we provide the best care available for the lowest cost ?

A CVS Caremark Store outside of Dallas, Texas

Dropping coverage of popular prescription drugs is sad and shameful

http://www.latimes.com/business/la-fi-lazarus-20141205-column.html

From the article:

Express Scripts, which handles prescription-drug benefits for millions or people nationwide, is dropping coverage for 66 brand-name drugs next month in an effort to keep costs down. Rival CVS Health is dropping 95 drugs from its own list of covered drugs.

Happy holidays.

Soaring drug prices remain one of the chief reasons Americans pay more for healthcare than people in any other country. Prescription meds account for about 11% of the roughly $3 trillion in annual U.S. healthcare spending.

Express Scripts and CVS dropping coverage for dozens of popular drugs is just one illustration of how our system works.

The two companies already steer people to lower-cost generics. Now they want to save insurers billions of dollars more by eliminating name-brand choices for patients, which in turn would help lower premiums.

And that’s undoubtedly true.

At the same time, however, drug manufacturers, wholesalers and retailers will continue pushing pharmaceutical prices higher in an effort to wring profits from a captive market — the sick

Poor Express Scripts only had a net profit last fiscal year of close to TWO BILLION DOLLARS.. and provided NO MEDICAL CARE !

Yes, prices are now high for brand name drugs.. but you  have to look back 50 yrs to see how we got here.. in the 60’s their was no PBM’s (Express Scripts & CVS Health) no Medicare/Medicaid.. there was also few generics available… the average Rx price was $4-$5 as opposed to today’s near $100. Wholesale prices were virtually stagnant. Research and Development for new meds was well funded.

First the PBM’s came on the scene.. abt 1970.. a scant few percent of the overall business.. Then Congress decided that Medicaid needed to only pay for generics and established MAC (Maximum Allowable Cost) what they would pay for a Medicaid Rx… as opposed to paying from  AWP (Average Wholesale Price). The then FDA Commissioner by the name of Kennedy testified before Congress – concerning MAC – that quality of the medication would never be compromised for a price.. After Congress passed the MAC law.. Kennedy ‘s statement became that we can tolerate a variance in quality to maintain a price.

As more and more meds came off patent.. the more money that was not available for the brand Pharmas to fund Research & Development (R&D) .. so they raised their prices.. because we expected new and improved drugs.. and/or new drugs to treat/cure previously untreatable diseases.

Today we have 80+ odd percent generic utilization and 90+% of prescriptions being paid by a PBM like Express Scripts. Until recently, they could claim that they were saving the system money by forced generic utilization and step therapy that started with inexpensive generics for a newly diagnosed pt.

They have apparently hit a wall … the increases in generic utilization and per-cent of Rxs paid can only grow at a snail’s pace.. so they are “proving their worth”  by taking away the option of very expensive meds… If you follow the money.. it is all about all the players making more money.. How many  pt’s quality of life or life itself be compromised by the decision of these for profit business like Express Scripts and CVS Caremark..  May never know… who is going to keep stats on this ?

15 Responses

  1. Here folks the lists of the drugs which will be replaced in 2015:

    Express Scripts: http://freepdfhosting.com/3e07c76294.pdf
    Caremark: http://freepdfhosting.com/cf5925c40e.pdf

    PS: Those files are safe, I checked

  2. PK Let me show you why I consider him an idiot:
    1. “Canada…says it’s against the law to price prescription drugs at unreasonable levels.” This is not true. It is not how the healthcare in Canada works.
    2. Again, Sovaldi example. Like I said Sovaldi is never used alone. Plus, if it can cure Hep C within a few months with minimal side effects(post-marketing studies are not available yet), it worth every penny. Old therapy for Hep C was horrible and not very successful. And yes, I have seen people waiting for a liver transplant at the hospital.
    3. “no novice when it comes to healthcare. She’s a retired hospital pathologist who examined tissue and cell samples from patients’ bodies.” I’m sorry that’s a histologist, but she knows absolutely nothing about medicine.

