A pharmacist's view: Proposed merger would devastate small pharmacies

Talk about it

I chose pharmacy as a profession because of the direct impact I could have on patient care. Both my wife and I are pharmacists and, along with our team at Globe Drug and Medical Equipment in Grand Rapids, we routinely make drug-therapy recommendations to minimize side effects, to decrease costs and to enhance outcomes, all because we are approachable and available.

That service and the value it provides is directly threatened by a possible merger between two of the largest pharmacy benefit managers, Express Scripts, Inc. and Medco Health Solutions, Inc.

This is a topic of such grave concern that just this last week I drove down to the Twin Cities to attend an event with U.S. Sen. Amy Klobuchar and Federal Trade Commission Chairman Jon Leibowitz. My concern is not only how it would impact Globe Drug and our ability to stay in business, but also how it would impact the health of our rural community and all those who rely on our services. That is why a small group of rural pharmacists and a pharmacy student flew to Washington, D.C., last fall to sit down with Minnesota’s two senatorial offices and several members of Congress. Rural pharmacists can’t compete with the lobbying dollars of Medco and Express Scripts, and when we talk to members of Congress, we represent real, Main Street jobs and a significant part of the face of all that is good in rural health care.

PBMs basically are middlemen between insurance companies, drug manufacturers and pharmacies. Their focus is mail order which, in theory, has lower overhead costs than the neighborhood pharmacy. But are all the savings passed along to customers? I don’t think so. I know they don’t offer a registered nurse certified in wound care or a respiratory team like we do. Our staff is a free source of health-care information, every day. We don’t quantify this in dollars and cents; it’s just what a community pharmacy does.

Compare this to the PBMs who want to make all the rules. They set our reimbursement rates. They control the formularies and rebate dollars they receive from drug companies. They set costs for premiums and even their own reimbursement dollars.

As big companies with huge ad budgets, PBMs can directly market their mail-order pharmacies to patients and businesses, putting still more pressure on neighborhood pharmacies. To add insult to injury, they audit us with rules they set so they can acquire more money from the providers and pad their bottom line. I don’t mind competition, but we can’t compete on this playing field.

This proposed merger isn’t about saving health-care dollars; it is about the ability of two powerful PBMs to merge so they can dominate the pharmacy business. Their objective is to increase profits at the expense of patient health and community pharmacies everywhere. That is why, last fall, I went to Washington, D.C., and joined with pharmacists from all corners of the country, asking Sens. Klobuchar and Al Franken and other members of Congress to help prevent this merger. Just as we helped highlight this issue last week when Leibowitz was in town, Minnesota citizens can help. More information on how is at preservingcommunitypharmacy.com.

My wife and I are committed to our community in northern Minnesota and have a vested interest in helping people lead healthier lives. We know this to be true of pharmacists all across this state. They deserve the best products and services and, with a level playing field and carefully regulated PBMs, we will keep providing exactly that.

Mike Brandt is a pharmacist with Globe Drug and Medical Equipment in Grand Rapids.

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