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Proposed health-care merger is a threat to Minnesota seniors

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.

Comments (5)

  1. Submitted by Brian Henry on 10/10/2011 - 10:45 am.

    Pharmacy benefit managers like Express Scripts work on behalf of you and your employer — or health plan, or government agency or other benefit provider — to deliver a cost-effective pharmacy benefit allowing you to get affordable medicines you need when you need them.

    The proposed merger between Express Scripts and Medco would in fact accelerate the companies’ ability to lower prescription costs, drive out pharmacy-related waste and improve outcomes for American families.

    All of these benefits represent what the country needs today — innovative solutions to the growing problem of healthcare costs.

    In order to achieve these goals, we work with pharmacies of all sizes and in all places. Over our 25 year history, we have collaborated with pharmacies to improve efficiency in processing payments, removing uncertainty and improving safety through our instant prescription adjudication systems and working to enhance prescription adherence.

    The authors specficially note our current negotiations with Walgreens and it is important to understand that Walgreens announced earlier this year that it was walking away from negotiations. We are still open to having Walgreens in our network, but only at rates that are right for our clients.

    Even without Walgreens, we still have a network of over 56,000 pharmacies nationwide that provide just as convenient, low-cost options to fill your prescriptions. For a pharmacy locator, go to

    Express Scripts, Medco and other PBMs work every day to lower costs, drive out waste and improve outcomes. We’re committed to working with pharmacies of all kinds to deliver a high-quality, cost-effective pharmacy benefit.

  2. Submitted by Richard Schulze on 10/10/2011 - 02:44 pm.

    If states do not draft their contracts properly, or fail to be vigilant in monitoring patients’ health, their experiment in managed care could be a disaster. On the other hand, if states are careful they could provide an answer to the question that has vexed America for years: how to provide good, cheap health care.

  3. Submitted by James Hamilton on 10/10/2011 - 04:46 pm.

    I’ve just read a number of conclusions and opinions, without a single reference to any supporting facts or studies.

    I’ve also visited the websites for Alternate Decision Makers, Inc., referred to above as a “Minneapolis-based care assistance agency”, and the Minnesota Secretary of State. Given common usage of the term “agency” one might think ADMI is a non-profit organization devoted to the well-being of its clientele, with no financial stake in the proposed merger. In fact, it is a for-profit corporation which appears to make some portion of its income managing the medical affairs of its clients. It is not unreasonable to suspect that the merger about which its founder complains is a threat to that revenue stream.

    I could find no website for Depth Inc, a drug and alcohol rehabilitation program, and no listing for it at the Secretary of State’s site. This may be due to an error on my part, of course.

    Bottom line: Why should I even consider what you have to say, given the above?

  4. Submitted by Bernice Vetsch on 10/10/2011 - 06:03 pm.

    #2 — “…an answer to the question that has vexed America for years: how to provide good, cheap health care.”

    The answer has been found, but so far not enacted because politicians say America is “not ready.”
    I’m afraid it’s the politicians who are not ready for what would work rather than what would please the drug and insurance industries: a Medicare-for-All single-payer plan covering each and every American.

    The national plan, HR 676, would save us as a country $400 billion per year (Harvard Medical School researchers, see, much of it in the avoidance of hugely excessive paperwork for both insurers and providers.

    Private insurance administrative costs include marketing and claims denial specialists, as well as paperwork, and run 20-25% of dollars expended while those of Medicare are about 2%. The state plan (SF 8 / HF 51) is being studied now to measure its savings for Minnesota.

  5. Submitted by Richard Schulze on 10/11/2011 - 06:41 am.

    @4 Ms. Vetsch,

    The only way out of this trap is to simultaneously offer Medicare for all. You can’t reform Medicare because to do so is an attach on seniors, which they will fight. You can’t means test Medicare because middle class seniors (the ones who vote the most) know that they will be paying more. But if you offer Medicare to all, reform is absolutely essential, and it will be harder for the seniors to argue about means testing when the young are paying 80% of the premiums and the old are taking 80% of the services.

    So if you are a conservative, you start by offering Medicare to all. You make the annual dues for young people astronomical for the full plan, so you offer them cheaper versions of Medicare which are not fee-for-service, or high deductible and co-pay, and/or run through private insurers. Then you tell the seniors that they have to move to the cheaper versions of Medicare if they want to avoid fees, fees which are means tested. This will take a decade or more, but if we don’t pursue a path like this, the politics become impossible.

    The takeaway lesson is that you can’t privatize or otherwise reform Medicare unless you make it universal, first.

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