Rx Benefits Group Lays Pricing Blame at Drugmakers’ Feet


Pharmaceutical companies may be blaming others for high drug prices, but they’re the ones who set the prices, the head of a pharmacy benefit manager group told me Oct. 27.

“We understand that the drug industry is in a desperate situation right now and is lashing out at a lot of different groups in order to deflect attention,” said Mark Merritt, president and chief executive officer of the Pharmaceutical Care Management Association (PCMA). “But ultimately, the drug manufacturer sets the price, and I think you have to start there.”

Drugmakers are under heavy scrutiny by lawmakers, consumers, medical professionals and presidential candidates for their pricing practices. Most recently, generic drugmaker Mylan Inc. came under attack for increasing the cost of its EpiPen allergy injection by 400 percent in nine years.

Meanwhile, Matt Gorman, the strategic campaign communications director at the Biotechnology Innovation Organization (BIO), told me Oct. 31 “the list price is not what the manufacturer generally makes on the drug,” and “at the end of the day, the insurer really determines what a person actually pays for a drug.”

Gorman said, “There’s been a lot of shouting about price, and I think it really started to amp up when insurance companies were looking for a scapegoat, essentially after premiums had to skyrocket for them under the” Affordable Care Act.

Insurers “needed to find a scapegoat and even their own data, which they’re required to disclose under that same law, show that drug prices are clearly not the reason for increased premiums,” Gorman said. “They’re a very small portion of that.”

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