Understanding Competition in U.S. Prescription Drug Markets: Entry and Supply Chain Dynamics
I have been an independent pharmacy owner in Arizona for over 12 years, providing pharmaceutical care to a wide variety of patients with multiple healthcare needs. Independent pharmacies are in a crisis on trying to stay in business for one reason alone, Pharmacy Business Managers (PBMs). Three of the largest PBMs (CVS/Caremark, Optum, and Express Scripts) comprise almost 80% of the PBM market. Their size in the market, along with the fact that there is no regulating body above them, has allowed them to engage in many anti-competitive/anti-trust, abusive behaviors to pharmacies. Through "take it or leave it" contracts with gag clauses, DIR fees, below cost reimbursements, steering of patients to their own pharmacies, preferred copays at mail order, multiple undisclosed MAC lists, denied MAC appeals, and changed reimbursements at a flick of a button, independent pharmacies are being forced out of business, leaving many short of suicide. Even last month, CVS/Caremark changed reimbursements to pharmacies in NY, OH, PA, KY, and FL to below cost reimbursements with no explanation, and many without ability to back bill to correct reimbursement amounts, while dictating that they must appeal individually themselves and not automatically through their PSAOs as usual. But who cares about us lowly, small business backbone of America, healthcare heroes to our patients anyway. No one, as we die off. The many ways we can save our patients and reduce healthcare costs lost forever.... But we aren't here today talking about how PBMs are single handedly taking down the independent pharmacy industry. We are talking about lowering drug prices. PBMs are giant because of increased drug prices. Rebates, non-transparent drug prices and contracts, and PBM owned pharmacies/mail order are some of the ways PBMs are raising drug prices. Since I can't talk about "trade-secrets", I can't give you the details. To reduce drug prices, the FTC needs to: demand/enforce a PBM oversight/regulation authority, require PBM transparency, mandate disclosed MAC lists with non make-believable drug prices, disallow gag clauses in PBM-pharmacy contracts so pharmacists can tell the public about abuses in the health care system and help patients freely, enforce PBMs to act as fiduciaries, abolish rebates, DIR fees, and co-pay clawbacks, disallow PBMs from owning their own retail and mail-order pharmacies, AND do not allow PBMs to own insurance companies. The PBMs are public traded companies. Their loyalties lie in showing profitability to shareholders, not to the health of the patients. CVS became the 7th largest corporation in the United States not by accident, but by "trade secrets" and hiding behind private non-transparent contracts. It is time for their pillaging of our health care system to stop. You, FTC, are the only ones who have the power to make a difference. For the sake of the American public, our future relies with you.