Secretive Boards of HCPs Control Access to Rx Drugs. Should There Be More Transparency? | Pharmaguy's Insights Into Drug Industry News |

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.


The nation’s largest pharmacy benefit manager, which is based in St. Louis County, does not disclose the names of the board members or any actual or potential conflicts of interest they may have.


Express Scripts is not alone. 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.


The reason behind the secrecy is to shield experts from the “tremendous” influences of lobbyists, Express Scripts executives say. But some critics say the process should be more transparent, as it is in many other countries.


The secrecy remains when the rest of the industry is required to publicly disclose its financial relationships. For example, drugmakers and device makers must report how much they pay doctors for perks such as food and beverage, travel and speaking engagements.


“All of us are subject to reporting on what money we receive. These folks should do the same,” said Dr. Adrian Di Bisceglie, co-director of St. Louis University Liver Center.


The list, or what Express Scripts calls its national preferred formulary, is a major tool to curb the rising costs of prescription drugs. The threat of being excluded pressures drug makers to lower their prices.


Other countries are much more transparent with this process of selecting drugs, and the secrecy is not common in other parts of the world, said Steve Morgan, professor of health policy at the University of British Columbia and an expert on international pharmaceutical policy.


“The professionals who are on these committees are put under enormous pressure — political pressure, lobbying pressure from patient groups and industry,” Morgan said.