- Comments from Gilead Sciences’ head of worldwide commercial operations last week to Bloomberg have reignited a furious debate within the industry over who is to blame for rising drug costs.
- Gilead’s Jim Meyers told the publication that pharmacy benefit managers (PBMs) are to blame for keeping drug prices high.
- But PBM Express Scripts fired back this week with a letter to Gilead CEO John Milligan urging the company to cut the cost of its hepatitis C drugs and even pay back the difference retroactively.
Despite Gilead being the first to bring a cure for hepatitis C to the market, the big biotech set off the drug pricing firestorm several years ago when it introduced Sovaldi (sofosbuvir) to the market for a price of $1,000 a pill, or $89,000 for a course of treatment.
The industry has since claimed that innovation is worth the high price tag and has started pointing the finger at PBMs, a kind of healthcare middlemen, which negotiate drug prices with companies for health plans and employers — often in undisclosed contracts.
Meyers' comments insinuated PBMs keep drug prices high in order to inflate their own revenues through the cut they take from rebates and discounts given by manufacturers.
Express Scripts, one of the largest PBMs, has taken particular offense to these accusations.
"I’m sure we all agree that Gilead sets the price of its drugs, unilaterally introduced Sovaldi at $1,000 per pill per day, and only reduced the price of Sovaldi and Harvoni for employers and health plans once Express Scripts preferred another curative therapy. In none of those scenarios does Express Scripts keep the price high. You do. In fact, our job is to get the price lower, which we did, as we’re sure you are also aware," wrote Everett Neville, SVP of supply chain and specialty at Express Scripts.
Neville went on to say that Express Scripts even welcomes Gilead lowering its price without changes to their contract — an argument Myers' used as a reason why Gilead wouldn't be able to unilaterally lower prices.
In the letter, the PBM requested Gilead lower the price of each of its drugs in the hepatitis C franchise to $50,000 per course of treatment.
"Repay all costs, above $50,000 per course of treatment that our clients, and federal and state governments, have incurred since the launch of Sovaldi. If you’re saying that the drug really is worth about $50,000, then it’s only right to make sure payers are made whole for overpaying," wrote Neville.
The request from Express Scripts was a bold one and unlikely to materialize in Gilead paying back its profits. Yet, the public back-and-forth adds another dynamic to who may be to blame for high drug prices — particularly as President Trump continues to promise he will bring down drug prices.