It's a matter of time CVS....

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MountainPharmD

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http://drugtopics.modernmedicine.co...Article/detail/594197?contextCategoryId=47443

It boggles my mind that this merger was ever approved. Of all the stupid things our government has done this ranks right up there. NCPA is collecting data from independant pharmacies. It's only a matter of time before CVS gets smacked down.

Hopefully some of you have noticed that CVS/Caremark insured can go anywhere to get thier scripts filled BUT they are receiveing preferential treatment if they use CVS pharmacies. They can get a a 90 day supply and mail order co-pays if they use CVS but not if they use a competing pharmacy.

A monopoly at its finest.
 
I hope they get their due for not playing fair... It's one thing to start your own insurance agency, e.g. WHI, but it's a completely different if you take over a major insurer and then restrict patient-access to indy pharmacies.
 
http://drugtopics.modernmedicine.co...Article/detail/594197?contextCategoryId=47443

It boggles my mind that this merger was ever approved. Of all the stupid things our government has done this ranks right up there. NCPA is collecting data from independant pharmacies. It's only a matter of time before CVS gets smacked down.

Hopefully some of you have noticed that CVS/Caremark insured can go anywhere to get thier scripts filled BUT they are receiveing preferential treatment if they use CVS pharmacies. They can get a a 90 day supply and mail order co-pays if they use CVS but not if they use a competing pharmacy.

A monopoly at its finest.

Clarification: Not all CVS/Caremark beneficiaries get this benefit - only specific groups.
 
Although I agree with the article that it is unfair, on the other hand. . . those independent pharmacies wouldnt be getting the business anyway. This is how all mail order operates. Allowing patients to at least get a cheaper co pay for going into CVS is better than not allowing them at all.
 
Plus personally, it affects mail order competition which is a plus for me since I see them as a threat. Now, retail is a threat to PBMs because retails now offer both mail order and store pickup plus will make money if the patient goes into the store and buy front end goods on the way.
 
The last couple months we have had some of our regulars at Wags get their refills rejected, saying they must use mailorder. When they call on it, they can use mailorder or go to CVS to get it filled. This is a bunch of crap, and I hope it gets corrected.
 
:soexcited: It's a matter of time CVS takes over the retail industry...that's was the plan from the beginning.

Now, if they can "improve" the damn PCI program that would be great..

Walmart did the $4 crap, Kroger followed..people complained but nothing was done about it..freaking Publix giving away antibiotics..nothing was done. Now CVS/caremark is saving the patient a copay with the 90-day supply and yall wanna crucify us...Good luck..
 
:soexcited: It's a matter of time CVS takes over the retail industry...that's was the plan from the beginning.

Now, if they can "improve" the damn PCI program that would be great..

Walmart did the $4 crap, Kroger followed..people complained but nothing was done about it..freaking Publix giving away antibiotics..nothing was done. Now CVS/caremark is saving the patient a copay with the 90-day supply and yall wanna crucify us...Good luck..

Seriously... why not bitch about medco requiring mandatory mail order along with all the other PBMs out there? What CVS/Caremark is doing right now is better in the sense that mail order isnt mandatory anymore. . . but patients can get it filled at a CVS pharmacy. This would be better than Caremark saying no, all orders must be filled mail order.
 
Seriously... why not bitch about medco requiring mandatory mail order along with all the other PBMs out there? What CVS/Caremark is doing right now is better in the sense that mail order isnt mandatory anymore. . . but patients can get it filled at a CVS pharmacy. This would be better than Caremark saying no, all orders must be filled mail order.

I agree. The CVS/Caremark is definitely the lesser of the two evils in this case (it certainly isn't the best option for the patient though).

The state pharmacists organizations in New York are lobbying for legislation that would make it illegal for PBMs to prevent their enrollees from choosing to go to a local pharmacy. Anyone know if other states have similar legislation in the works?
 
I agree. The CVS/Caremark is definitely the lesser of the two evils in this case (it certainly isn't the best option for the patient though).

