Express Scripts / Medco merger completed

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http://www.stltoday.com/business/loc...9bb30f31a.html

It's a done deal, folks...

Whoa.

Ding dong pharmacy is dead

"A group of independent pharmacists denounced the merger."

Wow, big surprise there....

"Express Scripts Holding Co. is the new formal name of the company."

So... does this mean the school has to change its name to the Express Scripts Holding Co School of Pharmacy?

Imagine trying to fit that on a ring.

Let's never forget the three criminals that aided in the destruction our profession:

http://www.ftc.gov/commissioners/rosch/index.shtml

http://www.ftc.gov/commissioners/ramirez/index.shtml

http://www.ftc.gov/commissioners/leibowitz/index.shtml

So supposedly all of this means that Walgreens will get their Express Scripts contract back since they have a contract with Medco. Thoughts?

I wonder what this means "The merged company will have increased purchasing power to pay less for prescription drugs.".

It doesn't take a rocket scientist to see where all these savings are going to come from or whose pockets they are gonna go into.

I can easily imagine the negatives to this...are there any positives?

I have to wonder, if drug prices the PBMs are willing to pay drop below a certain amount, are we just going to be exacerbating the shortages issues we've already seen? I realize reimbursement isn't the only cause of shortages, but I can't help but think it might be associated.

I think this is the beginning of the end for PBMs.

Originally Posted by Rx MPLS

I can easily imagine the negatives to this...are there any positives?

I do not see anything positive to this for either the merged company or pharmacy.

Originally Posted by PharmDstudent

So supposedly all of this means that Walgreens will get their Express Scripts contract back since they have a contract with Medco. Thoughts?

Don't think so. The contract is still being honored with Medco until it is up or short term at least... but at that point no one knows if it will get renewed.

If they do renew it will probably be all of Express Scripts + Medco and Walgreens will get even less than they would have before.

Walgreen's is going to cave. They have no choice. ESI can now take all the medco business from them. They likely get a worse deal now than if they had taken it back in 2011. ESI knows Walgreen's needs them and ESI doesn't really need Walgreen's.

Reimbursements will likely decrease, but that is only to a point. Business wise they can't cut so much that all the pharmacy say no. Walgreen's was stupid and put themselves on an island by themselves. ESI needs the retail chains. They would love everyone to do mail order, but a lot of people hate mail order. If they force mail order, then their customers will raise hell.

CVS buying Caremark looks pretty smart now. They are playing both sides.

Maybe the big Chains need to start uniting against these PBM's. Walgreens and CVS combined forces alone would force Express Scripts/Medco into accepting their terms which might need to happen in the future for pharmacy to survive.

I wonder what´s going to happen if all independent and big chains declare a boycott to this ESI monster and stop filling rx for its members?
All we need is little bit of more untity, at the very end PBMs are just another intermediaries in the game. They are unnecessary players in the rx business. The basic of this business only requires two licensed professionals,.- a MD and a RPH`, everything else is just a waste. PBMs are the biggest part of the mess of the healthcare system.

Exactly. PBM's are absolutely useless. Here you have company now with a market cap of 50 billion dollars that does nothing more than transmit claims.

I think this could be the beginning of the end for the PBM model as well.

At what point do all these mergers become anti-competitive? Or do we just not give a sh*t at all anymore about how consumers/patients are screwed by these companies.

Yea, this is really unfortunate. I wish all pharmacies would unite to combat this. What really irks me is when we (the retail pharmacy) have to fill emergency supplies because patients haven't received their mail order supply in time.

Originally Posted by lamasacrerx

I wonder what´s going to happen if all independent and big chains declare a boycott to this ESI monster and stop filling rx for its members?
All we need is little bit of more untity, at the very end PBMs are just another intermediaries in the game. They are unnecessary players in the rx business. The basic of this business only requires two licensed professionals,.- a MD and a RPH`, everything else is just a waste. PBMs are the biggest part of the mess of the healthcare system.

Who is going to pay for that $2,000 per dose Simponi Rx? The MD, the RPh, the patient, or the third party?

^ Not sure if serious - the third party.

Originally Posted by farmadiazepine

Who is going to pay for that $2,000 per dose Simponi Rx? The MD, the RPh, the patient, or the third party?

What good is the third party if no company accepts their terms?

Originally Posted by farmadiazepine

Who is going to pay for that $2,000 per dose Simponi Rx? The MD, the RPh, the patient, or the third party?

Good point and well worth feeding the PBM leach 30-50% as profit and pissing on the healthcare industry. Excellent thinking!

