CNN
FORTUNE -- When Elizabeth Purvis' son Tater was born last year with hemophilia, she had a wide range of pharmacies available to her through her pharmaceutical benefits manager (PBM), Express Scripts. Because the clotting medicine Tater takes to prevent excessive bleeding is rare and difficult to administer, she can't get it at her local pharmacy; it is only sold at so-called specialty pharmacies, which also offer nursing services. Two months later, Express Scripts dropped the pharmacy she chose, Coram, from its network, and sent her a letter with three choices. The first, "Hemophilia of the Sunshine State," was an out-of-state pharmacy she had never heard of. She later found out that it was owned by Express Scripts.
"They were pushing for all of us to use Express Scripts," says Purvis, who lobbied for a local alternative and eventually found a nearby provider that could bill Tricare, the health insurer for military families (her husband is in the Army). "The little branches are able to provide so much more for us," she explains, adding that she was apprehensive of depending on a large mail order operation based in another part of the country. "I didn't just want to be another number in Express Scripts' rolodex," she says.
Specialty drugs, which treat rare diseases such as hemophilia, cancer, and multiple sclerosis, are one of the fastest-growing--and most lucrative--areas of healthcare. Due to their small patient volume (there are about 20,000 hemophiliacs in the U.S., compared to some 37 million people with high cholesterol) and complex manufacturing requirements, specialty treatments can cost tens of thousands of dollars. According to the 2010 Drug Trend Report put out by Medco, one of the country's biggest PBMs, specialty drug prices climbed 14.7% last year, while regular brand-name drugs increased 9.2%.
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FORTUNE -- When Elizabeth Purvis' son Tater was born last year with hemophilia, she had a wide range of pharmacies available to her through her pharmaceutical benefits manager (PBM), Express Scripts. Because the clotting medicine Tater takes to prevent excessive bleeding is rare and difficult to administer, she can't get it at her local pharmacy; it is only sold at so-called specialty pharmacies, which also offer nursing services. Two months later, Express Scripts dropped the pharmacy she chose, Coram, from its network, and sent her a letter with three choices. The first, "Hemophilia of the Sunshine State," was an out-of-state pharmacy she had never heard of. She later found out that it was owned by Express Scripts.
"They were pushing for all of us to use Express Scripts," says Purvis, who lobbied for a local alternative and eventually found a nearby provider that could bill Tricare, the health insurer for military families (her husband is in the Army). "The little branches are able to provide so much more for us," she explains, adding that she was apprehensive of depending on a large mail order operation based in another part of the country. "I didn't just want to be another number in Express Scripts' rolodex," she says.
Specialty drugs, which treat rare diseases such as hemophilia, cancer, and multiple sclerosis, are one of the fastest-growing--and most lucrative--areas of healthcare. Due to their small patient volume (there are about 20,000 hemophiliacs in the U.S., compared to some 37 million people with high cholesterol) and complex manufacturing requirements, specialty treatments can cost tens of thousands of dollars. According to the 2010 Drug Trend Report put out by Medco, one of the country's biggest PBMs, specialty drug prices climbed 14.7% last year, while regular brand-name drugs increased 9.2%.
Read more >>