Pay Our Trusted Pharmacists Fairly & Provide Access Through Coverage
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Per a recent consumer reports study, most patients prefer independent pharmacy (Gill,2018). Unfortunately, many are not allowed to have a choice in accessing their trusted pharmacy for coverage of their life-saving medications as pharmacy benefit managers such as CVS Caremark, Optum RX, and Express Scripts have removed this option from our coverage as they forcefully steer patients to their owned pharmacies; although, across our nation news reports are highlighting the price gouging that is occurring behind the scenes as we are being forced to their pharmacies.
For example, recently medications that were filled by a hospital pharmacy were suddenly forced away from the hospital pharmacy to the insurance company's pharmacy benefit manager's owned mail-order pharmacy. It wasn't because our pharmacy was unqualified; they fill medications for children's transplant, cancer, and many other specialty medications every single day. The reply received from the insurance company's pharmacy benefit manager for the reason for denial stated that the pharmacy was not an appropriate location to fill these medications. Many would argue they were the most qualified and appropriate.
The unethical forcing and steering to a pharmacy outside of our trusted pharmacy is an issue with pharmacy benefit managers (PBMs) who control access and reimbursements. There is about an 80 percent chance your PBM is Express Scripts Optum RX or CVS Caremark. Sadly, these same pharmacy benefit managers force many to their own mail-order and retail pharmacies. For my family, our only in-network pharmacy is CVS and CVS mail-order pharmacy. The PBM, of course, is CVS Caremark. Life-saving medications, like my son's transplant medications, are mandated to only be received through the mail for coverage. This issue is not unique. It's happening across America.
Recently, a news article stated that CVS paid their own pharmacy much more. "For example, CVS would have to pay Walmart and Sam’s Club almost half again as much — 46 percent more — for generic drugs if CVS were to equal the rates it was paying its own pharmacies" (2019, Candisky & Schladen)"
When looking at the reimbursements of our independent pharmacies, unfair and unequal reimbursements are found. "For a Fentanyl Patch 100, CVS pharmacies were reimbursed $400.65 while mom-and-pop pharmacies were reimbursed $75.74. For Amoxicillin, CVS pharmacies were reimbursed $35.92 while mom-and-pop pharmacies were reimbursed $12.21 (Lopez,2018)" Upon speaking to many pharmacists, these reimbursements are barely enough or not enough to cover their overhead cost along with the cost of the medications.
After these unfair reimbursements Business Insider notes, "They also didn't know that, as their local pharmacists were getting squeezed, CVS was waiting in the wings, sending out letters offering to buy the very mom-and-pop shops it was forcing out of business (Lopez,2018)."
In Ohio alone, over 160 independent pharmacies have closed. Many were bought out by CVS and many did not reopen. These closures are leaving entire communities at loss of a critical healthcare provider to help them demonstrate how to use complex medications, to inform patients that it may be cheaper to pay cash instead of using their insurance card, to prevent patients from being forced to take the many risks of mail-order pharmacy such as delays, lost packages, thefts, loss of potency of medications due to lack of temperature monitoring, the risk of children and pets ingesting medications, and no one to communicate face to face with our elderly and people with chronic conditions.
The over-performance and hard work of our trusted pharmacist should be greatly rewarded not overlooked and disregarded. For example, CVS often states that they are paying per performance. For example, CVS states they pay the pharmacy based on factors such as patient adherence and use of generics. They often measure adherence by medications refilled by the customer. However, for some customers who are discarding medications by the table full due to auto refills and the price gouging of taxpayers dollars when generics are filled, many patients argue that the performance reward should go to our independent, community, and hospital.
Often, when a medication is refilled and the mail-order pharmacy has delayed the medication for days and weeks or one of many incidents that can go wrong with mail -order happens during shipment, our trusted pharmacies will fill an emergency prescription. What will happen as our trusted pharmacies close their businesses due to unfair reimbursements? Where will we go?
The insurance company's pharmacy benefit managers are hoping that we are all sleeping at the wheel. That we are not caring about the future of our pharmaceutical care. Let's unite and the PBMs and our regulators otherwise!
YOUR SUPPORT WILL SAVE LIVES
The greatest way that you can help is by sharing this petition & gathering 2-3 people in your community who are having issues and speak to your legislatures.
You may also make a tax-deductible donation to our advocacy and join with our trusted pharmacies who are working hard to fight against this unethical business practice.
Candisky, Cathy, and Schladen, Marty, and . “CVS Paid Itself Far More than Some Major Competitors, Report Says.” Gatehouse Media, Gatehouse Media, 2019, gatehousenews.com/sideeffects/cvs-paid-far-major-competitors-report-says/.
Gill, Lisa L. “Consumers Still Prefer Independent Pharmacies, CR's Ratings Show.” Product Reviews and Ratings - Consumer Reports, 7 Dec. 2018, www.consumerreports.org/pharmacies/consumers-still-prefer-independent-pharmacies-consumer-reports-ratings-show/
Lopez, Linette. “What CVS Is Doing to Mom-and-Pop Pharmacies in the US Will Make Your Blood Boil.” Business Insider, Business Insider, 30 Mar. 2018, www.businessinsider.com/cvs-squeezing-us-mom-and-pop-pharmacies-out-of-business-2018-3
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