Recently, there was an excellent op-ed on the Express Scripts/Medco Health Solutions merger by Steven Pearlstein in The Washington Post. I have been covering the potential hazards that this merger would have not only on local community pharmacies, but on the consumers. Pearlstein really outlines why this merger, and in particular, why the merger of two large entities can have a negative impact.
With the merger of Express Scripts/Medco Health Solutions, you would have one major pharmacy benefit management company, who would make the small community pharmacies face the pressures from big retailers and the PBMs. Pearlstein noted:
The independent pharmacists have good reason to be concerned — because of competition from the big retail chains and the PBMs, they’ve become an endangered species. Some of this is the result of competition that is thuggish and unfair and results in inferior and less-convenient service for customers. But some of it reflects the hard economic reality that mail order is a cheaper and more efficient way to fill prescriptions and scale is important when negotiating prices with patent-wielding monopolists in the pharmaceutical industry. Over time, we will miss them the way we miss the local ice cream parlor and dressmaker.
The other issue that arises from this merger is the fact that consumers will not receive the care and attention that the pharmacists at the local pharmacies provide. Many of these pharmacists know their customers and their medical backgrounds, especially in terms of which medication interferes with another.
Will the consumer be able to benefit from this merger without having to pay more? Pearlstein noted that it would all have to depend on the competition of other regional PBMs. With Express Scripts and Medco (two of the larger PBMs) merging, this will reduce the price competition, thus causing the prices to rise.
This merger is a bad idea, and one that could be detrimental to many who use local pharmacies and those who own them. Perhaps, it is time for the Federal Trade Commission to wake up and stop this merger.
Combining Express Scripts and Medco is an opportunity for two leading pharmacy benefit managers to apply private-sector know-how to solve our country’s biggest healthcare challenge: lowering cost while raising quality.
By joining complementary strengths, the merger will benefit patients, employers and managed care plans, leading to safer and more affordable medicines.
It’s important to note that neighborhood pharmacies have been and always will be essential partners in advancing our mission. More than 60,000 pharmacies of all sizes participate in our retail network, including 90 percent of all independent pharmacies.
PBMs play a central role in healthcare. We drive out fraud, waste and abuse while lowering costs and improving health outcomes. We increase adherence to prescribed medicines, identify and correct prescription errors, and promote cost-effective delivery. Our efforts save billions of dollars and extend millions of lives. By lowering healthcare costs for employers, we help boost employment and preserve employee benefits.
Express Scripts and Medco have well-established histories of doing what’s right for patients. The merger would accelerate our ability to do even more.
P.S. Pharmacy consolidation takes many forms. For further information, please see: http://www.stltoday.com/business/local/walgreens-buys-closes-independent-pharmacies/article_5b10d778-1b9b-11e1-858e-001a4bcf6878.html
The Express Scripts- Medco merger is bad for consumers and community pharmacy. I have run my family owned pharmacies for the past 41 years. These companies do not value the services we provide for our patients and their payment structure leaves little if any profit to add services that would improve patient care. I serve an inner city area where my two pharmacies are the only pharmacies. Express Scripts serves the two largest medicaid HMO. When Express Scripts was awarded the contract, there payment structure increased my account receivables by at least 20 percent. I was forced to close another location. These companies are unregulated in most states and have denied me payment exercising professional judgment that the Commonwealth of Virginia grants me.
Everyday I improve the quality of life for my patients. I provide services above and beyond the standards of care. Express Scripts pays me the cost of the medication plus $1,60 for most prescriptions( One HMO saw the value of my services and they had Express Scripts pay me more). The $1.60 is supposed to cover containers, labels, internet fee( Yes I have to pay every time I submit a prescription), insurance, rent, employees) Express Script nets over 3,00 on each prescription it processes. How is this good for free enterprise.
On the consumer side, in too many instances I have had patients denied care without a review by an MD. I had another patient who was locked into a Walgreen’s pharmacy and when the patient wanted to switch to me, the patient was denied services.
As Americans we take too much medication. And the push to fill more prescriptions to maintain the bottom line will end up costly all of us in the long run.
I hope this merger is blocked and that all of the PBMs will look at what they are doing not only to a great profession but our patients each and every day.
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