CVS Caremark Optum RX and Express Scripts are Pharmacy benefits managers (PBMs) who often force or steer patients to their own pharmacy for critical life-saving medications.

Over the past week, a news reporter confirmed that mail-order pharmacy has risks of medications becoming degraded due to extreme temperatures and that the degradation of medications has been fatal.

Last week, I listened as a professor from Minnesota gave a presentation to a crowd of people as he informed us of patients dying due to delays with mail-order pharmacy. “The insulin didn’t arrive in time.”

One of the most disturbing patient stories of mail-order pharmacy was one of an elderly woman, 74, who was barely literate and unable to read or understand the label. The mail-order pharmacy sent the wrong medication. The patient ingested the medication believing the pills were for kidney disfunction.  After ingesting them, she began to experience “confusion and hallucinations.” Her condition rapidly spiraled downward. She died within about a month later after ingesting the wrong medications sent by the mail-order pharmacy.

The stories have underlying themes. These issues may have or would have been prevented with face to face options with a trusted pharmacist.

Another more disturbing underlying theme in these reports is the blame of the patient. Even in the case with the elderly, illiterate, patient who ingested the wrong medication, the attorneys for the pharmacy benefit manager, stated that patients need to take more responsibility. Even in a more recent article discussing issues with temperature, a pharmacist’s states, “The patient does need to take some responsibility." In reality, we are not given the chance to be responsible when forced to mail-order pharmacy. We don’t even have an option for safe access. PBMs removed options of safe access and being responsible when PBMs forced us to their mail-order pharmacy for the most critical life-saving medications.

Patients want the options for more responsibility and control to ensure that medications are taken correctly by utilizing the face to face consultations that are readily and immediately available upon filling the prescription when we have the OPTION to receive our medications through the hands of our trusted pharmacists. For greed, PBMs irresponsibly removed the option. Patients want to ensure medications are protected from extreme temperature and humidity during transport and that they are not risking their lives with delays. For greed, PBMs irresponsibly removed the option. Even if a patient prefers to mail-order, patients whose lives depend on medications do not want to be forced to risk their lives with only one option of a mail-order pharmacy that hasn’t earned their trust and business. For greed, PBMs irresponsibly removed any other options of using other mail-order pharmacies. As the forcing and steering to PBMs mail-order increases, so does the motivation to prioritize patients and provide the highest standard of care. This can be seen in the most recent J.D. Powers reports showing CVS mail-order and retail had some of the lowest ratings of customer satisfaction, yet, many are forced/steered by CVS Caremark (CVS's PBM) to use only CVS pharmacies. 

The Employers, PBMs (Optum Rx Express Scripts, CVS Caremark), our federal and state governments have removed the patient’s ability to take control and responsibility of their lives and medications as the options for us to receive the highest quality of pharmaceutical care and ensure that we are not risking our lives has been removed.  We are being FORCED to risk our lives and the lives of our loved ones.

Instead of PBMs taking responsibility for the forcing us to risk our lives, patients whose lives depend on medications, are blamed and patients are expected to do a delicate dance around life or death to the loud sound of the PBMs beat in order to receive their most crucial life-saving medications. Most employers and government entities just watch patients are suffering and risking their lives as they do nothing to save the lives of the American people.

As patients, we are told that we should be home to get the medications out of the sweltering 150-degree mailbox immediately. Are we supposed to take off work until we lose our jobs? Then, how would we have health insurance coverage?

Where are our options for us to protect our medications from being shipped in a non-temperature controlled truck studied to reach temperatures of up to 170 degrees? Due to PBMs greed, these options are nonexistent. Where are a patient’s options to ensure that a face to face consult is readily available because of the color, shape, or size of generics changes frequently, patients have a difficult time understanding directions for an injection, or to ensure that patients don’t risk medications being lost, stolen, damaged or delayed? Due to PBM’s greed, they are nonexistent.

Patients didn’t ask for our trusted pharmacists to be removed from our coverage and to have trusted pharmacists replaced with the mail-man and the lowest level of pharmaceutical care. PBMs took high quality and safe access away from patients. It’s time for PBMs and all of those who refuse to act in the best interest of the patient to be held accountable.

Where is the PBMs responsibility and accountability for every patient who has went a day without their medications due to no fault of the patient, for medications being shipped in such high and low-temperature extremes without protection and proper temperature monitoring, and for forcing away the critical life-saving face to face options for those with literacy issues such as patients who are elderly, learning disabled, and chronically ill?

How many lives will be risked or taken by mail-order pharmacy, before Americans can have the best standard of pharmaceutical care once again? Our government officials, The Department of Justice and The Federal Trade Commission’s role in allowing this rapid decline as PBMs force us to their own mail-order pharmacy should be noted and they too should be held accountable.

In the meantime, those who are able must speak to their legislators and demand that patients have the options for the best care. Your voice is the only way that safe options and access to medications will be provided and lives can be saved.

Thank you,

Loretta Boesing, Founder of Unite for Safe Medications

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Share Your Story: Loretta@uniteforsafemeds.com

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