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Medicine manufacturers and middlemen

Posted on April 6, 2019 by admin

On Tuesday, the trio of companies making insulin in the U.S. is due before a House subcommittee that has seized on the diabetes medicine as definitive evidence of spiraling out of control prescription drug prices. anyaivanova Images

For the second time in two weeks, the price of insulin will be under scrutiny on Capitol Hill in the week ahead.

On Tuesday, the trio of companies making insulin in the U.S. is due before a House subcommittee that has seized on the diabetes medicine as definitive evidence of spiraling out of control prescription drug prices. The group has already heard from a patient, a parent, and doctors. This coming week, the subcommittee is expected to hear from insulin manufacturers and the middlemen in the prescription drug business model, pharmacy benefit managers.

American company Eli Lilly, Sanofi from France and the Danish firm Novo Nordisk are responsible for most of the world’s supply of insulin. Prices have tripled in the past decade, according to IBM Watson Health data as reported by The Washington Post. The manufacturers have raised prices at least seven-fold since they introduced their drugs, far outpacing the rate of inflation.

These drugs represent big money to their makers and their shareholders. Eli Lilly’s insulin brand brought in 13 percent of the company’s U.S. sales last year, making it the company’s second highest selling medicine. Its best-selling medicine was a newer treatment for type 2 diabetes. The performance has helped Lilly stock jump 64 percent over the past year.

The middlemen are supposed to be buffers between the drug makers and the patients that rely on the medicine. These middlemen are called pharmacy benefit managers — PBM for short. ExpressScripts owned by health insurer Cigna, Caremark run by pharmacy retailer CVS, and OptumRx a unit of health insurer UnitedHealth Group, also are expected at this hearing.

These PBMs bargain with the drug makers over prices. Some of that discount winds up in the price of the drug paid by patients. Some winds up as profit for the PBMs. The deeper the discounts, the more incentive to drug makers to raise their initial prices.

The drug makers may blame escalating prices on the middlemen; and the middlemen may blame the makers. In the end, it’s patients who pay.

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