Analysis: Pharmacy middlemen are under scrutiny for pushing up drug prices
Drug executives prepare to testify before the Senate Finance Committee hearing on drug prices in February. The middlemen who negotiate the prices paid by consumers at the pharmacy counter — known as pharmacy benefit managers — face their own
Expect an opposite narrative tomorrow, when executives for the country’s top three PBMs — CVS Health, UnitedHealth’s OptumRx and Cigna’s Express Scripts — will sit before the Finance Committee for its latest hearing on the high cost of prescription drugs. Executives for Humana’s in-house PBM and Prime Therapeutics, which is owned by several Blue Cross plans, will also be present at the Tuesday hearing.While they obtain rebates from drugmakers to ultimately lower drug spending – a worthy goal – there’s incentive for them to favor the most expensive drugs when creating the list of drugs covered by an insurance plan. That’s because they’re allowed to keep a share of the rebate, which is based on a drug’s list price.
Some PBMs have been taking steps lately to remake their public image, which has taken a beating in the past year as they’ve been blasted by Azar and President Trump. OptumRx announced it will pass along rebate savings to all new employer-sponsored plans, starting in January. Express Scripts, recently acquired by Cigna,
Yet Senate Majority Leader Mitch McConnell ha said there would be no vote in the Senate on a Republican health-care plan ahead of the 2020 election. Mulvaney acknowledged McConnell's stance. But the approach also risks alienating moderate suburban voters, including those who took a chance on Trump’s candidacy in hopes that his dealmaker persona would overcome Washington gridlock.”
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