If the universe is a fair and just place, one day a pharmacist will land the CEO position at Express Scripts. On that day, the practice of pharmacy will be more appropriately valued by a mega PBM CEO. In the meantime, pharmacists and their patients will have to endure public remarks likes those recently uttered by George Paz, Express Scripts current CEO.
“At the end of the day … Nexium is Nexium, Lipitor is Lipitor, drugs are drugs, and it shouldn’t matter that much who’s counting to 30,” asserted Mr. Paz. This quote was attributed to Paz by Tom Murphy, the AP’s business writer.
Mr. Paz is not a pharmacist, but rather he has a finance background. In 2003, he joined ESI as its CFO. Most people with any knowledge of business understand that a CFO is not a glorified “bean counter”, and by now, Mr. Paz certainly knows that pharmacists are not pill counters.
This is why pharmacists and their patients should find Mr. Paz’s most recent assault on the value of the patient/pharmacist relationship so ominous. This latest remark is not simply an ill-informed or thoughtless throw-away line, but rather a well-considered and calculated effort to commoditize community pharmacy to serve the profit motivations of Express Scripts.
Mr. Paz’s comment was delivered during a conference call with industry analysts. This is not a venue in which CEOs usually shoot from the hip. Quite to the contrary, CEOs typically use these meetings to clearly and carefully articulate the strategic direction of their companies and how that strategy will enhance shareholder value, drive growth and increase profits.
Make no mistake, Mr. Paz was providing insight into Express Scripts’ go-forward strategy; he is saying that pharmacists deliver minimal value and are viewed as interchangeable parts by Express Scripts. The implications of this posture are staggering. Express Scripts will include or exclude pharmacies in its pharmacy networks based solely on their profit utility to Express Scripts. Recent events indicate that this strategy applies to a single small business independent pharmacy as well as to a national chain with 7,000 plus stores.
Let’s be clear. Express Scripts is seeking to deny the value that local pharmacists bring to patients. In the brave new pharmacy world that Mr. Paz envisions where Express Scripts’ merger with Medco has been approved and Walgreens is brought to heel, patients on complex therapy regimens who are at high risk of non-adherence simply get pills counted and bottled for them rather than receiving face-to-face counseling from their local pharmacists. Patients using high-cost brands are not moved to lower cost generics when appropriate notwithstanding the impact on PBM rebate revenues as community pharmacists do every day. Patients with long-standing relationships with their community pharmacies see these relationships disregarded and are moved to Express Scripts’ mail order and central fill pharmacies. Of course, Express Scripts will continue to see value in creating retail pharmacy spreads that drive up its profits and reduce the available savings to health plans and employers.
Mr. Paz should explain to Congress why his recent remarks contradict previous comments he made to that body just this past fall. At that time, the standard Express Scripts talking points acknowledged that community pharmacists were critical partners to the PBMs.
Express Scripts is seeking the support of Congress in its effort to have the FTC approve its mega merger with Medco. Just like patients, health plans and pharmacists, Congress has the right to know where Mr. Paz really stands on the value of pharmacy before the FTC rules on the proposed merger. Will they continue to be valuable close-to-patient assets that can be leveraged to control cost and drive improved patient outcomes or does Express Scripts intend to reduce the role of pharmacists to mere pill counting? Because Express Scripts’ position on this critical question is still unknown even at this late date, NCPA continues to strongly urge the FTC to reject the proposed merger.