Understanding Competition in U.S. Prescription Drug Markets: Entry and Supply Chain Dynamics #00459

Submission Number:
00459
Commenter:
Walter Cwietniewicz
State:
Pennsylvania
Initiative Name:
Understanding Competition in U.S. Prescription Drug Markets: Entry and Supply Chain Dynamics
I am a (neighborhood/independent/community) pharmacist serving an urban population of patients that includes newborns to great-grandparents. I have been a pharmacist for 34 years. Have worked at this store for 46 years and owned it (Ellis Pharmacy) for 29 years and I'm only 57 years old. I can't remember such a mess in our healthcare system as we have now! We have PBMs ( so called benefit managers who only manage to benefit themselves!!) that are ripping off the government, public & independent pharmacy. One of the reasons that drug prices are so high is because the maufacturers have to give rebates to the PBMs to be a "formulary drug" and so covered by the insurance!! The insurance companies also are a huge reason the healthcare system is a mess. AND YOU CAN'T FIX THE PROBLEM BY USING THE PROBLEM(S)!!! 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). Also they have clawback methods where I'm told to collect a large amount from the patient and the PBM "claws" the money back from me most of the time making the amount I actually get paid BELOW MY COST but ripping the patient off!! Also one PBM at the end of October reduced drmatically what they pay us for generics --far below my cost! I have tried to call their complaint line at least 20 times but it is always "mailbox is full". To the same PBM I have sent at least 20 MAC appeals about the prices but I have not gotten any responses , even though per PA law they have to respond in 7-14 days. But our insurance commission REFUSES to enforce the law!! One would wonder why anyone would sign such contracts with these PBMs. Well "contract" usually infers some type of negotiation-HOW WRONG THAT IS!!. The contracts we get are TAKE IT OR LEAVE IT!! And I have to say we , independent pharmacy have NEVER gotten a raise in a contract dating back to the early 1990s if not before that! 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 AND reimbursing themselves much more then what they pay us!!. 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 .. Basically they ARE TRYING TO PUT US OUT OF BUSINESS! Remember the robber-barons of the early 1900s?? When only CVS & Walgreens are left it'll be to late!! How's that duopoly with Comcast & Verizon working out? Prices going down----NOT!!!! "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. We just want fair reimbursement, a level playing field. And if CVS is allowed to buy AETNA-where are the checks & balances? Healthcare is person to person--not assembly line-don't let it get any more mechanized! TO sin by silence When we should protest Makes COWARDS Of strong men... Thank You, Walter Cwietniewicz RPH