RENEE MONTAGNE, Host:
St. Louis Public Radio's Rachel Lippmann reports on whether bigger really would be better.
RACHEL LIPPMANN: For the last eight years, Lisa Jackson has been helping thousands of retirees navigate the often-confusing world of health insurance.
LISA JACKSON: It takes us a long time of holding their hand and walking through it with them month after month.
LIPPMANN: Jackson says Express Scripts employees are pleasant to deal with, and she's been able to easily resolve most of the glitches that happen with any bureaucracy. And she says the company - a pharmacy benefit manager - helps her retirees save money. Some are paying $150 less than they would getting the same prescription through the federal Medicare drug benefit.
JACKSON: These people that are on a fixed income, they should not have to decide: Am I going to take my medicine, or am I going to cool my home?
LIPPMANN: But there's a catch. The cheap drugs are only available through the mail, and Jackson says that drives some of her retirees away from the Express Scripts plan.
JACKSON: Your Medicare Advantage plans, I've had them stay with that as opposed to going with coverage that would cause them to have less out-of-pocket expenses. People just would rather have personal contact with a pharmacist.
LIPPMANN: PBM's also aggressively pushed the use of generic drugs, and analyst Dan Mendelson says that's their best cost-control tool. Mendelson worked on health care during the Clinton administration and currently runs his own research firm, Avalere Health.
DAN MENDELSON: A lot of major pharmaceuticals have gone off patent, and PBM's have been largely responsible for how rapidly those generics get switched over. Many plans actually give generics for free.
LIPPMANN: Express Scripts chief medical officer Steven Miller says his company plays a key role in keeping down co-pays.
STEVEN MILLER: Drug inflation may be going up 10 percent. Our average co-pay went from $12.47 to $12.15.
LIPPMANN: Researchers like Jack Hoadley at Georgetown University's Health Policy Institute say it's hard to tell exactly how much PBMs lower costs because the data isn't readily available. But he says they do offer other benefits.
JACK HOADLEY: During the time it takes for you to actually have that prescription ready to be picked up, the PBM is back behind the scenes making sure that this isn't a duplicative prescription, making sure there aren't dangerous interactions.
LIPPMANN: For NPR News, I'm Rachel Lippmann, in St. Louis.
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