Understanding Competition in U.S. Prescription Drug Markets: Entry and Supply Chain Dynamics
I own a small town pharmacy in a rural community. I have seen my ability to properly take care of my patients deteriorate over the last couple of years. CVS/Caremark has been a very big problem. The last couple of months the reimbursement rates have been slashed to below our acquisition cost with no fore warning at all. DIR fees are taken back for prescriptions filled 6 months ago, my patients are being told that the only preferred pharmacy on their plan is a CVS pharmacy or their mail order and now we are faced with the possibility of them getting even bigger and stronger. It would be one thing if bigger meant better cheaper care, but it has resulted in more expensive and rationed care. Patient's have lost their ability to choose their pharmacy providers. Patients are paying bigger premiums, bigger deductibles and bigger co payments. In many instances, the pharmacy benefit manager pays the pharmacy nothing- passing all the cost on to the patient as a copay and that copay they are passing is sometimes below the pharmacies actual acquisition cost. It is a fine way to unfairly push your expenses onto the patient and try to eliminate your competition in one move. Pharmacies are presented with a take it or leave it contract with NO negotiations available and many times the patients are directed or incented to use their own pharmacies or mail order. If that is not the exact definition of a monopoly,m than my view and dictionary differs greatly from your. Please do not allow this merger/sale to go through. It will not result in better, less expensive healthcare. It will drive up costs, limit patient choice and continue to line the pockets of PBM's. Thanks for your time.