By Brian Scott-Smith – www.connecticut-east.com
If you’re taking prescription medication and if you have Medicare Part(D) Drug coverage, you know how expensive it’s become.
If your health policy has either Express-Scripts or Prime Therapeutics as their Pharmacy Benefit Managers (PBM’s) on it, then you need to read on.
Both companies, according to the National Community Pharmacists Association (NCPA), are considering a partnership which they say, “Will squash local pharmacies and ultimately limit consumer choices.”
Doug Hoey is the CEO of NCPA and says, “These two companies operating separately already exert tremendous downward pressure on independent pharmacies. By joining forces, they can put many out of business and steer their patients to larger competitors.”
The NCPA is so concerned about this, they have written to all the States Attorney General’s Offices asking them to scrutinize the possible partnership.
Express-Scripts and Prime Therapeutics are two of the largest PBM’s in the country.
With Express-Scripts, owned by Cigna, controlling prescriptions for 75 million patients across the country and Prime Therapeutics, owned by a consortium of Blue Cross Blue Shield companies covering 30 million patients in 18 States.
In April of 2020 they formed a partnership to combine their negotiating power and, according to the NCPA, has already triggered sharp cuts in reimbursements to local pharmacies meaning they are filling prescriptions for patients often at a loss.
And in some circumstances those pharmacies are seeing patients steered away to a larger competitor or into Express-Scripts mail order pharmacy if they don’t agree to new contracts.
Express-Scripts has already been sued over anti-competitive practices before and currently the Attorney General of Ohio, David Yost, has filed a suit against Express-Scripts alleging the PBM was able to ‘pocket millions’ by overcharging the state’s Highway Patrol Retirement System, a public pension fund.
Express-Scripts in a statement about the case deny the allegations in the lawsuit saying they will, “vigorously defend itself as the matter proceeds.”
By partnering, rather than merging, the two companies can avoid certain regulatory and legal issues while benefitting financially from their respective percentage ownership of the new entity.
Connecticut’s Attorney General’s office said they had not received the letter from the NCPA when I initially contacted them about the matter, having pressed them for a statement on the issue their spokesperson, Elizabeth Benton emailed back the following, “ We do not currently have an open investigation, but we are watching this matter closely, along with our multistate partners who are all jointly committed to protecting competition and driving down the cost of prescription drugs. Connecticut is leading the nationwide multistate investigation and litigation regarding widespread antitrust violations in the generic drug industry, and we are keenly focused on matters regarding the high cost of prescription drugs and the impact that has on families here.”
The upshot to all of this is we ALL need to be talking more about this and contacting out local legislators and demanding they do something about it too.
And as Hoey says, “If you are being adversely affected by fewer choices, steering, mail order, higher copays and in particular Medicare related concerns, then contact Centers for Medicare & Medicaid Services on 1-800-MEDICARE (1 800 633 4227) and speak to them”
We can’t fix the problem if no one knows about it.
Brian Scott-Smith is a local broadcast reporter and producer with over 20 years experience in the news, TV and Radio business.
