By: Lynn R. Webster
Across the board, drug prices are soaring. Even the cost of cancer medications are so high that some patients are delaying cancer treatments or skipping them altogether. But who is most responsible for higher drug prices: pharmaceutical companies or pharmacy benefit managers (PBMs)? That depends on whom you believe.
According to Bloomberg, “PBMs deny raising costs and say pharmaceutical companies seek to mask their own profiteering. ‘Drugmakers set prices, and we exist to bring those prices down,’ Tim Wentworth, Express Scripts’ chief executive officer, said on a Feb. 15 earnings call. Larry Merlo, head of CVS (which, itself, is a PBM), sounded a similar refrain six days earlier, ‘Any suggestion that PBMs are causing prices to rise is simply erroneous.’ ”
However, drug companies are blaming PBMs for skyrocketing prices, and so is at least one health insurer. In a recent case, Anthem Inc. sued Express Scripts Holding Co. for about 15 billion dollars. The lawsuit blames Express Scripts for the high pricing of drugs. Anthem alleges it’s “overpaying for pharmaceuticals and not benefiting from rebates the pharmacy benefit manager has negotiated with drugmakers.”