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The timing of the announcement was notable.
It came just days after Republicans in the House passed a health-care bill that some estimate could leave millions of Americans without health insurance.
It also comes as Express Scripts and other pharmacy benefit managers have been widely criticized as major drivers of rising drug costs.
PBMs negotiate with drug companies on behalf of insurers and employers to reduce costs. But they’ve been accused of simply shifting more cost burden to consumers in recent years. They also are accused of keeping a secret slice of the rebates they negotiate, meaning they make more money when drug prices go up.
Consumers wouldn’t need discount programs like InsideRx if the list prices just came down, critics argue.
Express Scripts disputes that rebates cause drug prices to rise, saying drug manufacturers are solely responsible for setting list prices. The company also said the vast majority of rebates negotiated by PBMs are passed through to insurers or employers.
“We created InsideRx to help the 30 million Americans who have no coverage,” said spokeswoman Jennifer Luddy. She said the program gives the uninsured access to similar prescription benefits that insured individuals already have.
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Express Scripts recently announced it expects to lose its largest customer, Anthem, which sued last year claiming Express Scripts was unfairly inflating drug costs.
Express Scripts is the nation’s largest pharmacy benefit manager, but it’s the only top player that is a stand-alone PBM. Competitors CVS Health and OptumRx are part of larger companies with holdings like pharmacy chains and health insurers.
Critics say discount programs like InsideRx are aimed more at stopping consumers from shopping around for alternatives to brand name drugs than keeping costs low. And, they say, the programs are limited in scope.
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Those on Medicaid or Medicare can’t use InsideRx and it cannot be used in conjunction with private insurance plans. So any out-of-pocket expenses while using the discount card don’t count toward a patient’s deductible.
For patients with expensive medical conditions like diabetes, this kind of program is a losing proposition, according to Linda Cahn, founder of Pharmacy Benefit Consultants and the National Prescription Coverage Coalition.
“(Express Script’s) new program may look good, but it’s anything but,” she said, arguing that it encourages people to use high-cost brand name drugs that even after the discounts are more expensive than many chemically identical or therapeutically similar alternatives.
Cahn said she thinks this program was created for two reasons: “to generate another revenue stream for (Express Scripts); and to make (Express Scripts) look good after several rounds of bad press coverage recently.”
Luddy said generic options are always best if available, but InsideRx is intended to help people who must use brand name drugs save money.
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