Call it a truce. As pharmacy benefit managers and drugmakers continue to clash over their respective roles in controversial drug-price hikes, eight top pharmas and leading PBM Express Scripts have teamed up to offer cheaper meds to patients forced to pay cash for their prescriptions.
Through a collaboration that comprises drug companies, Express Scripts, 40,000 pharmacies and tech partner GoodRx, the program is designed to make drugs affordable for patients with high-deductible insurance plans, or no insurance at all.
The effort could help quell public outcry over drug pricing by limiting the hit to patients' pocketbooks. For instance, Mylan's EpiPen pricing scandal hit after parents buying back-to-school EpiPens faced big increases in their out-of-pocket costs—and those parents took to social media to air their grievances.
So far, the Inside Rx program has attracted a who's who among drugmakers, mostly weighted toward those headquartered outside the U.S. Indianapolis-based Eli Lilly & Co. is so far the only U.S drugmaker, with Lundbeck, Novo Nordisk, Sanofi, AstraZeneca, Takeda Pharmaceuticals and Teva Pharmaceutical Industries rounding out the current group. Speaking with CBS This Morning, Express Scripts CEO Tim Wentworth said other drugmakers have already expressed interest in joining.
How does it work? Patients go online to get an Inside Rx “savings card” that allows them to apply Express Scripts’ bulk purchasing power to the 40 branded drugs included. Then patients can search by medicine and pharmacy to find the best local price.
“They are essentially going to pay at the pharmacy counter, for the 40 drugs in this program, what large insurance companies typically pay,” Wentworth said during the segment, rather than list prices, which can be considerably higher.
Inside Rx includes brand-name drugs to treat asthma, allergies, acid reflux, chronic obstructive pulmonary disease, cardiovascular conditions, and diabetes. Patients on government healthcare and those in Tennessee aren’t eligible to participate.
“The biggest driver of healthcare costs is when people don’t take medications,” Eli Lilly CEO David Ricks said during the CBS interview, adding that patients often “walk away” from the pharmacy counter when they learn their prices.
“This initiative … is one way people with high-deductible plans or who pay cash can get a price similar to what big insurance companies get. We jumped on board and said ‘that’s a good idea.’”
Thirty million Americans are paying full costs for their drugs, Wentworth added; his company believes Inside Rx will bring billions of dollars of savings to those patients.
Facing scrutiny over their role in high drug prices, PBMs such as Express Scripts have been active lately working to reduce drug spending by getting aggressive with formulary negotiations. Speaking last week at the PBM Policy Forum in Washington, D.C., an exec with the PBM giant said Express Scripts is anxiously waiting to apply competitive pressure against GSK’s respiratory behemoth Advair.
Clients are “clamoring for savings” on the London pharma’s top-seller, she said. Glaxo has said it has cut Advair's price considerably amid pressure in the respiratory market.
Notably, Teva’s new AirDuo RespiClick, an indirect competitor to Glaxo’s Advair is “coming soon” to the new program, according to its list of included meds.
Lately, relations between pharma and PBMs have been contentious amid a push in Washington to lower drug costs, with both industries looking to defend themselves as the scrutiny continues. In one recent example of the animosity, execs for Express Scripts and Gilead got into a dispute over which company is responsible for high drug costs. Gilead’s executive, Jim Meyers, said that PBMs benefit from higher drug prices tied to rebates, while Express Scripts countered that drug companies are always the ones who set prices.