Understanding Competition in U.S. Prescription Drug Markets: Entry and Supply Chain Dynamics #00423

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Understanding Competition in U.S. Prescription Drug Markets: Entry and Supply Chain Dynamics
I am an independent pharmacist serving a rural community population of patients that includes newborns to great-grandparents. I have been a pharmacist/owned a pharmacy for almost 30 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 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. Many of today's PBM problems are occurring because of the merger of CVS with Caremark back in 2007. Chain stores regularly cite that mergers like this is to reduce costs and be beneficial to the patient. However, this is not the case and only the insurance company and PBM benefit. PBMs profit by keeping all or most of manufacturers' rebates rather than passing them on to plan payers, defeating the purpose of the rebate. CVS/Caremark must be doing these kinds of practices because each year they profit more according to Wall Street, even though reimbursements are becoming less for everyone else. Another major 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, especially the elderly, who cannot fill a prescription from their local neighborhood independent pharmacy may not be up to the task of seeking out a new pharmacy, choosing instead to forgo their medications and risk their health. I ask you to ask the question "where is the money going" and you will find that the PBMs are responsible for many of these wrong practices. 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