Now, that is money. Express Script Profits for 2011. Ready to be sent to The Caymans
Here you go. THE VAMPIRE SQUID.
The Vampire Squid are the PBMs. They are the tail that wags the dog. It is our own fault. As in other areas, we allowed non-pharmacists the nelm for the ship.
PBMs were not in existence 20 years ago. They saw an opportunity and they pounced. They went to the big insurers and said, “Hey, we can save you money. Let us administer your prescription benefits. We can save you money.
What they did not say is: “The way we will save you money is by ripping the skin off the pharmacists’ backs.”
PBMs provide NO medical care.
They are just specialized BIG BANKS. They have insinuated themselves into the “Cash Cow” Industry. It ain’t ours anymore. It is theirs.
PBMs are for-profit engines.
Okay, let’s see if this one has legs. I have to go. V and I are getting prepared for our drive back to Galveston.
Let’s see what you think. I’ll add to this later.
Comment on IT IS OUR OWN FAUL
7/16/2012 Found this in “Comments”. Too good to leave there.
From Greg Alston
You don’t have to rant about PBMs just ask the right questions.
Congressman, do you believe that mandatory patient counseling is a good law? Well thank you sir, so do I. But are you aware that PBM Mail Order plans make counseling ineffective?
Are you aware sir that the single biggest cost driver of healthcare dollars is the utilization of hospital services? Thank you, sir so am I. But did you know that Mandatory mail order plans virtually guarantee that these costs will skyrocket?
Well let me explain.
Seniors take an average of 6+ medicines and have 3+ chronic diseases being treated. At the same time their drug regimens have expanded the complexity of care has increased because they see multiple physicians.
The number one cause of hospital admissions for seniors is Drug Misadventures and the next biggest priority for their healthcare has been the problem of poor medication adherence.
So basically, a benefit design that forces or coerces seniors to use mail order takes our most frail and needy patients and puts them at the greatest risk. Just about the time they are beginning to lose cognitive function and require more careful monitoring we force them to abandon their neighbor, who has been caring for them, and leave them to fend for themselves.
Does it really make sense to increase the number of pills in their homes and decrease their contact with a professional pharmacist , to lessen drug misadventures and improve medication adherence? And the cost of these problems to the healthcare system is billions!
In addition, Mail Order pharmacy introduces multiple new potential errors in to the drug delivery system.
Is it really in the best interests of our nation to put 90 day supplies of 6 different drugs in a bag and ship them across the country? These drugs are subjected to temperatures in excess of 104 degrees and humidity far in excess of the mandatory storage requirements any Brick and Mortar pharmacy must adhere to. (1)At the very least their is no way for the patient to prove that the drug was kept below 78 degrees like the storage labeling requires of a retail pharmacy.
Most state laws define as adulterated any drug that exceeds its 78 degrees. How can drugs left in mailboxes at temperatures that exceed 120 degrees comply with this standard? The interior temperature of a vehicle can reach 123 degrees within 60 minutes if the ambient temperature is 80 degrees. (2) Thirty-eight Children die each year from being left in their cars for just a short time. If the heat can kill dogs and children, I believe it will ruin your medication.
B. Drug Utilization Review-
Patients allocate their drug purchases between mail order and retail. As a consequence our pharmacy records are incomplete. When I run a DUR screening with incomplete drug histories, because I don’t know which drugs a patient is getting from mail order, how can I possibly provide accurate advice to patients? How many drug misadventures would be prevented if the patient used a good local pharmacist? The Asheville project suggests quite a few.
So we make mandatory counseling a law and then we insure that this counseling is inaccurate? That makes absolutely no sense. It is no wonder drug misadventures are climbing.
There is no drug delivery pathway more convenient than same day or same hour delivery by a local pharmacist who correctly stores and monitors the drug, as well as provides the counseling necessary to ensure optimal drug use. Our patients don’t see coming to the pharmacy as an inconvenience. Many seniors love coming in to stay connected to the their friends and community. So with senior depression and loneliness such a huge issue how exactly is forcing them to sever their social ties good for them? We treat our patients like family we laugh, cry and play together. Are you suggesting that a website or 800 number is better than a real face-to-face relationship. Don’t judge all community pharmacies by the standard of a multi-site operator. The independent pharmacy is a much more engaged customer base.
D. Illegal Diversion-
When I did home visits to my patients in Sun City, I frequently discovered thousands of pills stashed all over the house, in large mail order bottles. And what do seniors do with too many pills? They trade them over the back fence.
It was very common for Mabel (Shout out to Lonnie Wilson), to share extra meds with the bridge club. But even more frequent is for grandkids and home care aids to help themselves to party pills. Is the risk of illegal diversion greater or lower by shipping out three times the quantity?
E. Freedom of choice
How does economically coercing patients in to mail order plans by artificially lowering the co-payments for mail order even remotely approach free choice and open access. If you removed the co-payment advantage mail order would disappear overnight because there would be no reason to use it.
I’m sorry Mabel, you can’t go to a pharmacist you trust and employs your neighbors because my company would like to make more money.
That is essentially the marketing truth for the PBM Mail Order. You all know the truth, share it with your customers.
PUTT has the proof to show you that the Mail Order mantra about saving money is a carefully fabricated lie. So support PUTT! But what I am saying is more fundamental when it comes to talking to your patients.
Patients may be sympathetic to your plight but not really engaged with helping you fix this mail order issue until you make it personal for them.
Here’s how to make it personal.
Points A ,B , C, D, and E above make it personal.
Ask them questions like:
You’ve paid for your medicine wouldn’t you like to know it is safe to use?
Wouldn’t it makes sense to keep drugs from being illegally diverted?
Wouldn’t it make more sense for you to trust your healthcare to me rather than some faceless 800 number in a different state?
Wouldn’t you like to know that someone cares about you as an individual and get help you out if your are in trouble?
How many times last year did that mail order pharmacist talk to you at church, share a cup of coffee with you or give you a hug?
We have the right story we just have to get much better at telling it.
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United States Pharmacopeia has the proof that shipping puts drugs at risk.
(1)USP Report Page 8: http://www.usp.org/sites/default/files/usp_pdf/EN/aboutUSP/theStandard2010Spring.pdf