The issue of high US drug prices and the effects of distribution intermediaries on those prices has been a hot-button issue since the last federal election—if not for many years prior. Now, just as the Trump Administration is making undefined gestures toward “doing something” about drug prices, Mark Merritt, president and CEO of the Pharmaceutical Care Management Assn. , has announced his year-end departure from the trade association of major pharmacy benefit managers (PBMs).
Merritt, who has defended PBMs’ role in pharmaceutical costs against all comers, has led the association since 2003, when, as PCMA puts it, the association grew from “an obscure group into the nation’s leading voice on prescription drug benefits.” Tim Wentworth, head of Express Scripts (the largest PBM) and PCMA board chairman, stated that “When [Merritt] came aboard in 2003, he started from scratch and built PCMA into one of the most effective advocacy and lobbying groups in American health care.”
PCMA has tangled repeatedly with the independent pharmacy association, the National Community Pharmacists Assn., over policy and reimbursement issues; in recent years, PBMs have come more into the spotlight over their retention of some of the rebates they garner from pharma manufacturers. With the pharma industry, PCMA has been a critic of the industry’s copay assistance programs, most recently with PCMA-member actions like “copay accumulators” that undercut the value of copays for patients. The three largest PBMs, on their own, control the pricing of an estimated 80% of the US drug market. In the past year, as the pricing issue grinds up against such trends as specialty pharmaceutical pricing, and the near-exhaustion of generic substitution for drugs with expired patents (generics are now 90% of US prescriptions, according to IQVIA data, and except for newly expiring drugs, there isn’t much more in branded-to-generic savings to be had), the major PBMs are merging with insurers (the proposed Cigna-Express Scripts deal, currently in the works), or have merged with health plans and providers (Optum PBM and United Health) or retail pharmacy (the CVS acquisition of what was Caremark).