Beyond the Big Three PBMs: A Conversation with Greg Baker, CEO of EmsanaRx, Part 2

Baker discusses specialty drugs and their discounting in this segment of his interview with Peter Wehrwein, managing editor of Managed Healthcare Executive.®

Everyone in the pharmacy benefit business knows about the growing number and increasingly high prices of specialty drugs. But Greg Baker says what counts as a specialty drug is ill-defined and the vagueness is a source of confusion — and added profits — between pharmacy benefit managers (PBMs) and their clients.

"There is no industry standard for what a specialty drug is," says Baker, CEO of EmsanaRx, a PBM launched by the Purchaser Business Group on Health.

Baker was a source of Managed Healthcare Executive®'s December 2022 cover story, "Beyond the Big Three: Smaller PBMs are taking on Optum Rx, CVS Caremark and Express Scripts."

In this segment of an interview with Peter Wehrwein, managing editor of MHE, Baker discusses what he desribes as "gamemanship" with generics and how categorizing a drug as a specialty can affect discounts and therefore the net price paid by the industry clients of PBMs. He gave Truvada (tenofovir disoproxil fumarate and emtricitabine), an HIV antiviral, that be classified as a specialty drug and therefore may be discounted far less by some PBMs than if those PBMs had it on their nonspecialty lists.

"Nobody's ever tried to say this is a speicalty drug, this is not. So everybody gets to create their own specialty drug lists," says Baker.