The state pharmacists organizations in New York are lobbying for legislation that would make it illegal for PBMs to prevent their enrollees from choosing to go to a local pharmacy. Anyone know if other states have similar legislation in the works?

from my standpoint that would be great

i hate losing customers to mail order
 
I agree. The CVS/Caremark is definitely the lesser of the two evils in this case (it certainly isn't the best option for the patient though).

The state pharmacists organizations in New York are lobbying for legislation that would make it illegal for PBMs to prevent their enrollees from choosing to go to a local pharmacy. Anyone know if other states have similar legislation in the works?

These laws will be ruled unconstitutional as the pervue of the Federal Government. Individual states are not permitted to interfere with interstate commerce.
 
These laws will be ruled unconstitutional as the pervue of the Federal Government. Individual states are not permitted to interfere with interstate commerce.
So you think they'll decide that it's unconstitutional to allow patients greater access to their medications? 😕
 
Aren't they effectively restricting patients' access by only allowing them to get scripts mail order, at a particular chain pharmacy, etc.? So... that's... ummmmm... what do they call that?... prohibiting patients from having full access to their medications...
 
So you think they'll decide that it's unconstitutional to allow patients greater access to their medications? 😕

I personally think all mail order should be eliminated. But I also hate instant replay and the designated hitter, but I don't get to make that call.

Health care used to local or regional. Not any longer it is national and individual states may not interfere with interstate commerce.

Article I, Section 8


U.S. Constitution - Legislative Branch, Enumerated and Implied Powers of Congress

Clause 1: The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States;​
Clause 2: To borrow Money on the credit of the United States;
Clause 3: To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes;
Clause 4: To establish an uniform Rule of Naturalization, and uniform Laws on the subject of Bankruptcies throughout the United States;
Clause 5: To coin Money, regulate the Value thereof, and of foreign Coin, and fix the Standard of Weights and Measures;
Clause 6: To provide for the Punishment of counterfeiting the Securities and current Coin of the United States;
Clause 7: To establish Post Offices and post Roads;
Clause 8: To promote the Progress of Science and useful Arts, by securing for limited Times to Authors and Inventors the exclusive Right to their respective Writings and Discoveries;
Clause 9: To constitute Tribunals inferior to the supreme Court;
Clause 10: To define and punish Piracies and Felonies committed on the high Seas, and Offences against the Law of Nations;
Clause 11: To declare War, grant Letters of Marque and Reprisal, and make Rules concerning Captures on Land and Water;
Clause 12: To raise and support Armies, but no Appropriation of Money to that Use shall be for a longer Term than two Years;
Clause 13: To provide and maintain a Navy;
Clause 14: To make Rules for the Government and Regulation of the land and naval Forces;
Clause 15: To provide for calling forth the Militia to execute the Laws of the Union, suppress Insurrections and repel Invasions;
Clause 16: To provide for organizing, arming, and disciplining, the Militia, and for governing such Part of them as may be employed in the Service of the United States, reserving to the States respectively, the Appointment of the Officers, and the Authority of training the Militia according to the discipline prescribed by Congress;
Clause 17: To exercise exclusive Legislation in all Cases whatsoever, over such District (not exceeding ten Miles square) as may, by Cession of particular States, and the Acceptance of Congress, become the Seat of the Government of the United States, and to exercise like Authority over all Places purchased by the Consent of the Legislature of the State in which the Same shall be, for the Erection of Forts, Magazines, Arsenals, dock-Yards, and other needful Buildings; and
Clause 18: To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer
 
I personally think all mail order should be eliminated. But I also hate instant replay and the designated hitter, but I don't get to make that call.

Health care used to local or regional. Not any longer it is national and individual states may not interfere with interstate commerce.

Article I, Section 8

Clause 3: To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes;
I understand what interstate commerce is. 🙂

My question to you is: aren't they already trying to limit such commerce by forcing patients into mail order or not mail order pigeon holes?

So... aren't they already interfering with interstate (or not) commerce?
 
I understand what interstate commerce is. 🙂

My question to you is: aren't they already trying to limit such commerce by forcing patients into mail order or not mail order pigeon holes?

So... aren't they already interfering with interstate (or not) commerce?

