Dr. Scott Gottlieb: PBMs, payers use 'rigged payment scheme' to block biosimilars

Food and Drug Administration Commissioner Scott Gottlieb, MD, criticized pharmacy benefit managers and health plans for inking contracts that don't favor biosimilars, Bloomberg reports.

"Consolidated firms — the PBMs, the distributors, and the drug stores; team up with payers," Dr. Gottlieb told attendees at America's Health Insurance Plans' health policy conference in Washington March 7. "They use their individual market power to effectively split monopoly rents with large manufacturers and other intermediaries; rather than passing on the saving garnered from competition to patients and employers."

Dr. Gottlieb's comments concern giant PBMs like Express Scripts, CVS Health and UnitedHealth Group's OptumRx. He further criticized rebates that incentivize biotech drug producers to arrange exclusive contracts with insurers and PBMs under which the producer's old drug is preferred.

"The rigged payment scheme might quite literally scare competition out of the market altogether," Dr. Gottlieb said. "I fear that's already happening," he added, pointing to the weak biosimilar market. Biosimilars are less expensive versions of complicated biotech medications. 

The FDA has little control over PBMs. However, Bloomberg reports Dr. Gottlieb's comments make the federal government's stance clear: high drug costs are the fault of PBMs too, not just pharmaceutical companies and biotechnology.

Dr. Gottlieb called on insurers and PBMs to use biosimilars as a default option for patients with new diagnoses. He also asked the industry to assist the FDA in assuring physicians that biosimilars are effective alternatives.

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