    PBMs replacing some brand name drugs is not my biggest concern. What I’m really concerned about, and what Lazarus should write about, is how Caremark leaves patients without their medicines. Unlike old times with Medco(which offered overrides in case of emergencies) Express Scripts and Caremark do not offer overrides if your medication gets lost in the mail. Caremark used to offer a bridge supply if your medication is late, but it could only be filled at CVS store, and it was a huge hassle to obtain. Plus, allowing to get a bridge supply at CVS only is a hassle by itself. What if you don’t have a CVS store close to you? That’s what he should write about.

    • First they came for the Socialists, and I did not speak out—
      Because I was not a Socialist.

      Then they came for the Trade Unionists, and I did not speak out—
      Because I was not a Trade Unionist.

      Then they came for the Jews, and I did not speak out—
      Because I was not a Jew.

      Then they came for me—and there was no one left to speak for me.

      • Steve great quote, but completely out of place. Since you used to be a pharmacist, tell folks here about the difference between Ventolin an Xopenex, or Victoza and Byetta.

        • Since my licenses in two states are still active and my CE’s requirements are currently met… I believe that I can still claim to being a Pharmacist. I chose to retire and no longer being a actively practicing Pharmacist.

          • Steve. My grandmother used to be a great doctor. She could diagnose a pneumonia without any fancy machinery or labs, she saved so many lives you have no idea(and she was a role model for me). But she has not practiced medicine for years. The same with pharmacy. The field changes really fast and it does not change to anything good.

  3. Gosh, this guy doesn’t sound like an idiot:

    “David Lazarus is an award-winning business columnist for the Los Angeles Times, focusing on consumer affairs. He also appears daily on KTLA-TV Channel 5 and is a part-time radio host. His work appears in newspapers across the country and has resulted in a variety of laws protecting consumers.”

    Including a drug on the preferred list may as well be excluding it. Doctors charge extra for the work to appeal the coverage of a drug, and patients don’t want to fight with their PBM either. And yet, I recently read where one guy said he’s never been turned down on an appeal — it just takes a lot of time, patience, and paperwork. (Of course, when we’re talking about treating a medical condition, time is of the essence.) Which I guess is what being a healthcare consumer is all about…

    Let’s see, as a healthcare consumer, should I take the generic made in India, or the one manufactured in the U.S. with Chinese ingredients?

    • U R So right PK. Being disabled and ‘fighting for’ every PAR,, formuplary exception,monthly pill limits, etc is like a part time job for me. Suffering from anemia, hypothyroid, sleep apnea, and other causes of fatigue make all the HOOP jumping a daunting proposition. I can see where some doctors offices, patients, and others wish to take the path of least resistance. the comment about never being turned down? I have found that to be true, BUT it is extremely frustrating having to ‘fight’ for half of the meds I am prescribed,and ‘covered’ for, that I couldn’t afford anyway w/out assistance.

      If a doctor deems a drug necessary for treatment why must he/she go through all this back and forth w/ an insurance flunky? WTHell do they know about anything other than the fact that a great percentage of docs do not wish to deal w/ extra paperwork (or hiring extra staff just to process all these ridiculous impediments?). Also grates me that the disabled are fed to insurance companies for profit. Dont any of these brain-dead Americans get it when both parties complain that each and every healthcare reform will not work? The translation means, reform wont work because it will cut into our donors profit margins and therefor their contributions to my re-election. Profiteering off the disabled is a disgrace. Too bad the mass news media never mentions anything like this.
      they steer viewers to hot topic ’emotional’ issues like gay marriage, abortion, etc, etc that at the end of the day dont mean diddly squat while they ignore the issues that matter, esp fiscal decisions and the REAL reason behind them. We have money to send ‘space ships’ around to look at cool stuff but require disabled citizens to live at poverty levels, one catastrophy away from becoming destitute because over half (at least) of their measly benefits go towards healthcare.

      Anyone else think the timing on the release of the report on torture (thereby upping security threats) came at an interesting time? Just as citizens are fed up w/ law enforcement and their overbearing actions, the government ‘reminds’ us how important they are for our security against threats [?] Call me a cynic but maybe that’s just me.

