The New York Times on Saturday examined how pharmacy benefit managers in recent years "have built lucrative side businesses ... acting as exclusive or semi-exclusive distributors of expensive specialty drugs."
According to the Times, the practice is "seemingly at odds" with their stated intention of helping employers manage prescription drug plans and get drugs at the best prices available.
The prices of specialty drugs -- which treat diseases such as cancer, multiple sclerosis and hepatitis C, and can be regulated as federally controlled substances -- range from about $5,000 annually to about $389,000 annually, and have been rising "much faster" than prices for mainstream drugs, the Times reports. Many large employers say their spending on specialty drugs is growing at more than twice the rate of the rest of their employee drug benefits.
Gerry Purcell, a health benefits consultant serving large employers, said, "We are headed right down into conflict alley with these exclusive arrangements," because PBMs "can raise the prices at will," and "employers will have little chance but to pay the bill." PBMs say providing employers with the best drug prices is still their top priority and have defended their involvement in the pricing of specialty drugs as necessary to keep track of the medications' use (Freudenheim [1], New York Times, 4/19).
Effect on Medicare