Express Scripts- Medco Merger The Final Straw for Community Pharmacy

I read NCPA’s blog The Dose, and sometimes it takes a few days to get to the email in my inbox with the initial blurb. Today’s talked about a New Mexico independent pharmacist. Being from there, I had to see if it was someone I know. I was impressed and saddened by what was put forth. Instead of just giving you the link, I am going to post the whole blog here. Read on, and then go write your senator with your story.

Blog is found HERE

New Year, Same Problems for a New Mexico Independent Pharmacist

Published January 17, 2012 pharmacy benefit managers 1 Comment

By John Coster, RPh., Ph.D.

NCPA routinely speaks to policymakers (and anyone else who’ll listen) about the value independent community pharmacies provide and the concerns of these pharmacists, which are often shared by their patients as well. Those efforts continue, but there’s no substitute for pharmacists expressing their views directly to elected officials, the local media and others.

One case in point is a recent message from rural New Mexico pharmacist Jake Mossman of Taos Pharmacy, who opposes the Express Scripts-Medco pharmacy benefit manager (PBM) merger, as does NCPA. The former Taos News’ Citizen of the Year passionately articulated his concerns for his pharmacy and his patients in an email to Senator Jeff Bingaman (D-N.M.).

Below are some excerpts from that message, shared here with Mr. Mossman’s permission, as an example of how community pharmacists and patients can get involved, both with NCPA and directly with elected officials.

Our income is down 39.4% for 2011 compared to 2010.  While our prescription volume did decrease by 19.2% this does not account for the severe drop in revenue which is twice the drop in prescription volume.  In addition, the decrease in prescription volume was largely due to the fact that we were unable to maintain adequate inventory on hand to serve our customers timely because of such a significant decrease in revenue. 

 “Our income is 92% from prescription revenue and 90% of that is from third party reimbursement.  As a result of the precipitous decrease we have reduced staff by 6 [full-time employees] and will reduce hours even more this week.  We have had to take all of our 401k money out and a $50,000 mortgage on our home which had been paid off over 10 years ago to continue pharmacy operations. 

 “We are fighting for survival and shrinking as quickly as we can without totally abandoning our employees to stay afloat.  We have changed our software vendor, our PSAO (third party contract representative), and our pharmacy suppy vendors to try to reduce our costs and eliminate the possibilities of revenue leaks.

 “Our financial strength in the past was based upon our high generic utilization percentage.  That has now become our Achilles heel as generic reimbursement has been slashed and product costs have skyrocketed.  Daily we identify claims that we are reimbursed for at less than our cost to purchase the drug.  This is a result of reduced reimbursement rates and increased drug costs.  In the past we have contributed greatly to cost containment to payers by our high generic substitution rates.  Ironically, we are facing insolvency for the same reason.  All of this happened within one calendar year as we noticed the downturn began in September, 2009.

 “Our PSAO must negotiate with Caremark, owned by CVS a mega drug chain and mail order provider, for our reimbursement rates.  We must negotiate with one of our largest competitors for our payments!  The merger of Medco and Express Scripts would dwarf even the CVS/Caremark giant and worsen this situation. 

 “I have always been an enthusiastic, progressive pharmacist.  We have been providing clinical services (cholesterol testing, A1c testing, diabetes, medication and nutrition consultations, and others) since 1996.  We were recognized as Innovative Pharmacy Practice in 2000 by the New Mexico Pharmacists Association.  I was named Citizen of the Year by the Taos News in 2007. 

 “I spend all my time scrambling to squeeze out every penny from the PBMs and my suppliers to avoid failure.  I feel I cannot serve my patients, my community, my employees, or my family in my role as a pharmacist.

 “Independent businesses account for almost 60% of employment in this country.  Independent pharmacies provide inexpensive access to healthcare advice to millions of Americans especially in smaller communities, rural communities, and inner city neighborhoods.  The elimination of independent pharmacies would result in incalculable increased costs to the healthcare system.

 “The hardest ‘pill to swallow’ is the fact that independent pharmacy is actually an important component to reducing the cost of health care delivery.  We can help eliminate avoidable hospital visits if given the time and reward for changing drug therapy to address therapeutic duplications, patient side effects, and lack of adherence.  We are trusted by the public to have their best health interests in mind.  We should be paid to help them achieve the best possible outcomes from their drug therapies.  We can help them reach goals, feel better, stay out of the hospital, and reduce the costs of medication therapy.  If we are lost the system becomes less personal, medication error rates increase and overall health care costs skyrocket. 

 “You don’t have to believe me just read the reports.  Fully one-third of hospitalizations result from problems due to medication therapy that could have been avoided with better care by their pharmacist and primary care providers.”