On the Side, Express Scripts Eyes Distributing High-Priced Specialty Drugs


Express Scripts Holding Co. built a multi-billion enterprise pressuring drug companies to lower their prices for U.S. patients. Now it is quietly building a side business: getting paid to help drug companies dispense a new generation of high-priced drugs.

Express Scripts is in talks with biotechnology companies Biomarin Pharmaceutical Inc., Spark Therapeutics Inc. and Bluebird Bio Inc. to have its specialty pharmaceutical business exclusively distribute their new gene therapies when they are expected to become available in 2019 and 2020, Chief Medical Officer Steve Miller told Reuters in an interview.
he confirmed to Reuters that modeller pricing for future treatments – a group often identified as drug benefit managers, health plans, and government agencies – BIOMARIN, Spark and Bluebird are taxpayers. Analysts say these drugs can grow from $ 1 million to $ 1.5 million.

In contrast to the anticipated high prices of medicines, Miller is affecting about 20,000 people in the United States, only about $ 20 billion in the United States because of the high cost of potentially curative therapies, possibly because of the high cost of hundreds of thousands of dollars in annual medical costs to treat discomforts like hemophilia.

Miller said, “Even if he asks for $ 1 million, that’s a big deal.” “So there will be some gene therapies that are so obvious that everyone with that disease should take it.”

Miller says he can work closely with biotechnology companies to help make expensive treatments commercially successful. To manage potential conflicts of interest, Express Scripts said it managed to separate benefit management and private pharmacy businesses.

Moving into hemophilia already has exclusive rights to distribute Spark’s Luxturna built on Express Scripts – if untreated, a $ 850,000 treatment for a rare genetic disorder that causes children to go blind. He told Reuters that he had a similar deal with Biogen Inc. in Spinraza. The medication costs $ 750,000 in the first year and rarely treats spinal musculoskeletal atrophy, which often kills infants within months of their birth. Spark and Biogen agreed on the deal.

– need to stay in a long hospital personalized treatment $ 475,000 Novartis AG, gene-based cancer treatment Kymriah: The company also helps you manage one of the most expensive gene-based cancer treatments on the market. Novartis confirmed the arrangement to Reuters.
These agreements have played a very different role in managing Express Scripts than drug claims sold to traditional commercial prescription employees for corporate and government customers. Cigna Cor.p found it worthwhile to buy 52 billion dollar Express Scripts in March.

Patients usually know Express Scripts and other pharmacy helpers (PBMs) as the name on the insurance card at the pharmacy counter when collecting prescriptions. This card puts the benefits managers are negotiating with pharmaceutical companies, usually through discounts, to lower prices. The PBMs make money by making money, and the rest go to the customers.

Express Scripts, which makes prescription payments to 80 million people in the United States, UnitedHealth Group Inc’.s Optum and CVS Health Corp. compete with.

These companies are often among the most vocal critics of the pricing practices of the pharmaceutical industry, and publicly disclose companies and their special products for high costs.

However, the pharmacy is exposed to growing criticism that US regulators, lawmakers, drug producers, and President Trump act as unnecessary intermediaries and are helping to raise prices for payers.

Billionaire activist investor Carl Icahn has launched a mandate campaign to stop negotiating on the anticipations that the Trump Administration will use to pay back the profits. However, the two shareholder advisory groups abandoned their efforts after they emerged in favor of the deal.

Since the PBM fight is open to the public, Express Scripts is expanding its low-profile private pharmacy business – which usually distributes drugs that are not sold by pharmacy because it requires special treatment. Express Scripts, using their own pharmacy instead of the outside, are able to make more profit through the drug distribution chain.

Ross Muken, an ISC’s Evercore analyst, said the private pharmacy is one of Express Script’s fastest-growing businesses and accounts for about a third of sales and profits. The company earned $ 4.1 billion last year, a total of more than $ 100 billion – not breaking financial information for private pharmacies.

Most of the newest and most advanced drugs, including gene-based therapies and personalized cancer treatments, will be distributed through private pharmacies, and Express Scripts trains biotechnology companies for specific regula- tions.

Sectoral sources and experts are open to questions about conflicting, industry resources and experts, working as a partner for the manufacturer paying for each sale, and a pharmacy aid manager responsible for negotiating the best price for traditional corporate and government clients.

“They could see this role as a great catalyst: helping to balance the views and interests of all these parties with this moderate facilitation role. Or can they see that they create a situation in which they have multiple conflicts of interest and manage them properly? “Says. The Mark Trusheim gene therapy pricing models of a group of international payers and providers formed by the Massachusetts Institute of Technology.

Express Scripts says it is making money for those paying for Luxturna, cutting the hospital pharmacy mark by 6 percent for the hospital Medicare program, more for commercial business – or at least $ 60,000 for a $ 1 million drug.

Miller said that the company’s private pharmacy business is a security wall that serves drug makers and employers paying on behalf of customers.

“Our PBM pharmacy acts as our private pharmacy as another pharmacy treatment on our network,” he said. “Therefore, it is not specific to procurement prices or anything else, and the private pharmacy is not exclusive to contracts PBM makes with paying customers or anything else.”

Beyond fears of potential conflict, there is a risk that gene therapies can not do this to the public.

The spark on August 7 said in a small experiment that two patients were experiencing a negative immune response to experimental hemophilia gene therapy and that their feelings lost more than a quarter of their value. And last month US regulators put Biogen’s gene therapy program on hold for spinal musculoskeletal atrophy, but no details were disclosed.

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