepatitis C treatment Harvoni. The PBM struck a deal making AbbVie’s newly-approved Viekira Pak the exclusive option for its members with genotype 1 hepatitis C, in exchange for a discounted price. According to the company’s Chief Executive Officer George Paz, Express Scripts’ next cost-cutting targets include expensive new treatments for cancer and high cholesterol.

At the J.P. Morgan Healthcare Conference, Paz noted that the new cholesterol-lowering drugs, known as PCSK9 inhibitors, which significantly reduce bad cholesterol to low levels but are expensive, is an area of opportunity for cost savings. Like the new hepatitis C drugs, the PCSK9 medications are likely to enter the market around the same time, with Amgen and Regeneron in the lead and Pfizer not far behind. With high competition between these companies, PBMs will be in a position to impose pricing pressure to reduce costs.

However, Paz said that the big opportunity for cutting treatment costs is in cancer. He said that cost savings on cancer treatments could be achieved if the PBM were involved earlier in the decision making process. Currently, physicians run a patient’s cancer treatment regimen through a major medical benefits instead of through the PBM. However, according to Paz, if they did go through the PBM first, Express Scripts would get its doctors and pharmacists involved to ensure the prescribed regimens are appropriate. Although the physician makes the final decision, the PBM would advise on the most cost-effective, best regimen for the individual.

“The big opportunity out there is really in cancer,” said Paz. “If we can get out in front of that, that is a huge opportunity.”

Source: Specialty Pharma Journal

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