Express Scripts' Miller lays out manifesto to fight sky-high drug prices

Express Scripts CMO Steve Miller

It's no secret that Express Scripts ($ESRX) Chief Medical Officer Steve Miller is hankering for some changes in the pharma business. He's been an outspoken critic of sky-high drug prices ever since Gilead's ($GILD) $84,000-per-treatment-course hep C med Sovaldi won FDA approval late last year, and last month he touched off a pricing war by forming a pact with competitor AbbVie ($ABBV) to exclude the California company's treatments.

But what many may not know, he told PharmExec, is that he's got a four-point solution to fix what he sees as the industry's biggest problems.

The way Miller sees it, many of today's astronomical price tags are linked to a lack of scientific innovation. Take Sovaldi, for example: Gilead picked up the rights to the future blockbuster from Pharmasset when the drug was already in Phase III, shelling out $11 billion and hiking the price Pharmasset had settled on--$36,000--by nearly $50,000, he points out. Both Big Pharma and smaller biotechs have been jacking up the price on existing products, too, a move he calls a "telling sign of failure."

"The industry is still innovating--but on a financial model of drug development that has little to do with science," he said. And the way he sees it, it's not sustainable.

So what can the U.S.--an "outlier country" when it comes to factoring cost into the value of pharma products--do to fix it?

First of all, its companies need to "exercise good judgment in adhering to society's social contract around pharmaceuticals," he says. That means setting up contracts with all stakeholders before a product is approved--and that includes payers' insights into "what we think is tolerable in the commercial space." It also means keeping aware of a drug's intended patient pool--in other words, no orphan drug pricing for nonorphan drugs.

Companies should also help secure a final U.S. biosimilars pathway, which will save payers billions and give them "more leeway" to fund the next-gen hep C therapies and pricy forthcoming PCSK9 inhibitors for cardio conditions. And enough with the "evergreening," Miller says--tweaking products to secure additional patent protection doesn't add value for patients or providers.

And finally, they should ramp up their efforts to force all developed international markets to "pay their fair share" of new drug innovation. "When the poorest person in America is asked to pay $84,000 for a course of treatment on Sovaldi while a rich stockbroker in London's financial district pays only $57,000 through the NHS--that's just not fair," he says.

The onus isn't all on drug companies, either. "All actors need to step up to the plate," Miller says, and that includes government and payers themselves. As far as Miller's concerned, he's already started, launching an exclusive pact with AbbVie that both secured Express Scripts a sizable discount on its Viekira Pak and coerced Gilead into doing the same with rival CVS.

"There would be no discounts if we hadn't done what we did," he told the Financial Times on Monday. "We found a partner in AbbVie that changed the whole dynamic. Today's decision from CVS is a natural extension of the good work that we've done."

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