Letters to the editor: January 22, 2007

January 22, 2007

Pharmacy benefit managers make so much money from the Rxs they adjudicate that a PBM officer had enough money to fund his own multimillion-dollar campaign for governor of New Jersey. The feds scream that Medicare/Medicaid costs too much, then they turn it over to the PBMs that are making so much money that they can handle a multimillion-dollar fine easily. One PBM-Express Scripts-is making a bid for another PBM, Caremark Rx, for $26 billion.

Am I wrong that the $26 billion will come from our pockets? The difference in what they charge the insurers and what they pay pharmacies to dispense the medication, plus the rebates they get from the drug companies for putting their drugs on formulary, is a trade secret, according to them. If they had to let us know how much they were making, maybe someone would wake up and put a stop to this rape of the country. Don't payers see that the PBMs are part of the problem, not the solution?

The other major component of the problem is the drug companies themselves. They pay more for lobbying, advertising, rebates to governments and PBMs, and political contributions (visible and not) than they pay for drug development. Drug price has nothing to do with the cost of the actual drug. In many cases, it is so low that manufacturers can afford to give the drug away to people who can't afford it. Drug companies make more money from manipulating dosage forms and making a spectrum of combination products than they do from original research into new drugs. Each new dosage form and group of combo drugs is priced as though it were an original research product. With no controls in place for these industries, and as long as they keep supporting the people in power (who have health insurance and retirement plans that we pay for), we will remain in the pit where we have been placed by the very people we have trusted to get us out of this mess.

Howard S. Feder
V.G.H. Pharmacy, Brooklyn, N.Y.

It's unseemly to time dispensing speed

I was fascinated to read your Dec. 11 article about Kaiser Permanente's standard requiring 80% of new Rxs to be filled within 15 minutes. This may be a laudable goal, but the cost is too great in terms of reduced patient safety and quality of service. It puts pharmacists at tremendous risk and contributes to job dissatisfaction and burnout. Corporate employers are typically unwilling to provide the staff and systems needed to support such a model, and they seem oblivious to or uncaring about any of the problems or risks this may cause. Fast-food restaurants are typically better staffed during their peak demand periods.

A second issue is the lack of input control. If a pharmacy could actually control its input in terms of new and refill prescriptions, then such a standard would become a desirable, reasonable, and attainable goal. There is no other profession or trade, for that matter, that does not control its input. Clients or customers must make appointments to see virtually any provider of service in health care, finance, or even auto repair.

This also illustrates the dichotomy in pharmacy service. While the profession is ardently trying to make the service the product, the industry is successfully making the product a commodity.

Anthony Montalbano, R.Ph., MBA
Caledonia, N.Y.