- In the latest tussle between pharma and pharmacy benefit managers, a CVS Health Corp. report finds almost flat drug pricing growth for its pharmacy benefit management clients at 0.2%, against manufacturer price growth of 8.3% for specialty brands and 9.2% for "traditional" brands.
- The retail chain giant's PBM also reported a low drug utilization growth. Overall, these rates have meant the lowest drug trend rate for commercial clients in five years, at 1.9%, with 42% spending less than in 2017.
- The CVS Health report noted a modest monthly decline in patient cost at an average of 10 cents. It noted three out of four pay out less than $100 in out-of-pocket prescription drug costs, and almost nine out of 10 spend less than $300. Adherence rates are also at a seven-year high.
The study and a similar one from Express Scripts Holding Co. earlier this year highlight the ongoing battle between pharmacy benefit managers and pharmaceutical manufacturers. The pharma companies justify high costs, particularly of specialty drugs, as being necessary to offset their R&D investments. Drugmakers also cast blame on PBMs for lack of transparency and not passing on rebate savings to patients.
PBMs point to high list prices as the driving factor.
"The health care landscape continues to evolve, but the cost of drugs remains a top concern for our clients and their members, who turn to us to ensure they are getting the most out of their pharmacy benefit plan," said Jon Roberts, executive vice president and chief operating officer, CVS Health in a statement.
According to the report, over 2017, CVS Health has "leveraged market competition, maximized use of low-cost generics, and effectively negotiated discounts and rebates." Its generics prescribing rate is now up to 86.1%. However, its branded drugs that keep the costs high – the PBM reports that brands are only 14% of prescriptions, but 69% of the drug spend.
One of the dramatic differences highlighted in the report is the impact of specialty drugs, which are increasing in use and number, and are often the biggest-ticket items in the drug budget.
The average wholesale price rose by 8.3% for specialty drugs in 2017, but CVS Health managed to keep that drug cost growth down to 3.7% for payers. This was achieved in part from indication- and outcomes-based contracting, and cost-cap based rebate approaches. Other strategies included managing patient adherence, symptoms and co-morbidities.
Late last year, a PhRMA report accused PBMs of not passing the discounts and rebates paid by biopharma on to the patients.