Understanding Competition in U.S. Prescription Drug Markets: Entry and Supply Chain Dynamics #00477

Submission Number:
Jeff Hetrick
New York
Initiative Name:
Understanding Competition in U.S. Prescription Drug Markets: Entry and Supply Chain Dynamics
I own an independent pharmacy. The issue is that the lower drug prices are not in many times passed through to the consumer. The Pharmacy Benefit Manager (PBM) captures much of this in the form of profits. As evidenced, Express Scripts (ESI) just put out guidance on how to use DAW 9 codes for when generic Viagra (Sildenafil) is beginning to be dispensed next week, but there are times they will mandate the use of Brand Viagra. Now that would not happen if they were being paid a rebate (kickback) from Pfizer that will off-set any cost to the customer along with enriching ESI. They surely would not do it for free. Here in Independent pharmacy where we are saddled with more and more regulations and paper pushing continually to meet the PBM demands although we continue to get paid less and less / claim even though the decrease is faster than the wholesale drug prices are decreasing! Now CVS is angling to purchase the insurance company, Aetna. CVS already owns the 2nd largest PBM in Caremark and thus steers business to their own stores. On Specialty Drugs, they will "steal your refill" by calling the patient on the 1st day it is re-fillable, and asking if they can assist them by sending it "mail order". They only know the Rx exists because it runs through their PBM! No other competitor would know you had filled a script for this patient other than CVS. Thus you loose a script that actually makes you more than $1.99 in profit. (35% of our scripts yield a profit of less than $1.99 / rx !). CVS now owning an insurance company if you allow this to go through will cause them to steer prescriptions and ups their customers of Aetna to use CVS only or preferred services. We need free market competition. If collaborating with CVS is in Aetna's best interest for their business, they can do that through a contractual relationship - they don't have to buy them! That squashes competition as if they only have a contact, then they can evaluate the next better offer from another competitor. If they are owned, there will be no other partner, ever. Doesn't matter if there is a better way. In summation, today's PBMs fatten their own and their stockholders pockets on a daily basis, whether it benefits the customer's health care or not! Sincerely, Jeff Hetrick