PBM Takeover

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Here’s something to consider when it comes to consolidation and access to health care. Take a look at those who process your medicinal orders and who you may depend on for your mail order prescriptions. Pharmacy Benefit Managers, or PBMs, are the third party supervisors that manage our prescription plans. They are an integral part in keeping our nation healthy with cost effective strategies. Yet, we are in danger of losing the benefits they provide.

Two of the three largest PBMs, Medco Health Solutions and Express Scripts, have proposed a $29 billion merger that would end competitive benefits for those who need it most. The acquisition of Medco Health Solutions by Express Scripts would expand their client base to 135 million and dominate over 30% of the market. This would also lead to control over 59% of the mail order market, a primary mode of income for PBMs.

The potential for a monopolization of the third party pharmaceutical market has many groups worried about the very real possibility of increased costs for consumers. Officials advocating for the merger have suggested that market dominance could decrease cost. But a collection of 23,000 independent pharmacies, the National Community Pharmacists Association (NCPA), have said the merger “would quite simply make a bad situation much worse for American employers, government agencies, consumers and pharmacists.”

NCPA spokesman, Joseph Lech, stood before the House Judiciary Subcommittee on the Intellectual Property to speak on the monopolistic intentions of Express Scripts saying,

“Over my 25 years in pharmacy, I have seen the large pharmacy benefit managers relentlessly gobble up smaller and medium-sized PBMs to reduce competition. The result is a highly-concentrated, consolidated marketplace. Yet, drug spending continues to go up, not down.”

The diluted market, if Express Scripts buyout were allowed to absorb the 3rd largest PBM in Medco, would allow for Express Scripts to dictate mail order bills to the entire country. The control of 59% of the mail order industry leaves no competition and consumer prices could skyrocket from corporate greed.

By 2016, specialty drugs will make up 8 of the top 10 drugs sold on the market. By and large, specialty drugs, which cost an average of $1,867, are sold through mail order. That would give Express Scripts, with 59% mail order dominance, unparalleled control over a market that determines our very health.

This is not just a Wisconsin issue. This affects everyone if the is merger is approved. The anti-trust violations are right under our collective noses and this merger has no positive outcome for the average citizen. Research the merger yourself and then take a step forward by contacting your United States Congressman. It is well worth the effort.

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