No longer mere middlemen, these major players’ ability to influence pharmaceutical prices keeps growing along with the number of covered lives they represent. That doesn’t necessarily translate into savings for health insurers, but it sure can. Some plans want PBMs to create pre-certification requirements for specialty drugs.
Over the past 18 months, formulary exclusion has gone from being a targeted tactic to a commonly used PBM weapon. The drugs kept out are often nonpreferred agents with low utilization, but for the first time a couple of specialty drugs are also on the outs.
In a wide-ranging Q&A, Steve Miller, MD, the CMO at Express Scripts, explains why he took the controversial stand again Gilead’s Sovaldi, and how he plans to further gain a handle on drug prices. For instance, “I’ve been advocating for biosimilars very aggressively over the last eight years.”