According to the latest issue of Chain Drug Review, the Pharmaceutical Care Management Association (PCMA) is running an ad campaign that accuses community pharmacies of overcharging patients and the employers that pay for their prescription coverage.  The PCMA is the trade association, aka lobbying group, that represents Pharmacy Benefit Managers in this great country of ours. Pharmacy Benefit Managers are the assholes that are ruining our profession.  Not because they need to but because they can.  This is occurring at the same time that more than 250 independent pharmacists are speaking to Members of Congress in favor of the Pharmacy Competition and Consumer Choice Act of 2011 “a bill designed to ensure transparency and proper operation of pharmacy benefit managers”.

      The Encarta Dictionary defines a pimp as”Somebody, usually a man, who finds customers for a prostitute in return for a portion of the prostitutes earnings.”  Encarta, in turn, defines a prostitute as “Somebody who uses a skill or ability in a way that is considered unworthy, usually for financial gain.”  If you substitute PBM for pimp and drug company for prostitute the definitions still make perfect sense.  Here’s why.

      Pharmacy benefit managers control an overwhelming majority of the prescription market in the United States.  Express Scripts/ Medco alone controls close to 40% of the market.  They hold millions of Americans hostage to their whims when it comes to prescription drugs.  Drug companies give billions of dollars in kickbacks (rebates) to PBMs in a never ending quest to maintain and grow market share.  In other words they willingly sacrifice billions of dollars in profit to have access to an ever increasing number of patients much as a prostitute pays a pimp a percentage for increased access to the “John” market and a protected piece of turf.  According to an article by Matthew Herper at Forbes.com, Pfizer gave 35% of their  $7.7 Billion US sales in rebates on Lipitor, AstraZeneca 61%  of their  $6.2 billion sales on Nexium and 30% of their $4.4 billion sales on Crestor and Bristol-Meyers-Squibb 25% of their $5.2 billion sales on Abilify in kickbacks to PBMs.  The list goes on and on.  According to Herper, rebates from drug companies to PBMs reduce net sales of the drug companies by about $40 billion per year.

      Drug Companies have a huge moral responsibility to society in addition to the fiscal responsibility to their shareholders.   Society counts on them to give us spectacular innovation in the treatment of the diseases that plague mankind.  Research into finding these new agents arguably costs a lot of money.  It seems to me the $40 billion per year they pay their “pimps” to keep their “corner” of the market could be used instead to save peoples’ lives.  But pimps rarely care about people, only money.

      Now the pimps are being called out so they are going on the offensive.  Community pharmacists are ripping off the patients and employers?  I can’t tell you how many negative reimbursements I see each and every day where I work.  How in the hell can we be ripping off the public when we lose money on half the prescriptions we fill?

      The only way we can win this is by educating the public and our elected officials on who is getting the big payoff.  The truth is PBMs are pocketing the kickbacks they receive from drug companies to keep the drug companies products in a favored status on the PBM formularies.  I have witnessed some of the negotiations.  PBMs are the modern day highway robbers.  Drug companies must pay their ransom to pass and continue down the road. That money is not forwarded to the employers and ultimately the patients that pay the premiums.  It is pocketed by the PBMs.

      Just like pimps getting their cut from prostitutes.  There is no difference.

      I’m not sure what the status of the Pharmacy Competition and Consumer Choice Act of 2011 is but I am going to find out and I am going to let my representatives in Congress know that I support the Act and that I want transparency and responsible operation from PBMs.  You should too.  I will be watching my representatives actions regarding this Act.  You should too.  I am also going to tell my patients that are having trouble with their PBMs about this Act and how they are being ripped off.  PBMs do not lower health care costs or premiums.  They raise them.  You should tell your patients too.

      It’s time everyone knows how much the pimps at the PBMs are making.

     

      According to a May 10th article in the Wall Street Journal,  Pfizer Inc. has thrown in the towel on their attempt to continue to sell Lipitor in the U.S. market, a move that will definitely help retail pharmacists. At its peak, Lipitor accounted for nearly $13 billion in yearly sales and was the #1 prescription drug in terms of sales dollars.  According to the Journal,  Pfizer had spent over $87 million marketing the drug since its patent expiration in November of last year.  It got them another $400 million in sales.

