Adam J. Fein, the drug price and supply chain expert consultant, said this morning that his review of 2018 reports by four large PBMs shows that drug spending by those PBMs grew by 2% last year.
"Once again we find that drug spending is not skyrocketing--contrary to what you often hear from journalists and politicians," Fein wrote in his Drug Channels report.
In this report and others, Fein emphasizes the net price paid after rebates rather than list prices.
In previous Drug Channels reports, Fein has written about the "gross-to-net bubble"--the "ever-growing pile of money that sits between a manufacturer's list price for a drug and the net price after rebates and other reductions."
Fein pointed out this morning that "what's missing from the PBM reports is a transparent accounting of how much patients pay out of pocket for highly rebated drugs that are sold to insurers and PBMs at deep discounts."
Fein's summary this morning is based on the 2018 reports by CVS Health, Express Scripts, MedImpact, and Prime Therapeutics. He has included links to the PBM drug trend reports in his post. It is an incomplete picture because, as Fein notes, OptumRx and Humana don't publish these kind of detailed drug trend reports. Fein elected not to include the report from Anthem's IngenioRX in his analysis. He described it as "skimpy."