Insurers, PBMs take heat for reaction to rising drug costs


Similar to the much-maligned pharmaceutical companies, health insurers are increasingly becoming the target of consumer backlash over the rising cost of drugs.

Insurers, though, are feeling the heat not over how prices are set but how they are reacting to spiraling costs.

In California, the advocacy group Consumers Union claims that Anthem and Blue Shield of California are unfairly using high drug price to justify requesting premium hikes of nearly 20 percent on their Affordable Care Act plans, California Healthline reports.

Drug prices, according to staff attorney Dena Mendelsohn, “may be the factor most open to exploitation by health plans searching for a Trojan horse with which to usher in excessively priced insurance rates.”

Yet both companies say their claims are valid. Anthem and Blue Shield predict drug cost hikes of 17.7 percent and 15.2 percent, respectively, for 2017, with Blue Shield spokesman Steve Shivinsky pointing to the “dramatic inflation” of the cost of treatments such as the EpiPen.

Major insurers are also facing accusations that their coverage of HIV/AIDS treatments are discriminatory, FierceHealthPayer reported.

Meanwhile, another battle is playing out in the pharmacy benefits management space. Express Scripts this week unveiled new recommendations for how insurers and employers should cover anti-inflammatory drugs. The model, it says, will align drug payments to specific conditions and well as refund payers for early discontinuation of expensive medications.

Yet some are concerned the move will limit their access to much-needed medications, with one rheumatoid arthritis patient telling the New York Times that “jumping through hoops” could cause major issues for those suffering from similar conditions.

Representatives from drug companies, including AbbVie and Amgen, also tell the publication that insurance companies should not dictate to doctors and patients what therapies are best.

But Express Scripts believes its new recommendations are justified.

"Painful inflammatory conditions like rheumatoid arthritis can cripple patients and obliterate payer budgets," Glen Stettin, M.D., senior vice president and chief innovation officer, said in the company’s announcement. "By finding creative ways to take better care of patients and protect our clients' budgets, Express Scripts is uniquely tackling one of the biggest health challenges facing our country today."