Originally Posted by Pharmpills

Maybe the big Chains need to start uniting against these PBM's. Walgreens and CVS combined forces alone would force Express Scripts/Medco into accepting their terms which might need to happen in the future for pharmacy to survive.

They'll just play the chains against each other as much as they have to. The retail part of this industry should act more like PhRMA and stand united against common threats like PBM overconsolidation (there are ways to sidestep "collusion").

I am shocked and disappointed at the negativity towards PBMs. PBMs provide a very valuable service and should be well compensated for it. It’s hard work managing the pharmacy benefits for these companies.

Originally Posted by MountainPharmD

I am shocked and disappointed at the negativity towards PBMs. PBMs provide a very valuable service and should be well compensated for it. It’s hard work managing the pharmacy benefits for these companies.

Your transformation has taken place much faster than anticipated!

Hope you didn't have any trouble with that little weather front that moved through yesterday...

Originally Posted by MountainPharmD

I am shocked and disappointed at the negativity towards PBMs. PBMs provide a very valuable service and should be well compensated for it. It’s hard work managing the pharmacy benefits for these companies.

Im going to take your piece of the pie. I may not know enough about pbm and retail but I do know I can save money by managing self insured organizations employee scripts. You guys are bad bad people.

Originally Posted by MountainPharmD

I am shocked and disappointed at the negativity towards PBMs. PBMs provide a very valuable service and should be well compensated for it. It’s hard work managing the pharmacy benefits for these companies.

LMAO!!!

Originally Posted by 297point1

Your transformation has taken place much faster than anticipated!

Hope you didn't have any trouble with that little weather front that moved through yesterday...

I am a company man what can I say!

Nope, the worst of it was a little bit south and east of me. We did get to spend thirty minutes crammed into the conference room while the tornado sirens went off. I was at work so I knew I was safe. God would never let something happen to us because we are to important and to valuable to the healthcare system. My goodness how would anyone be able to get thier prescriptions if we weren't there to help mamage thier pharmacy benefits?

Originally Posted by MountainPharmD

I am a company man what can I say!

Nope, the worst of it was a little bit south and east of me. We did get to spend thirty minutes crammed into the conference room while the tornado sirens went off. I was at work so I knew I was safe. God would never let something happen to us because we are to important and to valuable to the healthcare system. My goodness how would anyone be able to get thier prescriptions if we weren't there to help mamage thier pharmacy benefits?

Originally Posted by MountainPharmD

I am a company man what can I say!

Nope, the worst of it was a little bit south and east of me. We did get to spend thirty minutes crammed into the conference room while the tornado sirens went off. I was at work so I knew I was safe. God would never let something happen to us because we are to important and to valuable to the healthcare system. My goodness how would anyone be able to get thier prescriptions if we weren't there to help mamage thier pharmacy benefits?

I do love this new found sense of humor...amazing what a change of scenery can produce

Originally Posted by 297point1

I do love this new found sense of humor...amazing what a change of scenery can produce

His sense of humor is nothing new

Originally Posted by Its Z

His sense of humor is nothing new

It is less dark then it used to be.

I too love the "new" mountain.

Originally Posted by owlegrad

It is less dark then it used to be.

I too love the "new" mountain.

Give him 2 months. He will be pissed and annoyed by his cubicle mates.

The only thing that's changed is he's not fighting oldtimer or rxnupe.@

Originally Posted by Its Z

Give him 2 months. He will be pissed and annoyed by his cubicle mates.

You know, I thought the same thing about Mikey, but so far he still seems pretty positive about his new job.

Originally Posted by owlegrad

You know, I thought the same thing about Mikey, but so far he still seems pretty positive about his new job.

Mikey and mountain are very different. Mikey actually was very upbeat and positive about his hospital job when he was in it.

The hospital job was fine until the recession hit and they used it as an excuse to cut hours to the point where I found myself alone in a 160 census hospital. Then it got maddening.

Its amazing what a normal schedule, a comfy chair and an hour lunch everyday will do for a persons attitude.

I want everyone to know that I am hard at work sitting in my comfy chair everyday from 9-6 denying your customers prior auth requests because thier doctor is a dumbass and cannot follow simple directions when filling out a three question form. You now know whos fault it is when you are getting your ass chewed off by some idiot customer because their prior auth was denied. A dumbass doctor and a pharmacist sitting in a comfy chair.

