Pricing blame game continues: OptumRx CEO says pharma's using hikes to fuel profits

Mark Thierer, CEO of UnitedHealth pharmacy benefit manager OptumRx

Ever since Mylan placed some blame with PBMs in its EpiPen pricing defense, companies on both sides of the argument have been working hard to get ahead of a storm of public outrage. Now, a leading PBM’s CEO is the latest to come out against the notion that companies like his are responsible for high drug prices.

In an interview with Modern Healthcare, Mark Thierer, CEO of UnitedHealth pharmacy benefit manager OptumRx, said pharma companies have been using price hikes to drive shareholder value. “In particular, it's the high-cost biotech drugs,” he told the publication.

Thierer said PBMs don’t set the price of meds. They negotiate with drugmakers “to try to talk sense to them,” he said, and ultimately serve as a force to hold costs down. OptumRx competitors Express Scripts and CVS Health have taken the same line.

The CEO's comments come weeks after an association of 22,000 independent pharmacies urged the House Committee on Oversight and Government Reform to investigate PBMs. One committee member, a pharmacist, joined in critiquing PBMs' role in the pharma supply chain and calling for more accountability.

OptumRx is “taking a stand” with the pharma industry in the face of price hikes, Thierer said in the new interview. His company acts “as a guardian” so clients don’t see the full impact of a drug price increase, he said.

That may be, but as PBM critics point out, rebates to payers have more than doubled in the last four years to between $100 million and $130 million, according to an estimate by ZS Associates. Throughout Mylan’s EpiPen defense, the pharma said that PBM rebates are responsible for nearly half of its epinephrine injector’s $600 list price.

The issue and discussion will likely unfold further, as PBMs now face calls for investigation from the National Community Pharmacists Association, which cited secret rebate deals and consolidation in the PBM field in its letter to Oversight. Three of the companies control 78% of the market. In a column in The Hill, the only pharmacist in Congress, Rep. Buddy Carter, called the companies “the man behind the curtain” in drug pricing.

Mylan CEO Heather Bresch and others in the pharma industry have blamed PBMs for “incentivizing” price increases. In order to see a net gain, companies have to push through large list price increases, while they say sizable rebates are funneled back to PBM companies.

All of the discussion and blame-throwing is part of a yearlong drug pricing firestorm, sparked by now-notorious prices hikes from Turing Pharmaceuticals and Valeant Pharmaceuticals.

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