The insurance companies are conducting interstate commerce, poorly, in your opinion, but they are subject to regulation by the federal government and not the state government.
 
The insurance companies are conducting interstate commerce, poorly, in your opinion, but they are subject to regulation by the federal government and not the state government.
Ok. So you think that they'll be able to overturn that type of decision, because the federal government supersedes the states?


What if this leads to a revision or amendment of the Constitution? 😛
 
Ok. So you think that they'll be able to overturn that type of decision, because the federal government supersedes the states?


What if this leads to a revision or amendment of the Constitution? 😛

That's the only way. It's clear form the Constitution the power to regulate interstate commerce lies with the United States Congress (Pretty Scary, huh).

Don't you work retail? If so haven't you noticed the number of Blue Cross and Blue Shield Plans from out of state? The Bush Administration in an attempt to pay off the insurance industry passed regulations that allowed this to happen and it prevents states from regulating insurance companies. Want to mandate mamograms. No way. If your employer signs up with Blue Sheild of Wyoming and Wyoming allows plans w/o mamograms, too bad. Want to discipline said plan for violation of some provision of the the local state law, negatory big ben..... Want to file a complaint with your local insurance commission, tough.
 
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Not sure if this has been mentioned before (I am sure it has - but I am lazy and have no interest in searching)...

Wags no longer accepting caremark.

I am not sure if it was Wags no longer accepting caremark, or the other way around. I know it resulted in my parents moving their scripts from Wags to CVS - for which they were rather bitter (only because they liked the Wags pharmacist, not the company).

It was certainly after the merger occurred - Any thoughts?
 
http://drugtopics.modernmedicine.co...Article/detail/594197?contextCategoryId=47443

It boggles my mind that this merger was ever approved. Of all the stupid things our government has done this ranks right up there. NCPA is collecting data from independant pharmacies. It's only a matter of time before CVS gets smacked down.

Hopefully some of you have noticed that CVS/Caremark insured can go anywhere to get thier scripts filled BUT they are receiveing preferential treatment if they use CVS pharmacies. They can get a a 90 day supply and mail order co-pays if they use CVS but not if they use a competing pharmacy.

A monopoly at its finest.

I am sure walgeens would do the same thing if they could. You don't think walgeens is out there lobbying some benefits people to restrict their group to walgreens? I am sure your grocery store would do the same thing if they had the ability to. It's all business. If I ever had to get a medication that I don't want my coworkers to know about I would have to go pay cash somewhere, yes it sucks but that's business.
 
Not sure if this has been mentioned before (I am sure it has - but I am lazy and have no interest in searching)...

Wags no longer accepting caremark.

I am not sure if it was Wags no longer accepting caremark, or the other way around. I know it resulted in my parents moving their scripts from Wags to CVS - for which they were rather bitter (only because they liked the Wags pharmacist, not the company).

It was certainly after the merger occurred - Any thoughts?

Walgreens would go under if they no longer accepted any Caremark claims. This kind of thing is group specific. The group your parents are in has selected a restricted network in order to save money. This has been going on as long as I have been a pharmacist. Some groups used to ask you to select a specific pharmacy and you could only go to that pharmacy.
 
Walgreens would go under if they no longer accepted any Caremark claims. This kind of thing is group specific. The group your parents are in has selected a restricted network in order to save money. This has been going on as long as I have been a pharmacist. Some groups used to ask you to select a specific pharmacy and you could only go to that pharmacy.

It does seem to be group specific - Chicago Times article talking about 4 such plans - My parents were not included in these groups...

LINK
 
It does seem to be group specific - Chicago Times article talking about 4 such plans - My parents were not included in these groups...

LINK

It's those groups that sign up to enroll in those plans. It's not all of Caremark.
 
I was hoping someone would jump on the huge conflict of interest that now exists when the largest retail pharmacy chain and one the largest PBMs merge. It should never have been allowed to happen. I guess my point was to bring to light one of the big issues we face today are PBMs.

