Cancer Treatments the Next Big Area for Cost Saving Opportunities

Involving the pharmacy benefits manager (PBM) earlier in the decision-making process could lead to cost savings on cancer treatments, Express Scripts Chief Executive Officer George Paz said at the J.P. Morgan Healthcare Conference held in San Francisco, California, January 12-15, 2015.

Recently, Express Scripts aggressively negotiated discounts by making AbbVie’s new hepatitis C drug, Viekira Pak, the exclusive option for genotype 1 hepatitis C instead of Gilead Science’s Harvoni.

“When the AbbVie drug came to market, we spent a lot of time with AbbVie helping them position their drug, talking to them about price points, and how to make sure they could maximize their position on the formularies to get the best discounts possible for our patients and market share for them and profits, which they need as well,” Mr Paz explained.

Now he’s looking to the future for where the next opportunities for cost savings will appear. In particular he noted that new cholesterol-lowering drugs, which are very powerful at reducing bad cholesterol to low levels, but are also very expensive.

However, the big opportunity for lowering treatment costs is in cancer, according to Mr Paz.

He explained that the way systems are wired today, physicians will run a patient’s cancer treatment regimen through major medical benefits instead of through the PBM. If they did go through the PBM first, Express Scripts would get its doctors and pharmacists involved to ensure the prescribed regiments are appropriate for the prognosis.

Even though the physician ultimately has jurisdiction, the PBM would advise on the most cost-effective, best regiment for the patient and his or her situation.

“If we can get out in front of that, that is a huge opportunity for our industry and more importantly for all of American to help control costs and rive better outcomes,” Mr Paz said.