Give Patients a Choice of Pharmacy

Published in The Hill

To the Editor:

A report commissioned by Express Scripts, Inc. (ESI), a $45 billion pharmacy benefit manager and mail order pharmacy, estimates $403 billion in prescription medication-related "waste" in our health care system each year. ("Report: Patient apathy is pricey," April 8, 2011.) The company’s #1 recommendation for dealing with this problem is to steer patients, whether they like it or not, to distant mail order facilities, such as those it operates,

Yet, according to Express Scripts' own data, requiring patients to only use slow, impersonal mail order pharmacies would reduce this "waste" by just 1.9 percent, while angering many patients and harming local economies and jobs.

Express Scripts is one of three major, billion-dollar pharmacy benefit managers (PBMs) that face one of the most significant conflicts-of-interest in health care. They operate profitable mail order pharmacies and are also responsible for administering (on behalf of employers and health plans) prescription drug benefits, including setting the rules and reimbursement rates that they apply to rival, community pharmacies. As a result of this dynamic, these PBMs have been forced to pay $370 million to settle lawsuits alleging fraud and deceptive conduct.

The real pharmacy savings for America's healthcare system—the 98 percent of the $403 billion identified in Express Scripts report—are in altogether different areas, where community pharmacists are primed to play a leading role.

First, ensuring patients take their medication properly, known in scientific circles as "adherence," is estimated by this report to be as much as a $308 billion problem. Local pharmacists are among America's most trusted and accessible professionals and can interact with patients face-to-face to reduce these costs.

Second, we must promote the appropriate use of low-cost, generic medications. The Express Scripts report estimates these savings to be as high as $87 billion. The irony here is that in 2010 Express Scripts mail order dispensed generic drugs just 60.2 percent of the time and only 51% of the time in a Department of Defense program it manages. By contrast, community pharmacists achieved a 72.7 percent generic drug dispensing rate. Such a difference is serious money; researcher IMS Health calculated that every one percent increase in generic drug use equates to a two percent reduction in health care costs.

In sum, patients should be allowed to utilize the pharmacy of their choice—be it a neighborhood pharmacy or a mail order one—without impediment or discrimination. Open patient-pharmacist relationships are quite simply the best way to ensure that the benefits of prescription drugs are maximized and that low-cost, generic medications are utilized to the greatest extent possible.

B. Douglas Hoey, RPh, MBA
Executive Vice President and CEO
National Community Pharmacists Association
Alexandria, Va.

The full article in The Hill is available here.

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