Originally Posted by farmadiazepine

Who is going to pay for that $2,000 per dose Simponi Rx? The MD, the RPh, the patient, or the third party?

Who gets that anyway? The one package that we had expired on us.

Originally Posted by Pharmpills

Maybe the big Chains need to start uniting against these PBM's. Walgreens and CVS combined forces alone would force Express Scripts/Medco into accepting their terms which might need to happen in the future for pharmacy to survive.

They will lose just like Walgreens did. No one really understands PBMs or what they do. The general public thinks of everything as insurance. Medical, prescriptions, PBM whatever its all "the insurance" to the patient. PBMs claim they save the system and the customer money by managing the prescription benefit. Walgreens turning down the ESI contract made them look like a greedy corporation that only cared about getting more money. The PR hit was all on Walgreens. ESI claims all they are doing is saving the plan sponsor and the customer money. To the Wags customers who were displaced it looks like it was all Walgreens fault because they were greedy and wanted more money.

The PBMs have the upper hand. Express scripts proved it.

Originally Posted by MountainPharmD

They will lose just like Walgreens did. No one really understands PBMs or what they do. The general public thinks of everything as insurance. Medical, prescriptions, PBM whatever its all "the insurance" to the patient. PBMs claim they save the system and the customer money by managing the prescription benefit. Walgreens turning down the ESI contract made them look like a greedy corporation that only cared about getting more money. The PR hit was all on Walgreens. ESI claims all they are doing is saving the plan sponsor and the customer money. To the Wags customers who were displaced it looks like it was all Walgreens fault because they were greedy and wanted more money.

The PBMs have the upper hand. Express scripts proved it.

That is precisely because the chains weren't united. They are the ones who pointed the finger at wags. "Wags won't take your claims, so come here!" Rather than "ESI is reimbursing too low." Chains just race to the bottom, and they unfortunately have no problem burying each other on the way.

Originally Posted by Ackj

That is precisely because the chains weren't united. They are the ones who pointed the finger at wags. "Wags won't take your claims, so come here!" Rather than "ESI is reimbursing too low." Chains just race to the bottom, and they unfortunately have no problem burying each other on the way.

Exactly! Which is why the PBMs will win and chain pharmacies will lose.

Originally Posted by MountainPharmD

Exactly! Which is why the PBMs will win and chain pharmacies will lose.

Are you doing what's right for the patientz?

Originally Posted by MountainPharmD

Its amazing what a normal schedule, a comfy chair and an hour lunch everyday will do for a persons attitude.

I want everyone to know that I am hard at work sitting in my comfy chair everyday from 9-6 denying your customers prior auth requests because thier doctor is a dumbass and cannot follow simple directions when filling out a three question form. You now know whos fault it is when you are getting your ass chewed off by some idiot customer because their prior auth was denied. A dumbass doctor and a pharmacist sitting in a comfy chair.

Thanks! I really appreciate it.

Originally Posted by MountainPharmD

Exactly! Which is why the PBMs will win and chain pharmacies will lose.

You are right to a point. Those business men aren't going to allow it to be cut to a point of losing money. The PBMs can (and likely will try) to cut it very close to that point.

You have how many PBMs vs. how many pharmacy options? You also have pharmacies that are customer leaders...in that they are just there to help bring people in the door. They aren't money makers for the company.....they just want them to break even or lose very little per person they bring through the doors. CVS, Walgreens, RiteAid, and a few others...must make money on Rx.

Also, the PBMs must get the scripts to the customer. They can use the retail outlets or mail order (everyone hates mail order though), but it comes down to a cost factor to them.

Mail order....even if you can get the script filled for $1 a scripts after factoring in rent, utilities, labor, inventory cost (as money has a time value), and etc. You then have to ship it to the customer, and postage is going to be 3-4$ or more if you need them to sign for it. If you can get the retail stores to fill it for basically the same cost, then you are going to use them.

It comes back to which way makes the most money over all. You can't save a dime, and risk losing the customer/client.

Originally Posted by Its Z

Are you doing what's right for the patientz?

lol

Originally Posted by Its Z

Are you doing what's right for the patientz?

I have only been at the PBM for a month. I am not Mr. Pro-PBM quite yet. I do have an understanding of how things work that I did not have before I started. I do not buy into the argument that PBM's save enough money to justify thier existence. However, I don't think they cost the system any more money. The plan sponsors would be paying the same amount of money with or without the PBM. Since the PBM is the middleman money that would have gone to the pharmacy now goes to the PBM to pay for managing the benefit. I have a huge problem with that being a former retail pharmacist. I think the major insurance companies could manage the prescription benefit just fine and not cost as much as having PBMs do it..

