Letters: What drugs cost, and why

Re “Slashing choices to cut drug costs,” Column, May 4

David Lazarus misleadingly describes the role of the pharmacy benefit manager, or PBM, in determining which dispensing channel — home delivery or retail — patients use.

PBMs help create a robust, cost-effective pharmacy benefit. Plan sponsors lower costs by increasing generic drug utilization and patient adherence to prescribed drug therapy, and by offering a lower-cost dispensing option through home delivery. We offer these tools in a variety of options so that our clients can design plans that best meet their goals.

Some plans maximize savings by requiring that patients with prescriptions for long-term maintenance drugs receive them through home delivery. Of the plans that require home delivery, many are labor unions and government agencies that feel a responsibility to stretch their members’ dues further or to make the most of tax dollars. Choice is preserved in every option we provide.

Steven Miller, MD

St. Louis

The writer is chief medical officer at Express Scripts.

I would like to add an additional consequence to the mandated use of an online pharmacy after the second refill.

I take medication for high blood pressure and atrial fibrillation. My cardiologist, for various reasons, routinely makes changes to the medications or dosages. Because I am forced to buy a 90-day supply, I have hundreds of purchased but unused pills.

For Medco, one of the PBMs in Lazarus’ article, this proves to be very cost efficient. That efficiency is one-sided, however. I have actually ended up paying a higher cost than if I had been allowed to buy a 30-day supply from my local pharmacy. I submit that these are the types of things that actually increase my blood pressure.

William Hale

Chino Hills