Express Scripts Chief Medical Officer

My old boss and someone for whom I have great personal and professional respect is Steve Miller, MD who is the Chief Medical Officer at Express Scripts. I still remember the day I heard he was coming to the company and desperately trying to Google him to find out something about him. I couldn’t find anything. That has changed in the past few years. Now, you can find lots of information on him via Google as he is often interviewed and very active in Washington. (By the way (BTW), you should Google yourself and see what you find.)

As I sit her flying back to St. Louis from a meeting down South, I caught up and read an article where he was widely quoted as part of a panel. It has some good information for those of you interested in the pharmaceutical market.

• He talks about the electronic prescribing market with a few interesting facts:
  • 4% of the prescriptions in the US are prescribed electronically compared to 95% in the Netherlands.
  • If we increased the generic fill rate to the theoretical maximum, we would save $40B a year which is enough to pay for all the charity hospital care.
  • In his time at the hospital, they observed that in 25% of heart failure cases the diagnosis and treatment was different if they had the patient history at their fingertips…A great example being that the patient says they are on a drug but the physician seeing that they haven’t refilled it for 6 months.
• He talks about what happens after a drug gets approved by the FDA and how companies look at access, cost, and safety.
• He talks about drug pricing and the fear that people mistakenly have about generics being produced in other countries.
  • “By and large, generics, no matter if their source is in the United States or foreign, have proved to be extraordinarily safe.”
• He talks about reimportation of drugs from Canada.
• He talks about reference-based pricing that allows other countries to have lower costs for pharmaceuticals and about how manufacturers provide low cost access to patients through Patient Assistance Programs (PAPs).
• He also talks about the point at which cost can affect compliance with prescriptions – $150 for specialty drugs (which cost $1,500 a month on average) and $10 for oral solids. He also points out several of the other issues and points to the fact that price elasticity varies by class.
  • “It turns out people are most price sensitive to narcotics because narcotics are more of a discretionary drug, so if I am feeling economic pressure, I can forgo that pain pill.”