A national coalition of US pharmacists and pharmacy owners has begun a public information campaign to “expose the unjustifiably high prices of prescription drugs set by pharmacy benefits managers [PBMs].”
The coalition, Pharmacists United for Truth and Transparency, which has members in 40 US states, describes PBMs as an “unregulated, multibillion-dollar industry” that controls prescription health plans for more than 200 million Americans and says it has begun the campaign to protect benefit plan sponsors and enrollees from overpaying for prescription drugs.
“Pharmacists are in a unique position to compare actual prescription drug prices with the amount PBMs charge for the same lifesaving medicines,” said David Marley, a founding member of the coalition.
“Americans will demand swift and serious reforms when they see examples of their outrageous mark-ups,” he added.
For example, the group says, it obtained PBM price sheets and claims data last month which shows the lack of transparency in one PBM contract had led the plan sponsor to overpay for prescription benefit by nearly $2 million over a three-year period.
“The need for greater awareness of PBMs’ roles in the American healthcare system grew stronger in July, when Express Scripts and Medco Health Solutions announced merger plans that would create the largest PBM in the nation,” says the coalition. It notes that a bipartisan group of 14 Members of Congress has recently called for a “full and thorough investigation” of the proposed deal by the Federal Trade Commission (FTC), warning that an unregulated merger of the two PBMs would give the new entity “the ability to raise prices and/or block pass-through pricing for plans and patients, ultimately limiting critical access.”
“There is no part of the health care industry more egregious, harmful or rife with corruption than PBMs,” said antitrust attorney and former FTC policy director David Balton. “The fact that the profits of the major PBMs have increased by over 400% in the last five years is proof that our health care system isn’t working,” he added.
Meantime, another coalition – Preserve Community Pharmacy Access NOW! (PCPAN) – held a press conference in Washington DC at the end of last week to urge the FTC to reject the Express Scripts/Medco merger.
Douglas Hoey, chief executive of the National Community Pharmacists Association (NCPA) told the meeting that the current PBM marketplace is “flawed, and we fear matters will only get worse if the Express Scripts/Medco mega-merger is approved.”
The merger would give one corporation control of nearly 60% of the mail-order pharmacy market and 52% of the specialty pharmacy market, and could mean “more wasteful mail-order spending and higher price spikes for specialty drugs,” said Mr Hoey.
The already-limited pharmacy management options for the largest health plans, including the federal government, “will grow further captive to the major PBMs,” he warned, pointing out that 42 of the Fortune 50 largest US companies use the “Big Three” – Express Scripts, Medco or CVS Caremark.
“It is safe to say that if the merger is green-lighted, the remaining two companies would face little if any resistance to raising costs, reducing choice and otherwise putting their own interests ahead of those of employers, patients and others,” said Mr Hoey.