MAY 4, 2009 Wal-Mart Expands Drug Program
Retailer Steps Up the Competition Over Managing Benefits for Employers

Wal-Mart Stores Inc. is expanding a pilot prescription-drug program for companies, heating up the race among pharmacy retailers to transform the way drugs are priced and sold.

The discount retailer is offering businesses low-priced drugs if they sign up to buy directly from Wal-Mart's network of in-store pharmacies, rather than contracting to buy drugs through third parties known as pharmacy-benefit managers.

Wal-Mart's program follows other recent initiatives by big pharmacy retailers to grab market share by offering companies a less-expensive and simpler way to manage their drug plans.

The competition among Wal-Mart, Walgreen Co. and others to create more-efficient business


PBMs are making billions of dollars a year and do nothing except collect payment and then distribute it. It is insanity to think PBMs are necessary. Say what you want about Wal-Mart but it looks like they have come to that realization and are trying to do something about it.
 
I was hoping someone would jump on the huge conflict of interest that now exists when the largest retail pharmacy chain and one the largest PBMs merge. It should never have been allowed to happen. I guess my point was to bring to light one of the big issues we face today are PBMs.




PBMs are making billions of dollars a year and do nothing except collect payment and then distribute it. It is insanity to think PBMs are necessary. Say what you want about Wal-Mart but it looks like they have come to that realization and are trying to do something about it.

PBM's are certainly necessary- think about it. If you have 5 insurers and 5 retail pharmacies, without a PBM that is 25 transactions from insurer --> pharmacy. With a PBM, the number of transactions is cut down to 10. Now extrapolate that to the thousands of insurers and tens of thousands of pharmacies...Unless another system is put in place, PBMs are here to stay and are a very necessary part of our reembursment system.
 
PBM's are certainly necessary- think about it. If you have 5 insurers and 5 retail pharmacies, without a PBM that is 25 transactions from insurer --> pharmacy. With a PBM, the number of transactions is cut down to 10. Now extrapolate that to the thousands of insurers and tens of thousands of pharmacies...Unless another system is put in place, PBMs are here to stay and are a very necessary part of our reembursment system.

Stay? Yes. Necessary? No.
 
Saying that all PBM's do is pay claims = all pharmacists do are count pills.


Naive at best, disingenuous at worst....
 
Saying that all PBM's do is pay claims = all pharmacists do are count pills.


Naive at best, disingenuous at worst....

So tell us why PBMs are necessary. What other functions do they do other than receive and distribute payment?

After that expalin why PBMs had billions of dollars in profit last year while the reimbursement for pharmacy continues to free fall.
 
So tell us why PBMs are necessary. What other functions do they do other than receive and distribute payment?

After that expalin why PBMs had billions of dollars in profit last year while the reimbursement for pharmacy continues to free fall.

They monitor and manage drug therapy, manage drug interactions. They control costs for their clients as they attempt to deal with the massive costs heaped on us by the drug companies.

I have a friend who works for one of the PBM's he calls doctors all day and has just completed training to make MD office visits to educate the doctors so they are not just influenced by the drug reps....
 
So tell us why PBMs are necessary. What other functions do they do other than receive and distribute payment?

People tend to have a misperception that all PBMs do is to come up with a formula. That's far from the truth. PBMs invested hundreds, perhaps billions, in its infrastructure and in technology. In addition, it has contracts to do clinical work and to follow the patient's therapy like for revlimid. You will get more clinical training if you worked for a PBM than you ever will for a retail.
 
My reply to you both is watch this video.

http://www.preservepharmacy.com/VideoExcerpts.asp

It shows EXACTLY how the PBM's sell their program to the payor.... via "song & dance " and "smoke & mirrors"...

PBM's are here to make money...PERIOD. Open your eyes.....PBMs are one of the biggest problems we face.

If you understanding this then you understand why CVS and Caremark merged. You should also understand why it should never have been allowed by the government.
 
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PBM's are here to make money...PERIOD. Open your eyes.....PBMs are one of the biggest problems we face.

It is obvious that the PBMs want to make money but you are misguided to believe all PBMs do is to receive and distribute payment. If what they do is as simple as you think, they wouldn't become this powerful.
 
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