As Express Scripts’ chief medical officer, Dr. Steve Miller plays a key role in the pharmaceutical scene. He’s working to combat high drug prices, helping consumers get the drugs they need, and looking for ways to address the opioid crisis. Before joining Express Scripts, in 2005, he served as vice president and chief medical officer at Barnes-Jewish Hospital.
Why are prescription drug costs rising so quickly? You have new products coming to the marketplace. You have the prices of those products being incredibly high. You have branded products, versus generics, that are seeing enormous price increases. You have insurance companies shifting more costs to patients. And you have these high-deductible plans that subject patients to enormous initial out-of-pocket costs.
What is Express Scripts doing to address those issues? We aggregate a large number of patients and negotiate on their behalf. Instead of drug prices going up 208 percent, our patients in 2016 experienced a 3.8 percent increase in drug spending… Express Scripts has been one of the most vocal critics of pharmaceutical pricing. For the first time, we are directly negotiating with pharmaceutical companies to bring out their drugs at lower prices than anticipated.
“You have insurance companies shifting more costs to patients.”
Express Scripts has not been free of criticism for its role in drug pricing, though. If you think about who launches the criticism, it comes from two important constituencies: the drug manufacturers, because we are negotiating their prices down, and retail pharmacies, because we negotiate against them to get lower prices. You do not see our clients criticizing us.
What advice would you give someone on a limited budget? Work with your care provider to make sure that you need to be on all of those medications. Also, be sure that you are using generics when appropriate. Where you get prescriptions filled can also make a big difference in the cost—if you have the ability for mail order or know which retailer is in your plan’s network, then you can often get big discounts. Finally, changing your behavior so that you need fewer drugs is crucial.
Does it trouble you that Missouri is the only state without a prescription drug monitoring program? We are big advocates for drug monitoring programs, but we also believe there are other solutions. Some states have required the electronic prescribing of controlled substances. We’ve also developed models that can predict who is going to become addicted to a drug before they get their first prescription of an opioid; with this knowledge, doctors can be much more vigilant and get them to use alternatives.
