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Pharmacy Monopolies

Stanley Feld M.D.,FACP, MACE

 Pharmaceutical companies have been merging for years. Pharmacies have also been merging for years. The excuse for mergers has been efficient production, distribution and sale of drugs.

“Senior executives say the merger will significantly reduce the nation’s health care costs and deliver drugs in a safer, more efficient fashion. “

If any one believes this I have a bridge to sell you.

The real reason is to form a monopoly. President Obama and his Federal Trade Commission (FTC) have allowed pharmacies to get away with it.  

 “The Federal Trade Commission (FTC) is an independent agency of the United States government, established in 1914 by the Federal Trade Commission Act. Its principal mission is the promotion of consumer protection and the elimination and prevention of what regulators perceive to be harmfully anti-competitive business practices, such as coercive monopoly.”

The commission has not done a very good job in protecting consumers of healthcare for years.

The next wave of monopolies which will hurt consumers is the merging of pharmacy benefit management companies.  Their executives are using the same excuse to both the FTC and the congress.

“Senior executives say the merger will significantly reduce the nation’s health care costs and deliver drugs in a safer, more efficient fashion. “

 I have finally figured it out.

First, I must explain this attempt to create another healthcare monopoly that will result in increased cost to the healthcare system.

If past behavior is a predictor of future behavior, whoever is paying for the drugs will pay more.

 Express Scripts’ has offered to pay $29 billion for the acquisition of Medco Health Solutions. Both pharmacy benefit manager are among the biggest in the business.  

 Combined they will handle prescription drug benefits for more than 115 million people. The two companies now control 33% of the prescriptions filled in the United States. Their combined revenue is $110 billion dollars a year and growing.

 The Federal Trade Commission wants more details before it approves the merger. The antitrust subcommittee of the Senate Judiciary Committee wants to examine the antitrust implications of the merger.

 It is pretty obvious that the merger will decrease competition leaving only two major pharmacy benefit managers Express Scripts/Medco and CVS Caremark. 

  A Morgan Stanley Research indicated that the 50 largest companies in the United States rely heavily on the services of Medco, Express Scripts and the third major benefit manager, CVS Caremark.

"Dan Gustafson, an antitrust lawyer who recently helped write a letter to the F.T.C. objecting to the merger on behalf of the American Antitrust Institute, a Washington organization. “These are customers who require a broad spectrum of services on a national level,” he said."

The smaller pharmacy benefit managers (40) typically do not have the geographic reach, bargaining power or data-handling capabilities of Express Scripts, Medco and CVS Caremark.

“When benefit managers steer health plans to their own pharmacy fulfillment services, employers may have little choice but to agree, said Edward A. Kaplan, a benefits consultant at Segal, which advises employers and others about health insurance. “They have very little leverage,” he said.

The Senate subcommittee and FTC regulators want to study the implications of the merger on the individuals, large companies that provide drug insurance to their employees, the mail order pharmacy and specialty drug markets.

The merged company would control a third of the specialty drug market. This market produces a high net profit. By controlling the market Express Scripts/Medco would not only increase the price it would increase their net profit.

Robert Seidman, a former pharmacy executive at WellPoint who is now a health care consultant in Los Angeles said,

We’re not talking pennies here,” he said. “We’re talking thousands” per drug.

  Express Scripts/Medco retort is pretty lame. It asserts there is plenty of competition including companies like UnitedHealth Group, the powerful insurance company. The obvious reply should be that there is not enough competition.

 A number of consumer groups including Consumers Union, along with associations representing community pharmacists, chain drugstores and supermarkets, have sent letters to regulators and legislators arguing that the combined company would create a drug benefit giant with unrivaled power.

 The fear is Express Scripts/Medco would have the power to steer patients to its own mail order and specialty pharmacy businesses.

 “Our concern is that a mega P.B.M. would have tremendous power and control over what prescription drugs Americans can get, where they get them, and how much the drugs cost,” said Don Bell, senior vice president and general counsel at the National Association of Chain Drug Stores.

DeAnn Friedholm, the director for health care reform at Consumers Union, said her group was particularly concerned that the merger could reduce consumer choice.  

“We like the idea of having good choices for consumers that meet their needs, not just the need of these huge P.B.M.’s,” Ms. Friedholm said.

Just as President Obama and previous administrations has encouraged hospital systems to become monopolies in the name of efficiency, President Obama is going to believe Express Scripts/Medco’s promise of efficiency and lower costs and have the FTC push through the merger.

I would guess President Obama thinks he can control Express Scripts/Medco or he is playing favorites again or he wants the healthcare system to implode.

This is one more step toward the implosion of the healthcare system.


The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

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  • Joanne Velazquez

    Merging doesn’t happen because they want to help other people. They are merging because they just want to help their business to grow fast.

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