Comptroller Kevin Lembo recently released a letter to CVS Health – the state’s pharmacy benefit manager (PBM) – that questions whether the company’s financial interests motivate decisions to include certain pharmaceuticals on its approved drug list over the interests of those patients covered by the state health plan.

After discovering disturbing trends in the state’s claims data late last year related to prescriptions of Horizon Pharma pharmaceutical products, Lembo worked with the state Health Care Cost Containment Committee to stop any medically unnecessary prescriptions of certain Horizon Pharma drugs.

Horizon Pharma specializes in drugs that combine the active ingredients of commonly used affordable over-the-counter drugs (for example ibuprofen and Pepcid AC) that are regularly prescribed together – and then charges over 7000 percent more than what those drugs typically cost when purchased individually.

Lembo previously raised concerns about Horizon Pharma’s relationships with certain prescribers and pharmacies and has now requested information and a meeting with CVS Health related to any agreement it may have with Horizon Pharma.

CVS initially notified Horizon Pharma that it would remove a number of its products from its formulary and place them on an exclusion list. CVS ultimately restored those products to its formulary, and Lembo would like to know why.

“Are formulary placement decisions motivated by the interest of plan sponsors and patients – or financial benefits to PBMs and drug manufacturers?” Lembo said in a statement. “In light of these questions and concerns, I would like to request a meeting with CVS Health to discuss the Horizon Pharma case and – more broadly – how we can assure that the interests of the State of Connecticut and the patients it serves are aligned with those of CVS Health.”

Lembo also noted in his letter that “Horizon Pharma’s practices leverage the many perverse incentives imbedded in the pharmaceutical supply chain and regulatory framework. They are using the FDA approval process to establish patents, not on new innovative drugs that treat previously unmet needs, but rather to gain exclusive rights to market generic combinations that have been off-patent for decades. Horizon is then setting the list price of these combo drugs at high prices, which in some cases can be thousands of dollars for a month’s supply.”

“Business practices like those used by Horizon are driving up overall health care spending without adding value to the system. As a plan sponsor we depend on our pharmacy benefit manager to act as a bulwark against abusive manufacturer pricing and bring down total pharmacy costs. I have significant concerns about the fact that spiking costs to the state plan associated with Horizon Pharma products were only discovered by a review initiated by the state and its consultants – and not brought to our attention by CVS Health.”