Medical Director Profiles

Steve Miller, Express Scripts

Flexing That PBM Muscle: A Billion Reasons Why It Is a Good Thing

Howard Wolinsky

What does Steve Miller, MD, like most about his job as the chief medical officer at St. Louis-based Express Scripts, the largest pharmacy benefit management organization in the United States?

It’s the variety, said Miller, 59, a kidney transplant specialist and drug researcher, who was lured away from Washington University in St. Louis to become the company’s first CMO in 2005.

“I have what I consider the best job in the organization, and the reason is my role transcends every other department,” says Miller. “So within my department, we have all the clinical people that help design the clinical programs and make sure that they’re clinically sound. And I have the government affairs organization that helps with our initiatives in all the states and the federal level.”

Miller, who reports directly to the CEO, said every day is different. “Some days I’m out supporting our sales people and trying to acquire new business. Some days I’m with our legal teams trying to help them decipher new regulations. Some days I am with our supply team group negotiating with the pharmaceutical companies. Having a science background, really understanding drug development, has been very helpful for that.”

Miller went directly from high school to medical school at the University of Missouri in Kansas City; he still sees a few patients on occasion. But as CMO at Express Scripts, Miller, who has an MBA from Washington University and also taught there, said he influences the health of 85 million patients served by his company.

Miller felt the power of the position first in 2005 when, in a controversial move, he removed Lipitor, then the No. 1 brand-name drug, from the Express Scripts formulary and replaced it with less-costly generics. ”People thought that was crazy. We were going up against the single biggest drug in history, made by the most powerful pharmaceutical company, and we had 10% of our membership taking Lipitor at the time,” he says.

That one move saved Express Scripts and its clients $1 billion in the first year, says Miller. “It was the early success and the true proof of the concept that you could substantially change health care,” Miller said.

“Think about this. If I had stayed at the university, I would continue to help make a better university, improve the quality of care there, and save money…[but] how many people ever get to take part in a project that saves a billion dollars in health care?”

He said he has produced savings several times, including triggering a price war over high priced hepatitis C drugs that resulted in a 50% price reduction.

“It was another example of our being able to save over a billion dollars for Express Scripts clients and patients,” says Miller, who brims with self-confidence. “But it actually saved the country about $4 billion because everyone benefited from the price war we created.”

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