Has United States Senator Claire McCaskill (D-MO) no sense of ethics? Is she not embarrassed by her glaring conflict of interest in advancing the interests of pharmacy benefit manager Express Scripts that generously underwrites her political ambitions?
Pharmacy benefit managers (PBMs) are middlemen between the insurer, including Medicare, and the pharmacy that disburses prescription drugs. The PBM seeks to negotiate upfront discounts or rebates from the wholesale list prices of prescription drug manufacturers, and to share the deltas with pharmacies to depress the end user price. Three PBM titans, including Express Scripts, control 80-85 percent of the market. In 2015, Express Scripts reported more than $660 million in profits on sales exceeding $25 billion.
The federal government highly regulates the markets in which Express Scripts operates, including Medicare Part D created by the Medicare Modernization Act of 2003. As a member of health care-related committees, Senator McCaskill is a position to use her legislative clout to boost Express Scripts’ bottom line. Her incentive to do so is obvious even to an ingénue.
Express Scripts employees and its PAC have donated more than $150,000 to McCaskill’s Senate campaigns and her leadership PAC. According to Open Secrets, she was the largest recipient of Express Scripts’ political donations in 2010 and 2012. On its government relations web page, Express Scripts candidly acknowledges that its contributions target legislators who vote or go to bat for polices beneficial to it: “Contributions are disbursed according to the following criteria….Has the candidate voted for or announced positions on issues important to Express Scripts and our plan sponsors and patients?...Has the candidate demonstrated leadership on key committees of importance to our business?”
Senator McCaskill has shown herself worthy of Express Scripts’ contributions.
Missouri Governor Eric Greitens recently awarded a no-bid contract to Express Scripts to track opioid and other prescriptions. The award came two months after McCaskill, wielding her influence as a United States Senator, urged state lawmakers to enact legislation to establish an electronic database of controlled substance prescriptions.
On July 31, 2015, Senator McCaskill presided over a Senate Aging Committee hearing in St. Louis to which an Express Scripts executive, Brian Prim, vice president and general manager of government programs, testified in support of more muscular cost controls on Medicare Part D prescription drugs and specialty medications like those required to treat Hepatitis C.
McCaskill also helped Express Scripts in a contract dispute with Kaleo concerning the price of naloxone, which treats overdosing on opioids. She and other Senators wrote a letter to the CEO of Kaleo complaining about outlandish naloxone price jumps.
Further troublesome is the McCaskill Family Foundation’s stock ownership in Allergan, an opioid manufacturer that has been sued by the Ohio Attorney General for failure to warn users adequately of opioid risks. In March 2017, the Senator announced an investigation into Allergan’s rivals: Purdue Pharma, Janssen Pharmaceuticals Inc., Insys, Depomed and Mylan.
Public officials, like Caesar’s wife, should be above suspicion to promote public confidence in government, which is at historic lows. Accordingly, Senator McCaskill should recuse herself from participation in any congressional action that might materially influence the profitability of Express Scripts or the wealth of her family foundation. That might lose her Express Scripts’ donations, but it would gain her public trust, which would be far more valuable to her and the county.