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By Dennis Archer

After graduating from Western Michigan University, I was privileged to teach and work with some very important people—learning disabled children. These children needed a quality education and for someone to stand up for their rights – they needed a voice.

After becoming Mayor of Detroit, I dedicated myself to repairing the relationship between the city and the suburbs—standing with these communities and providing an opportunity for us to come together.

Today, I am “called” to take a stand – on behalf of the citizens of our society who depend on community pharmacies and the services they provide in rural and urban areas across America. These Americans are concerned about their prescription costs and access to services that will be severely limited if the Federal Trade Commission (FTC) approves Express Scripts’ bid to acquire Medco.

The FTC is in the final stages of reviewing a proposed merger between these two pharmacy benefit managers (PBMs). As two of the three largest PBMs in the country, these companies already hold immense market share. If allowed to merge, the new mega-PBM will have overwhelming market power to stifle competition and further promote their mail-order business.

A short list of practices employed by the PBMs include:

•    Exclusive dealing:  As wholesalers, PBMs promote deals with pharmacies to reduce their fees in exchange for access to customers. On the flip side, they also provide drug manufacturers a higher volume of sales in return for discounts and rebates. These dealings lack transparency, are considered proprietary and are undisclosed because their business practices are unregulated. Thus, the patients and insurers do not always benefit from the “so-called” cost savings.

•    Price fixing: PBMs have the ability, without regulation, to deal independently between manufacturers and pharmacies setting drug prices for specialty medication and determining when to use generics. Pharmacies must comply or lose their business relationship, and may be forced to close their doors.

•    Limit pricing: By virtue of using their own mail-order pharmacies, PBMs can easily bypass retail pharmacies, contacting customers who purchase routine medications directly and offering a lower price. This is an unregulated business.

As a lawyer and an advocate for consumers, I disagree with this anticompetitive behavior. I urge the FTC to block this merger. Moreover, legislators would be remiss for not closely examining the lack of regulation in PBM practices. A free market thrives on competition.

Dennis W. Archer was the mayor of Detroit from 1994 to 2001. Before that, he served on the Michigan Supreme Court from 1986 to 1990. After leaving public office he became the first African American president of the American Bar Association in 2002-2003. He received his Bachelor of Science degree in education from Western Michigan University, and his law degree from the Detroit College of Law in 1970. Currently, he is Chairman of the Detroit-based law firm Dickinson Wright. He has received numerous accolades from a variety of national organizations and media for his tenure as mayor and his achievements as a lawyer.

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Comment Preferences

  •  We're On Express Scripts and They're Evil nt (2+ / 0-)
    Recommended by:
    marina, Rogneid

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Wed Mar 28, 2012 at 11:15:20 AM PDT

  •  We are enrolled with Medco and they are also awful (4+ / 0-)
    Recommended by:
    Catte Nappe, marina, Rogneid, MKSinSA

    As someone who has had to fight not to use their mail service (a temperature sensitive medication and living in Austin) I find this news very disturbing.

    I know that their shenanigans could get a whole lot worse than they already are if given this sort of power.

    •  My insurance co. uses Medco. They have (1+ / 0-)
      Recommended by:
      Rogneid

      worked quite well for me, especially compared to the mail-order pharmacy they used previously.

      Mother Teresa: "If we have no peace, it is because we have forgotten that we belong to each other."

      by Amber6541 on Wed Mar 28, 2012 at 12:12:44 PM PDT

      [ Parent ]

  •  offer? hah! (5+ / 0-)
    Recommended by:
    marina, Catte Nappe, Amber6541, Rogneid, joynow
    Limit pricing: By virtue of using their own mail-order pharmacies, PBMs can easily bypass retail pharmacies, contacting customers who purchase routine medications directly and offering a lower price.
    Medco does not "offer me a lower price."  For maintenance meds (long term scrip), they threaten to club me over the head with obscenely jacked-up prices if I choose to use a pharmacy in my own community (where the $ spent go back into the community, at least partially).  

    The same generic scrip that used to cost me a $20 copay to pick up from a friendly human being now costs me three times as much unless I agree to let Medco ship them to my mailbox.  Which happens to be a freezing cold or blazing hot outdoor, non-secure metal box.  I think an under-discussed issue with the PBM industry is the health ramifications of reduced efficacy of meds held outside of the the range of acceptable temperatures.

    •  I have been concerned about exposure to extreme (1+ / 0-)
      Recommended by:
      tellthestories

      temperatures as well.  Not just in my mail box, but whatever the medications might be exposed to in transit.

      I have a bad hip, and getting to the mail box every day is sometimes difficult.  Because the delivery could be anywhere from 2-5 days from date of order, I often make a special trip to the box (about a block away in this condo complex) three or four days in a row.  At least the boxes are locked, so no problem with theft here.

      Mother Teresa: "If we have no peace, it is because we have forgotten that we belong to each other."

      by Amber6541 on Wed Mar 28, 2012 at 12:18:24 PM PDT

      [ Parent ]

    •  For some drugs, it's cheaper for me at Costco (1+ / 0-)
      Recommended by:
      tellthestories

      It costs less to pay cash, no insurance, at Costco than to use ExpressScript and pay the copay. Plus I use  free prescriptions at I Publix whenever I can.

      I tried mail order for about three months. What a nightmare. It actually cost more, then they didn't include syringes the first time, then the wrong ones, then just the accessories (alcohol, bandages) and no syringes or med.

      It's a frakkin' sick monopoly.

      I have spent many years of my life in opposition and I rather like the role. - Eleanor Roosevelt

      by Rogneid on Wed Mar 28, 2012 at 01:53:48 PM PDT

      [ Parent ]

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