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    Anthem, Express Scripts battle over drug prices

    Anthem filing suit against Express Scripts over prescription drug pricing puts another spotlight on the complexity behind high drug costs, according to industry watchers.

    The health plan is suing Express Scripts, its vendor for pharmacy benefit management services (PBM), to recover damages for pricing that is higher than competitive benchmark pricing, according to an Anthem press release.

    Anthem alleges that Express Scripts has been overcharging by $3 billion annually based on an audit conducted by a third-party consultant. Anthem says this is because Express Scripts is not sharing the savings from the rebates that it negotiates with pharmaceutical manufacturers.

    Express Scripts spokesperson Jennifer Luddy, tells Managed Healthcare Executive, that the PBM believes Anthem’s lawsuit is without merit.

    “Express Scripts values its relationship with Anthem and will continue to honor its commitments under the contract, as we would do with any client,” Luddy says. “Express Scripts has consistently acted in good faith and in accordance with the terms of its agreement with Anthem.”

    BrillBrill

    The lawsuit will likely lead to increased scrutiny on the contracts/rebates the PBM negotiate and passes back to its clients, according to Managed Healthcare Executive Editorial Advisor Joel Brill, MD, chief medical officer, Predictive Health LLC, an integrated medical management company.

    “Are the savings [from the rebates Express Scripts negotiates with pharmaceutical manufacturers] going to profit the PBM or returned in terms of lower overall premiums for patients whether in plans, exchanges, etc.?” Brill asks. “Are formulary decisions being made on clinical or cost grounds; are we still looking at pharmacy as a silo or part of the overall care—provider, facility, device, lab, etc.? Have PBMs inadvertently facilitated higher drug costs, if they keep the rebates/discounts or market share incentives?”

    Next: The role healthcare executives play

     

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