Conspiracy Theory: A Secret Group Controls What Drugs You Can Take

This no conspiracy, it is completely true. As this article in the St.Louis Post-Dispatch explains,  A secretive board controls access to prescription drugs for millions of Americans. As an employer, you contract with a PBM to make these difficult decisions in the interest of balancing necessity, efficacy, and savings. Unfortunately, you’re employees may not always see it that way.

In summary:

Express Scripts says secrecy protects board from lobbyist pressure but others want greater transparency.

Each year, Express Scripts releases a list of prescription drugs it will exclude from coverage for the upcoming year, and that list is determined by a secretive board of doctors and a pharmacist.Its rivals also exclude drugs from their own annual drug formularies — the list of drugs they will cover — based on the recommendations of unidentified experts.

Express Scripts negotiates the cost of prescription drugs directly with pharmaceutical companies and provides prescriptions to about 85 million Americans each year through their employer-based prescription drug coverage. After reviewing relevant scientific information on particular drugs and a review of its competitors that treat the same issues, the committee either recommends to include or exclude the drug from the annual list. Express Scripts recently released its 2017 list of drugs it will cover and those that it will exclude from coverage. For drug manufacturers, being excluded from Express Scripts’ list of preferred drugs has financial consequences.

We recommend you check out Samantha Liss’ article from the St. Louis Post-Dispatch. Alison Kodjak of NPR also released a similar article yesterday as heard on the public broadcasting network’s Morning Edition Program (below).