Understanding Competition in U.S. Prescription Drug Markets: Entry and Supply Chain Dynamics
I am an independent pharmacist serving many communities from a five store corporation. Our corporation was established 94 years ago and we have survived, as you can imagine, many changes in the marketplace, while still providing optimum care for our patients. 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 prescription drug (usually a generic). In other words, PBS's (such as CVS-Caremark) sign agreements with "Brand Manufactures", to receive rebates (kickbacks) and disallow claims for generics. This practice alone, cost patients and their employers millions of dollars each year and drives up-the cost of healthcare! "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....". Furthermore, I believe, the current relationship between CVS, CVS-Caremark, CVS mail order and CVS PBM is already illegal, restriction of trade, collusion, "drug and patient steering", deception, fraud and abuse, price diverting, spread-pricing, and a monopoly! "PBM's are NOT the helpful, cost-saviing third part 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 p,an 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 the 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 PBM'S have over the out-of-control cost of healthcare." The pending CVS Health merger with Aetna, will tip the balance of power to CVS in an environment that already fosters abuse of power without checks and balances. This merger would allow CVS to control the market from soup to nuts. They will aggressively promote their mail order pharmacies (which on an equal playing field) cost much more than independent pharmacy and certainly don't provide ANY care, consultation or supervision on medications. They will also provide independent contracts that pay less than what CVS and CVS mail order pharmacies are paid, while stating "they are saving the plan spronsors money. They will discriminate (as they already do) against independent pharmacies and provide "discounted co-pays" to patients for using CVS and CVS mail order pharmacies. They will include provisions and restrictions in independent contracts that will restrict us from dispensing a 90 day supply of meds, while promoting themselves as the ONLY way to receive the 90 day supply and save money. They will continue to MAC drugs at their own discretion, with total disregard of the true cost of certain drugs. They will continue to "spread-price" and promote their pharmacies as "cost-saving", while in actuality WE rarely receive the "amount we bill" (this is the figure they use) and what we actually get paid Misn't the total amount paid. The PBM takes a cut out of the reimbursement-> " SPREAD-PRICING". PBMks also profit by keeping all or most of manufacturer's rebates rather than passing them on to the plan payers, defeating the purpose of the rebate. There is a true conflict of interest!