Hi everyone, 

PBMs like Express Scripts, CVS, and Optum RX decide what medications are on the formulary, determine reimbursements to pharmacies, and determine which pharmacy we can use. Although this feels like a conflict of interest and a monopolistic practice, PBMs often force patients to use their owned mail-order pharmacy as it may be the only option of coverage. They often will charge us less copay to use their mail-order pharmacy, BUT patients should always look at their Explanation of Benefits (EOB)s to see what the mail-order pharmacy has been reimbursed. These may be online where patients log in to pharmacy benefits website while others may be mailed. Some may be alarmed at what they find as there is widespread price gouging happening across many plans as they force us to mail.

As PBMs force us to their mail-order and after researching the reimbursements, many have found that the PBMs reimburse their own mail-order pharmacy much more. For example, an independent pharmacy was reimbursed $125 for a drug that the PBM reimbursed its own mail-order pharmacy $1449 for. I discovered that CVS Caremark reimbursed its own mail-order pharmacy $178 for a drug that cost $50 cash. They reimbursed our trusted pharmacy $24 for this same medication.

Although the copays were less, this will raise our premiums drastically overtime if PBMs are not regulated.  Please, keep in mind that no amount of money is worth the risking of patients lives. This price gouging is just another reason why we must stop the forcing of mail-order pharmacy.

There are many other articles of this happening. As we are forced to their mail-order pharmacy the transparency of cost will be decreased. The doors to our trusted pharmacy will close and many will not have a place to go when they need an emergency fill as medications are sometimes lost, stolen, damaged, and delayed.

Check out your pharmacy benefits to see how much the mail-order pharmacy has been reimbursed for a drug. Feel free to message me what you find and I can look up to see what the average cash price and wholesale price of the drug is. My email is below. 

Thank you, 

Loretta Boesing, Founder of Unite for Safe Medications 

Unite for Safe Medications is officially a nonprofit organization. Please feel free to make a tax free contribution to our advocacy by clicking on the link above.

Email: loretta@uniteforsafemeds.com

Facebook page: Issues with Mail Order Pharmacy @justamomwholovesherson

Twitter: @BoesingLoretta