Tough-and-vocal PBM executive Steve Miller says pharma may be coming around on pricing

A top official with Express Scripts said his company is seeing more cooperation from the drug industry.

While drugmakers and pharma middlemen have clashed lately, a top official at pharmacy benefits manager Express Scripts said he's noticed a new willingness by pharma to compromise on pricing.

A swell of public and political attention to drug pricing has pitted some industry players against one another, but Express Scripts Chief Medical Officer Steve Miller said he believes pharma is “taking responsibility” and “trying to work together with us to address” costs.

Take, for instance, recent pricing announcements on three drugs: Sanofi and Regeneron’s atopic dermatitis med Dupixent; Radius’ osteoporosis entrant Tymlos; and Genentech’s multiple sclerosis drug Ocrevus.

Miller said they’re all examples of drugmakers pricing new therapies lower than the market expected—and a “recognition by certain pharmaceutical manufacturers that they are in control of their price and can do something” about growing costs. Those decisions have a “beneficial effect” on patient outcomes and on healthcare costs, he added.

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Soon after the Dupixent approval and pricing announcement, Leerink Partners analyst Geoffrey Porges wrote that payer reception was “largely positive,” suggesting “that patients may not be subject to the exhaustive prior authorization and step edit requirements that have delayed and limited access to innovative medicines in recent years.”

If that prediction pans out—which remains to be seen, given recent dispensing rates, Bernstein analyst Ronny Gal said last week—it would be a change from the recent high-profile drug launches that have been hobbled due to payer attempts at putting a lid on growing costs. Novartis’ heart failure drug Entresto and PCSK9 cholesterol drugs from Sanofi, Regeneron and Amgen have each taken off more slowly than expected due to such restrictions.

On Ocrevus pricing, a Roche spokesperson told FiercePharma back in March that MS drug prices have grown by 400% over 12 years. The company’s decision to price its drug at a discount to competitors was in part to help “reverse this trend,” he said.

Aside from those specific pricing examples, Miller pointed out that many top drugmakers have pledged to limit their price increases to single digits as attention to the industry has mounted, threatening new regulations on the industry from the U.S. and state governments.

RELATED: Can Radius fight off big guns Lilly, Amgen with new bone drug Tymlos? One analyst says no

For two years, pharma’s pricing has been under the spotlight thanks to multiple controversies, including last year's intense focus on Mylan’s epinephrine injector EpiPen. In response to the scrutiny, Mylan CEO Heather Bresch said rebates to industry middlemen have been on the rise, forcing the drugmaker to increase its prices more to keep up.

Representatives for other drugmakers such as Gilead have also criticized PBMs for their rebate strategies. Novo Nordisk's former U.S. chief linked its insulin price increases to repeated increases in rebates that ate away at net price hikes.

PBMs have hit back by reiterating that drugmakers always set their prices and by arguing that tough negotiations drive healthcare savings.