Medco Chief Slights Community Pharmacists after Brief Embrace


By Kevin Schweers

Did Halloween come early to Franklin Lakes, N.J.? How else can one explain the Dr. Jekyll and Mr. Hyde performance of Medco’s CEO embracing community pharmacists before Congress only to subjugate them below robots days later?

Under oath before Rep. Bob Goodlatte’s (R-Va.) House Judiciary Subcommittee on Intellectual Property, Competition and the Internet hearing on the proposed Express Scripts-Medco merger Sept. 20th, Medco Chairman and CEO David Snow, Jr. professed to be a positive agent for, even an ally of, independent community pharmacists.

“In short, either as a stand-alone company or combined with Express Scripts, Medco is dependent on the continued existence of strong independent retail pharmacies,” Mr. Snow testified. He went on to cite Medco’s Cognitive Care Initiative, a collaboration with community pharmacies in Illinois intended to improve medication adherence.

It’s true that his testimony occasionally appeared to slight local pharmacists. For example, Mr. Snow called pharmacies “complementary” to PBMs, to which NCPA member Joseph Lech, RPh, retorted: “As a professional, as a pharmacist they’ve got that totally backwards. It is our profession, it is our art, our science that, in a sense, they are getting in the way of.”

However, the clear takeaway impression was one of PBM affection for and support of community pharmacists. “We need these retail pharmacies,” Mr. Snow repeated.

Then, just two weeks later, out came Mr. Hyde. Medco’s CEO laid out this doozy, according to the PharmExec.com blog entry, “Medco CEO Champions Robots over Pharmacists”:

“Medco CEO David Snow told attendees at the Cleveland Clinic’s Medical Innovation Summit last week that pharmacists are not in fact doling out health information to patients. ‘I’m not dissing retail [pharmacy], but…there’s a fiction that a pharmacist comes out and dialogues with you,’ said Snow. ‘In reality, a high school student hands you a script from the shelf.’ In a follow-up dis to retail pharmacists, Snow added that Medco’s ‘robots’ are ‘twenty-three times more accurate’ than human pharmacists, in terms of errors in dispensing prescriptions.”

Memo to Medco: Does your mail order dispensing robot…

  1. Help confused patients navigate their health plan’s ever-changing drug formulary?
  2. Have much to say about its role assisting patients bewildered by prescription denials by PBMs and drug plans in the early days of the Medicare Part D drug benefit?
  3. Traverse Vermont flood waters to deliver prescriptions to patients by National Guard helicopter, all-terrain vehicle and even horseback?
  4. Help evacuated Pennsylvania flood victims taking 16 daily prescription medications get back on their regimen?
  5. Open make-shift pharmacies to restore patients’ access to essential prescription medicines within 24 hours of a devastating tornado?
  6. Help patients manage their diabetes to avoid much more costly health complications and treatments?
  7. Save lives by helping underserved patients know when it’s critical that they see a doctor or go to the hospital?
  8. Dramatically expand the accessibility and affordability of influenza immunizations?
  9. Dispense cost-saving generic medications roughly 20 percent more often than mail order? Or, in this case, the rest of the mail order?
  10. Compound personalized medications for special-needs patients or to alleviate drug shortages?

One area where the output of PBM mail order computerization appears to be indisputable is in “automatic shipping” and other forms of mail order waste. At that same Congressional hearing, Mr. Lech released “Waste Not, Want Not,” a sampling of the needless pharmaceutical spending associated with mail order, particularly mandatory mail order.

Since that hearing, community pharmacists continue to report seeing expensive mail order excess. One independent community pharmacist relayed participating in a one-day drug disposal program.

“We took in a little over 150 pounds of expired and unwanted drugs,” the re-cap read. “About 75% of them were mail order labels (Medco). …I was shocked at all the expensive drugs like Aricept, Namenda, Actos, Accolate, Lidoderm, Focalin, Lyrica, Cymbalta, Crestor, Advair, Combivent, Welchol packets, Lantus SoloStar- that the patients had more than one 90-day supply of – and were going to waste.”

Robots are better for some things than others.

5 Responses to “Medco Chief Slights Community Pharmacists after Brief Embrace”


  1. 1 The Redheaded Pharmacist October 26, 2011 at 3:09 am

    I attributed David Snow’s comments under oath during that House Judiciary Subcommittee hearing to him executing his game plan: to make the Medco/ESI merger sound as appealing as possible. The contrast to the comments he made during the health conference is striking. I wonder which extreme reveals his true opinion of pharmacists but I have an idea which side he believes most. I think this merger proposal should be a huge wake up call for the profession of pharmacy. It should be something we resist with all of our efforts. No good can come out of this joint venture.

  2. 2 kathy rothrock October 26, 2011 at 5:36 pm

    Either David Snow was lying under oath, or at the Health Conference! A PBM CEO- telling a lie? NO- say it isn’t so !!!!

  3. 3 connie blair October 27, 2011 at 12:47 pm

    Local pharmacies are indespensible; they have the medical knowledge and the knowledge of their consumers that cannot be attained through any mail order. They are available 24/7 very often, and not through a long distance toll free phone call; they can’t fill a script at 2AM. A local retail office keeps the money in the USA, taxable income for Uncle Sam that can in return add to the future finances needed to help assist those high script prices from large drug companies.

  4. 4 Pharmaciststeve October 31, 2011 at 11:09 pm

    Sure they need indys… if there was no indys… then the resulting battle will be between giants… without a wide community based Rx distribution system… their whole system will fall apart. Who is going to be in the small towns where the majority of indys are “keeping the lights on” and if one of the major chains walks away from an agreement.. Our convenience orientation -fast food – society will not tolerate such a system… Everyone needs to remember that the first Baby Boomer turned 65 this year and the YOUNGEST is now 47.. We have been a constant force of change on our society.. and many of us are now managing our parent’s (greatest generation) financial matters… and are in or approaching the age of our highest needs for healthcare. Mr Snow and other entities, may find that we won’t passively accept change that we don’t see in our best interest.


  1. 1 Pharmacists are more than just medication dispensers « APhA CEO Blog Trackback on October 26, 2011 at 1:38 am

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