Understanding Competition in U.S. Prescription Drug Markets: Entry and Supply Chain Dynamics
I am a community pharmacist serving a rural area, and have practiced for more than 35 years. I am the only pharmacy in the county that offers 24 hour service, and serves the only 2 nursing homes in the county. PBM's are a scourge on the health care system, by their increasingly negative 'take it or leave it' contracts. Their forced mail order to their own pharmacies, abusing the Medicare system by filling mail order prescriptions whether the patient needs or orders them, ensuring that their patients are "100% compliant. Case in point, I checked some mail order meds for a patient recently admitting to the nursing home, the patient had over one year of medicine, filled every 75 days, plus a gallon ziplock baggie of mail order rx's that were expired. When I asked the family why they had so much medicine, they said the mail order sends them every 75 days, we called and tried to stop it, but they sent it anyway. What a waste of tax payer money! All these PBMs are publically traded companies so you can google their quarterly profits, some of them in the Billions of dollars a quarter. Meanwhile they continue to hurt independent pharmacies with their negative reimbursement, DIR fees, and 'Claw backs', we are losing thousands of dollars a year to these 'schemes' implemented by the PBMs and no one is stopping them from destroying pharmacy. Every week we deal with patients who complain: 'my mail order did not send my medicine can I buy some? 'My mail order made a mistake on my medicine, can I get the right thing? 'My mail order send me x number of bottles of this, and the Dr discontinued the med, what should I do with these bottles? PBM's continue to force patients to their own pharmacies, whether it is mail order, or places like CVS. There is not a CVS in my county, but that is the only 'preferred pharmacy' for some Medicare care plans in my county. Of course the plan is an Aetna plan. It is only going to get worse if this merger is approved. PBMs should be held accountable or be eliminated. They are an unnecessary burden on the health care system, and have driven up costs dramatically. Instead of drug companies competing to keep prices low, having patients and Doctors in charge of their health care, these PBMs keep the profit, mandate care, whether appropriate or not and steer patients to their own pharmacies and Drs to write from drugs they get kick-backs for, or in MEDCO's case they own the drug manufacturer, so they steer claims to their own drugs. It is shameful.