Listen up, Valeant. Express Scripts is watching you.Express Scripts CMO Steve Miller
The leading pharmacy benefits manager is poring over "every single claim for their products," Chief Medical Officer Steve Miller told Bloomberg, noting that the company is "getting extra scrutiny."
The PBM has made it very clear within the last few months that it has its eye on Valeant ($VRX)--and that it isn't too pleased with some of its tactics. Back in October, Express Scripts ($ESRX) made moves to terminate a Valeant-linked specialty pharmacy--the now-deceased Philidor--from its network after reports tied it to shady business dealings. Philidor had allegedly instructed employees to change prescription codes to secure Valeant's costly branded drugs over cheaper generics.
Valeant, for its part, has been working to rehab its image in the wake of the Philidor allegations and political pushback over its recent price hikes. Interim CEO Howard Schiller has said Valeant intends to nix most of its planned price increases this year, and the Quebec-based drugmaker recently launched a program with Walgreens to offer some of its products at generic-matching prices. The company hopes its Walgreens ($WBA) deal will replace some of the business lost when it dumped Philidor.
But Express Scripts doesn't much like the Walgreens deal, either--a point it made clear last month when it announced plans to freeze out Valeant's diabetes drug Glumetza.
"By excluding Glumetza from these formularies, Express Scripts clients are ensuring that their patients be dispensed the more affordable generic formulation of metformin," it said at the time, noting that "branded Glumetza will not be allowed to process" under any circumstances.
But it's not just Valeant that's been drawing the PBM's attention. Express Scripts, a champion of the generic meds that tamp down its own costs, has been taking aim at captive pharmacies around the industry. In November, the PBM cut off one specialty pharmacy that worked closely with Ireland's Horizon Pharma ($HZNP).
In the formulary exclusions department, Express Scripts has been making headlines the past few years as it kicks new and high-profile meds to the curb. In August, its list of excluded meds reached 80, with victims including AstraZeneca ($AZN) diabetes med Onglyza, Johnson & Johnson's ($JNJ) hep C treatment Olysio and Vivus' ($VVUS) weight-loss therapy Qsymia.
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