Today, it's critical for everyone to share their issues or concerns about PBMs with the Federal Trade Commission (FTC). The FTC is again taking public comments about how pharmacy benefit managers (PBMs) that have merged with mail order pharmacies such as Optum RX, Express Scripts, and CVS Caremark interfere with patients’ accessibility and affordability of medications.
If you would like to comment: click here. Select "Browse Documents." Scroll down and select "Comment." There is an option to make your comment anonymous.
My advocacy began after CVS Caremark forced us away from our trusted hospital pharmacy to their own CVS Mail Order Specialty Pharmacy that doesn’t properly store most medications during shipping as they don’t correctly monitor temperatures of or protect most room temperature medications. Forcing to mail order also forces patients to risk lives with delays or interruptions in treatment. The PBMs call this pharmacy steering. They will often set the patients' prices at their competitors’ pharmacies higher than at their own pharmacies. In my child’s case, they raised the cost of what we would pay for his lifesaving medications to 100%, raising our cost from under $100 to the thousands if we used another pharmacy other the PBMs own pharmacy. This alone should raise the eyebrows of the FTC commissioners as their primary function is to protect “consumers by stopping unfair, deceptive or fraudulent practices in the marketplace.”
In my case, I have several complaints to the FTC as we were:
- Forced to a pharmacy that isn’t regulated by the FDA or adequately by the State Boards for pharmacy.
- Forced away from a trusted pharmacy staff that works closely with our son’s physicians, that knows my son personally, and his conditions.
- Forced to risk our child’s life with delays.
There are many other ways that PBMs hurt patients and our communities. For example, PBMs work out deals with drug manufacturers and create a restrictive formulary or list of covered medications. Often, the medication that makes the covered list may not be the best medication for the patient's health or affordability. The prescription drug that makes the list of medications covered may be the one that makes the PBMs the most profit.
Please share your story with the FTC if:
- Your doctor ever prescribed a medication that your life or quality of life depended on but the medication was denied coverage by your insurance or pharmacy benefit manager.
- If you were steered to a medication that was more expensive.
- If you were forced to a PBM mail order or retail pharmacy such as CVS and found out that the cash price or using GoodRX at another pharmacy was lower.
- Any other related issue.
PBMs not only hurt patients by steering to their own pharmacies, but they are killing America's access to local pharmacies. Frequently, PBMs will purposefully reimburse pharmacists below the costs of their medications. As 3 PBMs (CVS Caremark, Optum RX & Express Scripts) oversee about 80% of America’s prescription drug coverage, pharmacists have no option other than to accept the abusive one-way contracts. As pharmacists beg legislators to protect them, pharmacy closures and pharmacy deserts are erupting across our nation.
PBMs often force patients to their own retail pharmacies too. For example, CVS Caremark has merged with CVS. They will sometimes require that patients only receive coverage for medications if the patients use CVS even if CVS isnt' the closest pharmacy to their home or town.
Allowing PBMs to force to their own pharmacies has hurt the entire future of pharmacy as many passionate, caring pharmacists and technicians are leaving the profession due to abusive and unsafe corporate retail pharmacy environments. Even prior to Covid, pharmacists at corporate chain pharmacies appeared on news headlines across our nation due to understaffing and unsafe working conditions. New York Times stated that one CVS pharmacy was cited with a 21% error rate. Some pharmacists feel trapped. As CVS often buys out pharmacies after reimbursing them below the costs of their medications, they are left with few other options to work.
The list of abusive PBM practices is much longer. I'm asking you today to please share your own experiences.
Save lives today by using your voice. Click here for the link. Again, go to Browse Documents. Click Comment.
Thank you for your support!
Loretta Boeing, Patient Advocate
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loretta@uniteforsafemedications.com