      • Coonhound: Thanks for verifying that appeals to your PBM can be successful — I think a lot of people just assume they can’t win, so they don’t try.

        • That’s what the PBMs are banking on. I had a Publix pharmacist tell me that several doctors in our area won’t even bother to process appeals if meds are denied or needed exceptions, PARs, etc!

          If he/she was MY doc he’d last about as long as a one legged man in a butt kickin’ contest. It never ceases to amaze me what some patients put up w/ in doctors, (and pharmacies) its like they don’t think they have a choice.
          I guess I’m just not one to waste time on a losing proposition.
          Some put Drs on pedestals like they’re volunteers or something. They don’t realize or may forget that being a doctor is a career choice and they work for you, kinda like a mechanic. I don’t take my car back to a shop that screws up repairs or overcharges me, why keep seeing a doctor that dismisses my concerns or wont go the extra mile to ensure proper medical treatment.

          When I moved to GA. I needed a new PCP. First one ‘recommended’ to me said we needed to do away w/ alprazolam (.25mg #30 lasting me about 2-3 mos). When I asked why he asked me “what, do I want to take ‘this stuff’ for life”?
          I had started having panic attacks after losing our 3 dogs in a house fire while out of town visiting ex’s family (Xmas no less).Never previously been on any anxiety meds either prior to the previous 6-7mos.
          Piece of work that he was, he never even bothered to ask what I was taking them for. Needless to say he got an immediate Donald Trump-like ‘your fired’!!

          • I’m so glad that I no longer have to depend on doctors and PBMs… it’s a freedom I hope more pain patients come to know.

            I’m so sorry about the loss of your friends, and I hope during the holidays this year, you remember only the good things.

  4. Quoting an article written by an idiot. Very nice. And not here is the opinion of someone who did some research into the topic.
    I’m not a fan of our PBMs at all, but: they can’t just exclude the drug. They exclude one drug, but include another drug on preferred list.
    Step therapy may be not the best solution for some patients, but…our doctors love to prescribe without thinking. At my store I had dozens of children prescribed Singulair for no particular reasons.
    It cost around $1 billlion to get one brand name medication on the market.
    The only reason the world enjoys new medicines is because we pay for it. The US spends more on R&D than most of the rest of the world combined(at around $55 billion per year). And now lets see Canada. Their current research spending is the lowest ever. The prices are negotiated by the provincial authorities. In simple words, they tell you the price and if you can’t give them the price they want, your drug will not be a part of the formulary.
    As for generics, I stated it many times: if you talk to your pharmacist at your local private pharmacy, you can get you a really great price(some prices better than Canadian pharmacies).
    As for Sovaldi. The idiot at LA times did not bother to research that it’s never given by itself, but always in conjunction with other drugs. It would cost me $21,000 to order 1 month supply and overall cost to treat your Hep C with a combination of Sovaldi and Olysio is around $180,000. Is is expensive? Absolutely…just as expensive as spending 4-5 days at the hospital.

  5. Why are you blaming President Obama for the decisions of Express Scripts and CVS? Is he on their Board of Directors?

  6. Restricted formularies harm patients….its not cookie cutter medicine folks, shame on them. Generics are no longer ‘cheap’ because most companies have either quit making them or mergerd into one company decreasing the competion of who is making them hence the price increases of late. Well Obummer promised if you liked your doctor, you could keep your doctor PERIOD. NOT, if you liked your plan, you could keep your plan, PERIOD..NOT, now it looks like if you like your medication you can keep your medication….NOT at least according to Express Scripts and CVS/Caremark

  7. And step therapy is expensive to patients, as well as harmful. For instance, medical cannabis patients usually have to take all available “standard” drug treatments before they are allowed into a program, especially if you’re a “severe chronic pain” patient. So, here, take this Vicodin and Oxy, have this surgery and these invasive injections… because they’re better for you than medical cannabis.

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