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GIC hears PBM briefing on drug-cost trends; commissioners raise concerns about GLP-1 denials and member disruption
Summary
GIC pharmacy consultant Devin Shaw outlined PBM functions and rising cost drivers — notably GLP-1 weight-loss and diabetes drugs — and reported increased prior-authorizations and lower approval rates for those drugs; commissioners described frequent member denials and customer-service problems and asked staff for comparative pricing and appeals data.
Devin Shaw, GIC—s lead pharmacy consultant, briefed commissioners on pharmacy benefit manager (PBM) operations, the role PBMs play in claims processing and rebates, and current drug-cost trends the commission should watch.
Shaw outlined three near-term trends of special interest to GIC: the rapid uptake and high list prices of GLP-1 weight-loss/diabetes drugs (retail list prices cited around $15,000 per year, with uncertain net pricing after rebates), the growing pipeline of biosimilars (which can reduce specialty-class spending), and the potential of pharmacogenomics to tailor…
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