Caring for an elderly or disabled family member can be overwhelming. There are complex decisions to be made, financial needs to meet, medical information and paperwork that can be dizzying. All of these challenges distract us from the task that is of most importance: enjoying a relationship with our loved one.
Anything that makes this kind of care more difficult and more complicated should be reconsidered and rejected.
That’s the case with a proposed merger between two national pharmacy benefit management (PBM) companies, Medco Health Solutions and Express Scripts. This is a health-care-industry plan that ought to be stopped by the Federal Trade Commission (FTC), not just because it would create a large company with excessive control over the prescription drug market, but because it will be detrimental to the care of the most vulnerable members of our communities.
A PBM is a go-between that negotiates prescription medication reimbursement terms between health benefit plans and pharmacists. In short, they determine which pharmacies you can use, how much you’ll pay, and in many cases which drugs are even available to you. It’s these middlemen who have a largely one-sided say-so over how patients interact with their pharmacies.
Allowing these two companies to merge would only make a bad situation worse. The combined company would control somewhere from a third to half of the supply line of prescription medications. That means two things: prescriptions get more expensive, and they get harder to obtain. This is how PBMs make their money — by squeezing the health-care system to the disservice of patient care. Between 2008 and 2010, Express Scripts revenue went up 14 percent, for example.
Pharmacy limitations — or prescriptions by mail
If the companies are allowed to merge, many patients will be forced to go to certain pharmacies for their prescriptions. Some will even be forced to obtain their needed medications by mail. That will be especially true in rural areas. Ripping a patient away from his or her trusted community pharmacist could have terrible effects on their overall well-being.
Make no mistake; this is not a threat just to the elderly or to the disabled. All families who rely on a retail pharmacy will feel their access restricted and their costs increase. Additionally, every business that provides health benefits to its employees will feel cost increases. With health-care costs seemingly on a continual rise, providing health benefits to employees is already a difficult expense for many small businesses. The additional expense that would result from this merger being allowed to move forward could lead to the elimination of jobs in the pharmacy industry and in the small-business sector.
Veterans should also be on guard. Just take a look at the posture of one of these companies, Express Scripts, which is already taking on community pharmacies. That company is prepared to walk away, as soon as January, from working with the nation’s largest chain of pharmacies, Walgreens. That means the one in three Americans who relies on Walgreens will have to go elsewhere, and that includes TRICARE enrollees — our military veterans and their families.
Navigation more difficult
The bottom line is that the planned merger between Express Scripts and Medco would make navigating the complex health-care delivery system more difficult and more expensive. Americans would have less access to the pharmacies of their choice, and that will be harmful to our overall health.
For our seniors, disabled, and other vulnerable patients, it will translate to a reduced quality of life and possibly reduced life expectancies. Anyone caring for a loved one should be vehemently opposed to this planned merger.
Stephen Grisham is the president and owner of Alternate Decision Makers, Inc., a Minneapolis-based care assistance agency. John Richards is the CEO of Depth Inc., a drug and alcohol education program.