Exclusive: Beyond Valeant, U.S. payers scrutinize other drugmaker ties to pharmacies

Fri Oct 30, 2015 11:29pm EDT
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By Deena Beasley

LOS ANGELES (Reuters) - Express Scripts Holding Co, the largest U.S. pharmacy benefit manager, is reviewing pharmacy programs run by AbbVie Inc and Teva Pharmaceuticals Industries Ltd after finding questionable practices at Valeant Pharmaceuticals International Inc's partner pharmacy, Philidor Rx Services.

Express Scripts and other big managers of prescription medicine benefits for health plans said on Thursday they would no longer work with Philidor as concerns mount that Philidor was improperly directing drugs made by Valeant to patients.

Valeant, which has headquarters in Quebec, has since said it was cutting ties with Pennsylvania-based Philidor, and that the pharmacy was suspending operations.

A handful of other drugmakers operate their own pharmacies and ship drugs directly to patients. Many of the rest employ independent specialty pharmacies that can haggle with insurers and link patients to programs under which drugmakers cover their out-of-pocket costs.

Such tactics can allow drugmakers to work around reimbursement restrictions from Express Scripts and other insurers, which are directing patients to cheaper generic versions of widely-used medicines to save costs.

Health insurers, faced with sharply rising drug costs, are increasing their oversight of prescription drug pricing, which has also become a key issue in the 2016 presidential election.

"We are reviewing and evaluating all similar captive pharmacy arrangements that we know of and will work to identify others," said Brian Henry, a spokesman for Express Scripts. He defined a captive pharmacy as one that derives the vast majority of prescription volume from one manufacturer or one product.

AbbVie said its wholly owned Pharmacy Solutions business aims to help patients and doctors verify insurance coverage in certain instances for drugs such as its widely-used rheumatoid arthritis treatment Humira. The company said the program accounts for less than 0.2 percent of its U.S. sales.   Continued...

A screen displays the share price for pharmaceutical maker AbbVie on the floor of the New York Stock Exchange July 18, 2014. REUTERS/Brendan McDermid