Former President Ronald Reagan once quipped "The nine most terrifying words in the English language are: I'm from the government and I'm here to help."
Last week, President Donald Trump unveiled his administration’s plan to lower prescription drug costs—which are first on everyone’s mind, even though they account for only 10% of the healthcare dollars spent by the government.
In his address, the President laid a smackdown on the PBMs (prescription benefit managers), stating the plan will, “end the dishonest double-dealing that allows the middleman to pocket rebates and discounts that should be passed on to consumers and patients.” President Trump also wants to end gag clauses and allow pharmacists to help their patients explore lower cost options.
I worked nine hours today at the community pharmacy, a job that I truly love even after 37 years. Today was frustrating, and virtually every obstacle was due to the PBMs or the drug manufacturers.
One of the PBMs gets the award for raising my blood pressure the most on a busy Monday. Jenny is a 70-year-old woman with hypertension. Her physician wrote for Benicar HCT 40/12.5. “Claim denied, prior authorization necessary” was the message from the PBM when we transmitted the generic version of olmesartan medoxomil.
The patient had previously taken Benicar HCT with success, as prescribed by her family physician. When I looked up the cost and saw that the wholesale acquisition cost (WAC) was $12.00 a month, the patient offered to pay cash to avoid not getting her medication. This is micromanagement to the most ridiculous levels. The PBM would rather our patient not have her medication for three days until they get around to approving the drug.
I’m convinced that the decision makers in these organizations have virtually no understanding of half-lives. The half-life of olmesartan is 13 hours, which provides round the clock coverage for hypertension. The PBM’s choice is losartan (Cozaar), which has a terminal half life of 2 hours, which would not cover Jenny through the night and morning when she would be most likely to have a stroke. But then, a stroke doesn’t matter to the PBM’s accountants because of the disjointed healthcare system we operate in.
So, President Trump what can you do for Pete Kreckel, and his fellow pharmacists who truly care about their patients? I’m glad you asked. Here’s my Top Ten List:
- Eliminate PBMs, pure and simple. They provide absolutely nothing to the healthcare system.
- Eliminate prior authorizations for any drug that costs less than $50.
- Pay pharmacists a reasonable dispensing fee, so pharmacists can make a good livelihood, along with their technicians and others who make a community pharmacy happen.
- Penalize any generic or brand company who raises prices more than the consumer price index.
- Penalize any generic manufacturer who quits making a product just to drive up the price, as we saw with the dermatological products a few years ago, and currently with clonazepam.
- Eliminate any preferred networks. Our patients should not have to patronize a pharmacy that they don’t wish to go to on their own volition. All copays should be equal whether it is my 1,200 square foot store or the big box down the road. Patients can decide on what health care professional they want to care for them.
- DIR (direct and indirect remuneration) fees must go now! Pharmacists need not be penalized for their patient’s adherence insufficiencies or their physicians prescribing patterns.
- Eliminate gag clauses that keep me from offering more sensible solutions that affect the patient’s wallet.
- Enact tort reform as soon as possible. Loser pays, and the frivolous lawsuits go away.
- Allow pharmacists in on these discussions. I’ll be awaiting your e-mail, Mr. President.
When I think how my career has changed over the past 37 years, from taking care of my patients to taking care of their PBMs, I can also hear President Reagan saying: "Government is not the solution to our problem. Government is the problem.