Understanding Competition in U.S. Prescription Drug Markets: Entry and Supply Chain Dynamics
I am a neighborhood pharmacist serving an urban population of patients that includes newborns to great-grandparents. I have been a pharmacist & owned pharmacies for more than 20 years." 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 ..." 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. I look at it like this... When a company (the PBM) is supposed to be managing prescriptions & keeping drug costs down (and they fail to do so since they are skyrocketing), yet manage to attain RECORD profit year over year ... shouldn't that system get another look at? Why are we allowing a middleman who manages prescriptions to profit and allow costs to rise so much. This middleman would get fired in any other circumstance. Then we have 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 In addition to 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. I have included 3 screen shots (patient info removed) of the same prescription on 3 different dates 09/29, 10/26 & 11/22/2017. Please note how CVS/Caremark decided to change the reimbursement of $13 in September to just over $2 in October and back to $13 after the PSSNY (Pharmacist Society of the State of NY) began threathening lawsuits for their invalid actions. These companies have way too much power over the public and pharmacists. There is also a 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. We need the FTC to unwind the damage caused by the unchecked, unregulated practices of big business PBMs.... if we want to find the wasted and fraud money... we MUST start with the PBM's... the money is there!