      So why is this good for retail pharmacy?  The answer is simple.  We will no longer have to deal with the nightmare that is known as the Lipitor $4 Co-Pay card.  You’ll no longer have to see the $4 offer on TV, in newspapers, on the radio, on web page sites, in the snail mail or posted above the urinal in the men’s room at large sporting venues.  You’ll no longer have patients scream at you because their doctor told them their Lipitor would only cost them $4 and you’re charging them more. You’ll no longer have doctor’s offices calling you asking why their patients have to pay more than $4 because the Pfizer rep told them it would only be $4.  It was Big Pharmas version of the $4 prescription and it will hopefully be the last of such offers we see, although I doubt it. 

       Drug Companies are very smart creatures.  They devote millions of marketing dollars to generate billions in sales.  It started innocently enough years ago with detailmen, as they were referred to in the day, calling on individual physicians often by appointment but just as often dropping by to chat briefly with the doctor in between patients, discussing the virtues of the medications they represented.  They would leave samples of the drugs with the physician in hopes that they would be given to patients, the drug would produce the desired effect and the physician would then prescribe the drug to the patient.    Doctors would rely on the detailman for any and all information concerning the products they represented. This system worked well for both physicians and patients as well as the Drug Industry.

      It worked so well in fact that Drug Companies decided that if one detailman called on one physician once a month, then two or three or even four Drug Representatives, as they were now called,  visiting the same physician would equate to a geometric rise in the number of prescriptions for their product(s) that physician would write for.  It worked.  I worked for one of the largest drug companies in the world and even in the 1990′s, we had the technology to track not only the exact number of prescriptions each physician wrote for our product, but also how many prescriptions were written for competitive products.  This was the beginning of the end of the personal relationship between the Drug Company Representative and the physician.  Soon many physicians offices had more Drug Representatives in their waiting rooms than patients.  There would be holding patterns of Drug Reps in parking lots waiting for the Drug Reps in the waiting rooms to leave so they could take their turn in the waiting room.  One physician told me that he had fifteen Drug Reps from the same company calling on him each month.

      Fast forward to today and Drug Reps for the most part are banned from physician offices and clinics.  But that’s okay for Big Pharma because there is now direct-to-consumer (DTC) advertising.
We are now bombarded with advertisements about treatments for arthritis, cholesterol, irregular menstrual cycles, depression, post menopausal hot flashes, osteoporosis, diabetes, erectile dysfunction, irritable bowel syndrome and benign prostatic hypertrophy all of which I have experienced symptoms of after being exposed to DTC advertising.  My physician has me on a strict “no drug advertisement” viewing regimen as a part of my overall wellness plan. 

      As all pharmacists and technicians who have dealt with the Lipitor $4 Co-Pay card know, virtually no one pays just $4 for a month of Lipitor.  The fine print includes exclusions by Medicare, Medicaid or any other federal or state health care programs.  In fact to get your 30 tablets of Lipitor for $4, your out of pocket expense could not exceed $79 per month and you can only qualify for up to $1,000 in savings per year.  There are other restrictions as well.  Sounds complicated and it is.

     In order to be absolutely truthful and not misleading in any way Pfizer should have called this program the “Lipitor if  you are not covered by a Medicare, Medicaid or any other federal or state program and if your out of pocket cost is less than $79 you will only pay $4 Co-Pay card”.  I guess that wouldn’t all fit on the card they send you in the mail. 

     At any rate. the Lipitor $4 Co-Pay card was a giant pain in the ass of pharmacy and I am glad it will not be around much longer.  I wish Pfizer Inc. the best of luck in discovering and bringing to market innovative life changing medications.  That’s what Drug Companies need to concentrate on instead of trying to copy Walmart in order to wring a few million bucks more out of a dead cash cow.

    A small victory for community pharmacists.  One less third party plan to waste our time on.