PHARMACY BENEFIT MANAGERS’ IMPACT
There is more going on behind the scenes that creates the potential for harmful products and practices, Vinson said.
Pharmacy benefit managers are “middlemen” that manage prescription drug benefits by handling insurance claims, managing lists of drugs covered by insurance, and negotiating drug prices and rebates, he said.
The harmful part comes in when these pharmacy benefit managers are also pharmacies and insurance companies, he added.
CVS, Optum Rx and Express Scripts are three of the biggest pharmacies that are also Pharmacy Benefit Managers intertwined with insurance companies, he said. CVS is the parent company of insurance company Aetna, Optum Rx is an affiliate of UnitedHealthcare and Express Scripts is part of Evernorth Health Services, a Cigna organization.
The Federal Trade Commission filed a lawsuit Feb. 26 against the three largest pharmacy drug benefit managers — Caremark Rx, Express Scripts and OptumRx — and their affiliated group purchasing organizations, accusing them of engaging in unfair rebating practices that have artificially inflated the list price of insulin drugs.
House Bill 1150, introduced in the Arkansas Legislature in January, seeks to ban pharmacy benefit managers from owning pharmacies, which would make Arkansas the first state to do so if it passes, Vinson said.
Shelly Bendit, a spokeswoman for CVS, has denied the company is gouging competitors, saying in a statement “CVS Caremark reimburses independent pharmacies at higher levels than CVS Pharmacy.”
“Any policies that would limit our ability to negotiate with drugmakers and pharmacies would ultimately have an adverse impact on patients by increasing the cost of medication and potentially limiting access to care,” Bendit said. “In many cases, such policies serve as a handout to the pharmaceutical industry.”
The weight loss drug shortage and the resulting poor practices by smaller wholesalers and compounding pharmacies have in large part been a result of larger manufacturers and companies controlling the market, Vinson said.
Those companies are driving drug prices up for competitors and consumers, steering both patients and pharmacies to less accredited sources for affordable weight loss drugs, where it is more likely to find counterfeit or simply less safe drugs, he added.
Some pharmacies in Arkansas don’t even carry weight loss drugs or have stopped filling them for new patients because they’re losing money, Vinson said. Even if there is enough product from a manufacturer, part of the weight loss drug shortage has been a result of pharmacies not stocking what loses them money to fill, he said.