It’s true, pharmacy benefit managers (PBMs) are complicated, admitted Tim Wentworth, president and CEO of Express Scripts, during his presentation at the JP Morgan Healthcare Conference in San Francisco, California. However, the company is built to succeed in the future of healthcare, he said.
It’s true, pharmacy benefit managers (PBMs) are complicated, admitted Tim Wentworth, president and CEO of Express Scripts, during his presentation at the JP Morgan Healthcare Conference in San Francisco, California. However, the company is built to succeed in the new environment, he said.
Looking back at the 30 years of Express Scripts’ history, Wentworth highlighted how the company was able to find solutions to problems. When the first hepatitis C treatments came onto market, Express Scripts created competition to lower the prices by 50% and create patient access to a cure and a guarantee of effectiveness, he said. In addition, the company’s specialist-focused pharmacy model meant that outcomes were as good as those seen in clinical trials.
“For 30 years we have been the original patient advocate,” he said. “We forced the market to compete for access to our patients, for access to our payers, and to create outcomes that are, clinically, the right outcomes for our members.”
He promoted the fact that Express Scripts has a high retention rate among its clients and that of the 6 large health plans that renewed with the company, 4 of them immediately moved the specialty business from an open network to just Express Scripts. They did that, Wentworth said, because the PBM has been able to deliver outcomes.
The move away from open networks in the specialty space to working exclusively with 1 PBM represents a huge shift from just 5 years ago, he added.
“They now realize it’s not about dispensing and getting patients access, it’s about managing, getting the results, keeping patients on the drugs, [and] getting the intended downstream benefits that a well-run clinically deep specialist-driven specialty pharmacy company can do,” Wentworth said.
Several times during his presentation, Wentworth highlighted Sparks Therapeutics and its new gene therapy to treat a rare condition that causes blindness. Last week, Express Scripts announced that it had agreed in principle to participate in a new contractual model that would enable payers to spread payments for the $850,000 treatment over multiple years.
In addition to Sparks’ gene therapy, Luxturna, Express Scripts currently offers access to one of the chimeric antigen receptor T-cell therapies and is expecting to also provide access to the second one soon. The challenge with these products is that they will “require different algorithms.” Similar to Luxturna, new payment models will need to be created, and Express Scripts is in the position to help payers pay for these treatments.
“How can we help a manufacturer guarantee its effectiveness and get that payer back some money if in fact the product, which is so new, doesn’t work? That’s what we are built to do and that’s what we are doing for these products,” Wentworth said.
In addition to gene therapies, biosimilars are going to be an important part of the future business. He predicts they will be as important as the generic wave in 2000 was. Biosimilars will be able to create headroom so the system can keep paying for innovative, but expensive products like Luxturna.
“The Sparks product has 2200 patients—we have to figure out how to pay for it,” Wentworth said. “Biosimilars have the key to unlocking that.”
He closed by explaining that Express Scripts is ready for the challenges of the future and of today because they are similar to ones the company already faced and successfully handled in the past.
“By the same token, the sophistication, the clinical focus, the amazing amounts of data that are needed to take care of patients in today’s environment, are the things we are perfectly positioned to leverage in order to drive the kind of outcomes that the market needs,” Wentworth concluded.