Over half the states are contesting a merger between two of the three biggest Pharmacy Benefit Managers (PBM): Express Scripts and Medco Health Solutions. States are contesting this merger under federal anti-trust laws, on the grounds it would create a monopoly.
What Would a Merger Between the Two Biggest PBM's Mean?
Just like the bean-counters who tell us what services our insurance companies will and will not pay for when we see a doctor, PBM's tell us which drugs we can have and which ones they won't pay for when we go to the pharmacy. Pharmacists are often at odds with PBM's, who audit pharmacies whenever they think they can, ostensibly to save us and our insurance companies money. Statistics along with pharmacist complaints tell us the only people saving or making money are the PBM's, in the form of monetary benefits given to them by drug makers and insurance companies.
How this affects you: Cheaper drugs, generic drugs, and big-box pharmacies.
Here's why it matters to us, the patients. Pharmacy benefit managers are calling doctor's offices every single day, trying to get them to steer patients toward cheaper drugs, generics, and big-box pharmacies. CVS/Caremark was even fined over $25 million for this tactic, because they were requiring patients to use CVS pharmacies, and their own mail-order pharmacies, rather than the pharmacies the patients wanted and had been using for years.
Most patients will pay the same amount for their drugs. The PBM's charge the insurance company a similar amount for the drugs, but because the large drug distributors like CVS/Caremark own these pharmacies, they get monetary rewards from drug makers for selling the drugs they bought at a much lower cost for the same ─ or even a higher price.
Work overload is one of the reasons cited for the high number of prescription mistakes by pharmacists working in retail pharmacies. Specialty pharmacists and doctors are complaining now that ExpressScripts is steering patients and pressuring doctors to switch patients to their specialty pharmacy, CuraScript. Patiens must use this pharmacy for drugs for Hemophilia, Hepatitis C, and drugs that treat autoimmune illnesses, such as Humira, Enbrel, Remicade, and some cancer drugs.
Impact on Pharmacy Errors
It is anyone's guess as to the impact of this proposed merger on the safety of big-box retail pharmacies like Walgreens, Kmart, Walmart, and others. What is known is that the pressure put on the pharmacists and pharmacy techs to fill prescriptions in just two to three minutes is not only unreasonable, but is unsafe for the patients. If these two pharmacy benefit managers merge, it will create even more pressure.
Is Telepharmacy next?
Is the next step going to be where the pharmacist Tweets or Skypes with techs to check the accuracy of their medication fills? Will the pharmacists be allotted only one minute per prescription, so that they are forced to fill 600 scripts in a day, rather than 300? It's hard to say, but we think that if the FTC allows the merger to take place, it really won't bode well for consumers.
If you want to know how to take action against prescription errors, you can order our FREE book to learn more about pharmacy claims. You can then contact our board certified attorneys to review your case free of charge. Contact our office 24/7 by sending a confidential contact form or by calling 888-526-7616.