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PBMs one-up drug makers on drug copay assistance schemes

  • Reuters reports that U.S. drug prices fell 5.6% in Q1, 3.6% more than a year ago. Sector & Sovereign analyst Richard Evans believes most of the decline is from "copay accumulator" programs instituted by pharmacy benefit managers (PBMs) last quarter that do not allow copay assistance payments to contribute toward a patient's deductible before insurance kicks in. He says ~17% of health plans with at least 5K employees use copay accumulators.
  • The approach forces drugmakers to keep paying out-of-pocket costs for patients or risk reduced demand because of the added expense to consumers. Mr. Evans says makers of costly meds will feel the most pain, including Eli Lilly (LLY +0.4%), Biogen (BIIB +0.7%), Gilead Sciences (GILD +0.9%) and AbbVie (ABBV -0.1%).
  • AbbVie chief Rick Gonzalez has admitted that the programs are crimping revenue but says the impact has been immaterial to earnings. In April, Biogen chief Mike Vounatsos said the programs had no impact on Q1 sales.
  • Express Scripts Chief Medical Officer Steve Miller says, “It’s a constant cat and mouse game. Pharma companies want anything they can get out there that allows them to raise the price of the drug ... Our job is to protect the integrity of the plan.”
  • Pharma firms remain undeterred in their efforts to drive up prices, however. AbbVie and Amgen (AMGN +0.7%), for example, have recently begun giving patients prepaid debit cards that cannot be tracked by PBMs in order to sidestep the copay accumulator programs.
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