Frank T. Messina, General Counsel of Script Care Ltd. in Beaumont, Texas.

Somewhere, working quietly in the shadow of headlines about high prescription drug prices, is general counsel Frank Messina of Script Care Ltd. in Beaumont, Texas.

Script Care is one of the nation's largest privately owned pharmacy benefit managers—a power broker between insurance companies and the pharmaceutical industry.

Working for member corporations, a PBM—as Messina and the industry call it—negotiates drug price contracts with lawyers representing networks of nearly 70,000 pharmacies across America.

Corporate Counsel recently talked with Messina about his role behind the scenes of the drug price controversy. Here are his comments, edited for clarity and brevity.

Corporate Counsel: First, tell me a little about your background. 

Frank Messina: I've been practicing law for 10 years. Prior to Script Care, I was an attorney at Germer with an emphasis in commercial litigation and employment law. I've been at Script Care six years, and I'm the sole in-house counsel, responsible for all aspects of its corporate governance, legal operations, litigation efforts and regulatory compliance. Handling all of these areas requires being highly specialized within the PBM industry, but also being a "jack of all trades" in all things general counsel. It's a constant juggling act, but I love it.

CC: What is a pharmacy benefit manager, and how does it affect drug prices?

FM: Candidly, prior to being contacted by Script Care, I was unfamiliar with PBMs. Any company that has health insurance has a PBM. They are an integral hub within the prescription industry chain that negotiates on behalf of their clients with pharmacies and pharmaceutical manufacturers to lower prescription costs for clients. In a nutshell, PBMs are responsible for developing the lists of drugs, called formularies, that offer the greatest value and efficacy for patients. PBMs contract with pharmacy providers to control prescription costs, negotiate competitive discounts or rebates with pharmaceutical manufacturers to offset prescription costs, and process and pay prescription drug claims.

CC: Describe the key elements of your job? 

FM: I do tons of negotiations on contracts and oversee litigation, working with outside counsel. A key, overarching element of my job is to understand all aspects of the PBM industry, as well as Script Care's business lines and business goals.

In private practice, I used to be able to say, "The issue presented is more of a business decision." But that verbiage has been almost entirely removed from my vocabulary now. I have to view legal issues, such as deals or legal disputes, through the lens of business goals now.

CC: Do you use artificial intelligence to analyze data or other technology to handle your contracts?

FM: Deloitte [Deloitte Touche Tohmatsu Ltd.] actually brought up the idea of artificial intelligence software, but we haven't decided to look at that yet. We are looking at purchasing a searchable database for all our contracts.  

CC: What do you see as your biggest successes?

FM: One of our biggest successes was to be one of the first PBMs in the industry to actively investigate, obtain recoveries through litigation or mediation, and halt opportunistic compounding pharmacies throughout the nation. The compounding labs were attempting to bilk money from clients with elaborate billing schemes.

Another big success was renegotiating multifaceted pharmaceutical rebate agreements that have benefited our clients with increased savings while attracting new clients seeking prescription savings.

We also just won in October a massive lawsuit against a competing PBM, but there is a nondisclosure agreement so I cannot discuss it further. I can say it was time-consuming.

CC: What factors will likely impact your job and your company in 2020? 

FM: The PBM industry is rapidly evolving with new laws, regulations and industry changes. For instance, over the past several years federal and state legislation has increasingly been implemented to govern PBMs, and I think this trend will continue.

I also anticipate that the PBM client-contracting model will continue to evolve to provide more price transparency, and PBMs like Script Care that are already fully transparent on their costs will benefit from these new regulations.

Additionally, I expect an increase in value-based rebate agreements that tie drug reimbursement to how well the drug performs in treating the patient.

Another hot topic will be the ever-increasing costs of specialty drugs and a PBM's ability to manage these costs through its various pricing tools, such as drug utilization reviews, step therapy and comparative effectiveness reviews.