Tomorrow is the last day to submit comments to the Federal Trade Commission, Department of Justice, & The Department of Health & Human Services on the issues with healthcare consolidation. Submit yours here! If you're rushed on time, submitting a simple 2 to 3 sentences can still be helpful.
Mine was different as I know most pharmacists cannot speak about issues with regulatory boards without fear of retaliation. Your comment doesn't have to mention the State Boards of Pharmacy. Please submit your comment about whatever issues you're facing in accessing the medications, pharmacies, or care that you need due to the consolidation in the healthcare industry.
Many pharmacists can comment on the issues with healthcare consolidation. Few pharmacists can speak openly about how healthcare consolidation is interfering with the ability of regulatory boards to serve their purpose and protect patients from harm without fear of retaliation from the Boards or the PBMs. As a patient advocate, I can and will. Here is my comment to the FTC, DOJ, & HHS:
The consolidation in healthcare has consequences that have led to a concentration of power that has resulted in regulatory boards having insufficient ability to protect patients.
My son is a transplant survivor. My advocacy began after being forced to mail order pharmacy, and I learned about loose regulations as most room-temperature meds are shipped in bags, exposed to up to two times room temperature in trucks and mailboxes. Many encounter delays without protection or justice. Upon uniting with others about these issues, I uncovered pharmacy benefit managers (PBMs).
I started a petition on Change.org with over 220,000 supporters to stop the forcing to mail order. See the attached comments. Names from the public comments have been omitted but can be provided.
PBM mail order pharmacies, and large chain pharmacies have developed a stronghold on some Boards of Pharmacy and the National Association of Boards of Pharmacy. Many Board members hold positions at large PBMs or corporate chains. Other members receive up to 80% of their reimbursements from three PBMs: Optum RX, CVS Caremark, & Express Scripts. Standing up for patients can have significant consequences for any Board member or pharmacist. One pharmacist who talked to a Board about the issue faced an audit by a PBM afterward, resulting in the loss of thousands of dollars.
To illustrate the influence PBMs and corporations on regulatory bodies, consider my experience advocating for proper temperature storage at a Florida Board of Pharmacy. Despite the importance, members opposed regulations to ensure patient protection. One of the members was from Walgreens.
Recently, I addressed the Texas Board of Pharmacy regarding temperature regulations. I witnessed the same Walgreens Board member on Florida's Board also serving as a lobbyist for the corporation, attending other Boards of Pharmacy to protect corporate profits. I was appalled to see that he walked to the front and spoke against temperature regulations in Texas. I confirmed that this Walgreens lobbyist still held a seat on Florida's Board.
After speaking to the Arizona Board alongside a patient who received melted meds, the Board met with large mail pharmacies. One Board member questioned the complexity of regulating temperatures across state lines. One member stated that it would be a "nightmare on the mail order pharmacies." These protections should have been in place before patients were forced to mail order pharmacies or shipping across many state lines. One attorney stated that this was a perfect example of regulatory capture.
An Express Scripts lobbyist claimed that questionable meds are quickly replaced. This has not been the experience for many. PBMs mail order pharmacies have 1-star ratings on many consumer sites. The Better Business Bureau (BBB) issues a warning for Express Scripts, stating, "BBB is advising consumers to use caution when considering doing business with Express Scripts. BBB has received a pattern of consumer complaints alleging delays or failure to ship correct prescriptions or meds; failure to accept returns or meds which were shipped in error; failure to issue refunds..."
At an Oklahoma Board meeting, a CVS lobbyist spoke against a regulation for safe temperatures, stating that they receive meds hot, so how can they tell their pharmacists not to ship meds the same way? Unlike mail-order pharmacies, the FDA regulates drug manufacturers, and CVS should be filing complaints if meds arrive hot to the touch. These meds should not be shipped out once again, risking further adulteration.
Per the attached NBC report, a CVS lobbyist stated," 'If you're requiring the pharmacy to ship in this way, and you [the pharmacy] receive those medications, and they feel warm, the pharmacist can refuse them,' she said. 'But at what point does that hinder patient access by not having medications in the pharmacy?'
Hendricks, the board director, pushed back. 'So we would hinder access to a medication that could possibly be not good with that [requirement] — wouldn't that be a good thing?'"
During public comment on the proposed rule, Express Scripts threatened to sue the Board. See the attached NBC news report stating, "It also urged the board to instead require pharmacies to follow existing accreditation standards that Express Scripts already does, and asked the board to 'be mindful that standards it sets may be subject to legal challenges.'"
Some Boards demonstrate willful blindness by enabling mail-order pharmacies to justify the adequacy of med storage based solely on outside air temperatures. However, since the late 1990s, we have been aware that the interiors of delivery trucks and mailboxes can reach temperatures of 120-170°F in summer. See attached meeting notes.
I encounter a bureaucratic maze when I attempt to address concerns about the Boards inability to protect patients. Calls to my Attorney General leads to redirection to the Governor, as the Attorney General's office cites its commitment to defend the State Board in lawsuits.
I have reached out to other agencies. The Department of Insurance referred my complaint to the Department of Labor, which deemed PBMs' coercion of mail-order pharmacies from which they often receive complaints unethical but not illegal. Seeking recourse through the Center for Medicare and Medicaid Services led to instructions to file complaints with the same PBMs and their mail-order pharmacies implicated in fraudulent practices.
Filing complaints with the Department of Justice yielded no response despite my efforts. Attempts to contact the Department of Health and Human Services and the FBI were similarly fruitless, with reports seemingly not taken seriously by the authorities. The FBI asked what crime was committed by the PBM-owned mail order pharmacies. What would the consequence be if I improperly stored my child's life-saving meds, knowing the risk to his life?
Recently, a new job meant that our family was again forced to use CVS mail-order. I asked a CVS pharmacist to contact the manufacturer and ask what temperatures the manufacturer states are safe. The pharmacist confirmed with the drug manufacturer that it was no more than 86 degrees and should not freeze. Yet, the pharmacist confirmed that they'd ship the med without protection.
My husband spoke to his employer, which reached out to CVS. See the attached letter to understand how CVS manipulates employers. CVS claimed they ship all meds from CVS Specialty overnight and injectable meds like insulin are shipped in a refrigerated mailer or box. I later confirmed that this is not how CVS would handle our son's meds, so our family dropped our employer-sponsored coverage for our son.
These experiences highlight the real harm of healthcare consolidation. Despite persistent efforts to challenge this status quo, patients remain trapped in a system that prioritizes corporate interests over their well-being, as powerful corporations dictate the rules. This system prioritizes profits over people in a most unethical way, leaving patients vulnerable and regulatory bodies compromised.
Loretta Boesing, Patient Advocate