Every year, a secretive board of physicians and a pharmacist decides which drugs will be excluded from Express Scripts coverage for the upcoming year, according to the St. Louis Dispatch.
St. Louis-based Express Scripts, the nation's largest pharmacy benefit manager, does not disclose the names of its board members, or any possible conflicts of interest they may have, according to the report. The company's opaque system is designed to protect experts from the "tremendous" influence of lobbyists, Express Scripts executives told the St. Louis Dispatch, but critics argue the process should be more transparent, especially since such transparency is enforced in other areas of the healthcare industry.
"All of us are subject to reporting on what money we receive. These folks should do the same," said Adrian Di Bisceglie, MD, co-director of St. Louis University Liver Center, according to the report.
Express Scripts, which provides prescription medications to roughly 85 million Americans each year, negotiates the cost of prescription drugs directly with pharmaceutical companies. The company's national preferred formulary, or its list of covered drugs, acts as a tool to stunt the rising costs of prescription drugs; the threat of being excluded pressures pharmaceutical companies to lower their prices, according to the report.
Earlier this month, Express Scripts revealed a list of 85 drugs it plans to exclude from insurance coverage in 2017.
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