Understanding Competition in U.S. Prescription Drug Markets: Entry and Supply Chain Dynamics
I am an independently owned community pharmacist serving an urban community in the city and I have owned a pharmacy for more than eight years. The PBM's who are middle-men/businessmen are really interfering adversely in the pharmacists role as the patient's trusted partner in prescription medication care. They make the pharmacist dispense their preferred brands because they probably get a rebate from the manufacturers while there are equally effective less expensive generics available; thereby driving up the cost of healthcare. As owners of retail and mail order pharmacies themselves, these PBM;s infringe on the patient's right to choose their own pharmacy by intimidating the patient's to patronize the PBM owned pharmacies which interferes with the patient's health adversely because there are situations where you see a patient with poorly controlled hypertension, running helter-skelter on a weekend night because their meds did not arrive from the mail order pharmacy and they are totally out of meds. The PBM's on a regular basis, reimburse the non-PBM owned pharmacies below cost making it hard for us to remain in business. I see a conflict of interest here and non-competitive behavior,whereby CVS Caremark will eventually frustrate myself and other independents out of business by constantly reimbursing us below cost and thereby depleting our resources and making it impossible for us to stay in business. Since October the 26th, CVS Caremark reverted to MAC reimbursements, unannounced, further worsening the below cost payments they have been doing. I have filled a prescription that cost $30.75 for Etodolac 400mg, quantity 60 and CVS reimbursed me less than $4.00 total, including the patient's copay of $1.00. This is just one example; the commonly prescribed blood pressure medications like Amlodipine and Lisinopril are constantly reimbursed at less than $1.00 for a 30 day supply of medication and this amount supposedly covers for my professional fees and other overheads involved ion filling a prescription. This leaves me struggling with a back log of wholesaler/supplier bills even in the face of the fact that I let go of my technician and I have to work alone. This means that the PBMS are at liberty to do whatever they desire, with nobody regulating or over-seeing their activities. I am therefore calling on the FTC to check the unregulated practices of these PBM's and undo the damage they have already caused. Yours Sincerely. Independent Pharmacy Owner.