Understanding Competition in U.S. Prescription Drug Markets: Entry and Supply Chain Dynamics #00259

Submission Number:
Sam Rahman
Initiative Name:
Understanding Competition in U.S. Prescription Drug Markets: Entry and Supply Chain Dynamics
Raj Patel: State the problem as you see it: As a pharmacist, I am the patient's trusted partner and last line of defense for prescription medication care. PBMs are compromising that trust by forcing the use of contractual "gag clauses" that require my silence when I see a less expensive, but equally effective alternative to a prescribed drug (usually a generic) ... "Although drug prices are skyrocketing, non-PBM-owned pharmacies are being reimbursed drastically below cost. Meanwhile, PBMs force patients to use PBM-owned mail order and PBM-owned retail pharmacies (like CVS) in order to save on their copays. This is anticompetitive behavior that downgrades pharmacy and the seriousness of prescription medical treatment, as if buying prescription drugs were the same as buying dish soap or paper towels ..." Ask the FTC to take action: "PBMs are not the helpful, cost-savings third-party administrators they portray. They are industry middlemen profiting at every stage of the prescription drug supply chain from the manufacturers and the dispensers to the plan payers and patient. They are driving up drug prices, promoting the use of certain drugs over others, forcing medical providers to remain silent and costing patients and taxpayers tens of millions of dollars every year. The FTC's mission is to protect consumers and prevent anticompetitive business practices. On behalf of patients, drug plan sponsors and small business pharmacies who depend on trusting relationships with their patients, please intervene in these unregulated entities and break up the enormous power PBMs have over the out-of-control cost of healthcare." OTHER TOPICS YOU CAN MENTION The pending CVS Health merger with Aetna, which will tip the balance of power to CVS in an environment that already fosters abuse of power without checks and balances CVS/Caremark's unannounced change to MAC reimbursements beginning Oct. 26, which resulted in even deeper cuts to reimbursements that were already far below cost How PBMs profit by keeping all or most of manufacturers' rebates rather than passing them on to plan payers, defeating the purpose of the rebate The conflict of interest arising from PBMs who administer drug benefit plans, and then mandate plan enrollees use PBM-owned pharmacies, including mail order, to "save money" on copays Patient choice is limited and their rights infringed upon. Patients who cannot fill a prescription from their local neighborhood pharmacy may not be up to the task of seeking out a new pharmacy, choosing instead to forgo their medications and risk their health. DON'T LET THIS OPPORTUNITY TO SPEAK UP PASS YOU BY! The FTC was founded with the intention of protecting the needs of the American public. They are charged with enforcing anti-competitive behavior - like preventing the mergers of giant entities (such as CVS/Aetna) and stamping out obvious conflicts of interest such as PBM mandates that force plan participants to use PBM-owned pharmacies and PBM-owned specialty pharmacies, or brand name drugs from "preferred" manufacturers. We're calling on the FTC to unwind the damage caused by the unchecked, unregulated practices of big business PBMs. While it's daunting to think about posting to a public forum, we've seen a number of victories lately as our members take actions one brave step at a time: commenting in public, asking for legislators' attention to PBM abuses, asking patients to tell their stories, participating as a named or unnamed source for a media story or sending updates, news story ideas and other thoughts to PUTT's Communications Director.