Steve Miller - Express Scripts

Ushering in a new era in drug pricing

Name: Steve Miller
Title: Chief Medical Officer, Express Scripts

Express Scripts' ($ESRX) Dr. Steve Miller wasn't always on the pricing end of the pharma spectrum. Before joining the pharmacy benefits manager 10 years ago, Miller worked in drug R&D and served as chief medical officer at a leading hospital.

But Miller was frustrated with the U.S. healthcare delivery system, and he figured he could help improve care and lower costs by joining St. Louis, MO-based Express Scripts. Since then, Miller has helped usher the PBM through some of the pharma industry's biggest changes, including the shift from traditional to specialty drugs, and the development of biosimilars. Throughout the process, Miller has been a vocal critic of drug costs, pushing for lower prices for specialty meds and looking for opportunities to cut costs while encouraging innovation. 

Now, Miller has set Express Scripts up as an arbiter of cost-effectiveness in the U.S. By aggressively excluding some branded drugs from the PBM's national formulary, and later leading the charge in hepatitis C drug negotiations, Miller has created a new role for private payers in the U.S.--a role that other countries hand over to stated-funded agencies and ministry officials. That role is deciding which new drugs are worth premium prices.

"If you create a drug that's uniquely better, the marketplace has always shown an ability and a willingness to pay for it," Miller told FiercePharma. "And when you look at some of the products we cover, they're extraordinarily expensive but because they're the best for the patient, we pay for those." 

Last year was a "bellwether year" for Express Scripts, as it waged a hepatitis C pricing battle that will trigger $4 billion in savings for the healthcare system, Miller said. In December, the company made AbbVie's ($ABBV) Viekira Pak its preferred treatment for the disease, undercutting Gilead Sciences' ($GILD) rival treatment Sovaldi and setting off a pricing battle. 

More than 5,400 products are in human testing in the U.S., Miller pointed out, and burgeoning new drug approvals are creating competition across categories. As new products enter the playing field, Express Scripts plans to continue using its formulary powers to push drugmakers for better pricing. 

The PBM has its eye on pricing for diabetes products, PCSK9 cholesterol fighters and some next-generation cancer therapies, but it's also counting on biosimilars as a way to push patients toward cheaper alternatives. Express Scripts has been "aggressively advocating" for biosimilars for more than 8 years, Miller said, and the company is optimistic that they will hit the U.S. market in 2015 despite legal obstacles.

U.S. payers would save an estimated $250 billion over the next decade by moving patients to biosimilar versions of 11 top drugs that have already lost patent protection or will soon, Miller said, citing a study the PBM published several years ago. And the cost-saving measures could make room for promising new classes of treatments for cancer and other ailments.

Miller sees a need to manage drug spending even more tightly in the coming years. One of the biggest issues in the U.S. is access to healthcare, and pricing drugs more affordably will allow patients to get the therapies they need, he said. The company will continue to look for more opportunities to cut drug spending in 2015 and beyond.

"When you see people having to make choices between rent and drugs, or food and drugs, that's just not a fair trade-off," Miller said. "We want our healthcare system to be great; we want our pharmaceutical industry to be the most innovative in the world. But we also need to have affordability so we get to a sustainable system that's great for patients but also great for the industry."

-- Emily Wasserman (email | Twitter)

For more:
Express Scripts takes a bow for cutting $4B off hep C drug spending
Thanks to hep C pricing war, Gilead, AbbVie both score spots on Prime's coverage list
Gilead Sciences adds fuel to fire in hep C pricing battle with Anthem deal
Express Scripts' Miller lays out manifesto to fight sky-high drug prices
Sorry, Gilead. AbbVie cuts exclusive hep C deal with Express Scripts

Steve Miller - Express Scripts
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