To answer your question, yes I think we are doing what is right for the patient and what is right for the plan sponsor who is picking up the tab. The PBM is not about denying a patient their medication. The PBM is about controlling costs based on parameters selected by the plan sponsor when they signed up for the benefit. If a plan sponsors employees were allowed to get whatever medication they wanted for any reason or no reason at all the cost of the benefit would be so high that it would have to be discontinued.

Should everyone who sees the commercial for the purple pill be allowed to march into thier doctor's office and demand a prescription for it because sometimes when they eat Mexican food right before bed they get a little heart burn? Should a plan sponsor have to pay for everyone of thier employees who wants to do this? Or does it make sense to have a checks and balance system in place that limits a patient from getting the purple pill unless they actually have a documented medical reason for it and have failed the less expensive generic alternatives first. Thats what the PBM does for a plan sponsor and how they keep the cost of the benefit dfown for them.

Z, you are a hospital man. How important is cost control in the hospital? Do you order whatever you want without regard to cost? Why should it be any different in the retail setting?

Originally Posted by MountainPharmD

I have only been at the PBM for a month. I am not Mr. Pro-PBM quite yet. I do have an understanding of how things work that I did not have before I started. I do not buy into the argument that PBM's save enough money to justify thier existence. However, I don't think they cost the system any more money. The plan sponsors would be paying the same amount of money with or without the PBM. Since the PBM is the middleman money that would have gone to the pharmacy now goes to the PBM to pay for managing the benefit. I have a huge problem with that being a former retail pharmacist. I think the major insurance companies could manage the prescription benefit just fine and not cost as much as having PBMs do it..

To answer your question, yes I think we are doing what is right for the patient and what is right for the plan sponsor who is picking up the tab. The PBM is not about denying a patient their medication. The PBM is about controlling costs based on parameters selected by the plan sponsor when they signed up for the benefit. If a plan sponsors employees were allowed to get whatever medication they wanted for any reason or no reason at all the cost of the benefit would be so high that it would have to be discontinued.

Should everyone who sees the commercial for the purple pill be allowed to march into thier doctor's office and demand a prescription for it because sometimes when they eat Mexican food right before bed they get a little heart burn? Should a plan sponsor have to pay for everyone of thier employees who wants to do this? Or does it make sense to have a checks and balance system in place that limits a patient from getting the purple pill unless they actually have a documented medical reason for it and have failed the less expensive generic alternatives first. Thats what the PBM does for a plan sponsor and how they keep the cost of the benefit dfown for them.

Z, you are a hospital man. How important is cost control in the hospital? Do you order whatever you want without regard to cost? Why should it be any different in the retail setting?

Already getting drunk on the koolaid, eh?

Originally Posted by MountainPharmD

I have only been at the PBM for a month. I am not Mr. Pro-PBM quite yet. I do have an understanding of how things work that I did not have before I started. I do not buy into the argument that PBM's save enough money to justify thier existence. However, I don't think they cost the system any more money. The plan sponsors would be paying the same amount of money with or without the PBM. Since the PBM is the middleman money that would have gone to the pharmacy now goes to the PBM to pay for managing the benefit. I have a huge problem with that being a former retail pharmacist. I think the major insurance companies could manage the prescription benefit just fine and not cost as much as having PBMs do it..

To answer your question, yes I think we are doing what is right for the patient and what is right for the plan sponsor who is picking up the tab. The PBM is not about denying a patient their medication. The PBM is about controlling costs based on parameters selected by the plan sponsor when they signed up for the benefit. If a plan sponsors employees were allowed to get whatever medication they wanted for any reason or no reason at all the cost of the benefit would be so high that it would have to be discontinued.

Should everyone who sees the commercial for the purple pill be allowed to march into thier doctor's office and demand a prescription for it because sometimes when they eat Mexican food right before bed they get a little heart burn? Should a plan sponsor have to pay for everyone of thier employees who wants to do this? Or does it make sense to have a checks and balance system in place that limits a patient from getting the purple pill unless they actually have a documented medical reason for it and have failed the less expensive generic alternatives first. Thats what the PBM does for a plan sponsor and how they keep the cost of the benefit dfown for them.

Z, you are a hospital man. How important is cost control in the hospital? Do you order whatever you want without regard to cost? Why should it be any different in the retail setting?

Originally Posted by joetrisman

Already getting drunk on the koolaid, eh?