There is only one drug available to save your child’s life and only one seller. What price would you be willing to pay for it?
PBMs like ExpressScripts actually interviewed pediatric neurologists to determine how much they money they could get by with charging for a specialty drug for which they have exclusive distribution rights. Where’s the Federal Trade Commission? Or an even better question: What ethical compass guides the guys at ExpressScripts?
As reported by the New York Times, ExpressScripts arbitrarily raised the price of a vial of H.P. Acthar Gel, a drug used to treat a rare, severe form of epilepsy from $1,600 a vial to an astonishing $23,000!
The drug in question is part of a category called “specialty drugs,” medicines needed by relatively few people but are critical to the health of those people. So who picks up the tab for this extraordinary cost? Employers and patients, of course.
A PBM is supposed to negotiate with manufacturers to obtain drugs as discounted prices on behalf of employer-sponsored health plans. But when PBMs begin acting as exclusive drug distributors for lifesaving drugs, it’s an obvious conflict of interest. Along with rebates they get from manufacturers, this is just another way PBMs control access to medications, not because it’s actually best for patients, but because it is best for the PBM’s bottom line.
While these profit-mongers claim to keep healthcare costs down for their customers, exclusive drug distribution deals pose an obvious conflict of interest. Since specialty drugs have no generic equivalent and an ever-increasing chunk of PBM revenues comes from the monopolization of specialty drugs, it is hard for these companies to argue that they are looking out for the people they are supposed to serve.
