More Congressional Concern on Express Scripts-Medco PBM Merger

By Kevin Schweers

Four more Members of Congress, Republicans and Democrats alike, recently voiced their concern over the proposed mega-merger of pharmacy benefit managers (PBMs) Express Scripts and Medco, bringing the total to 74 combined Senators and Representatives who have raised the issue.

Letters to the Federal Trade Commission (FTC) were sent by U.S. Reps. Rick Crawford (R-Ark.), Robert Dold (R-Ill.), Ron Kind (D-Wisc.) and Bobby Rush (D-Ill.).

“The proposed merger of these two corporations could result in an unparalleled market concentration in an already limited PBM market further exacerbating an increasing problem for pharmacists and further restricting consumer choice,” wrote Rep. Crawford. Citing the one-sided nature of PBM contracts and laws prohibiting independent pharmacies from collectively bargaining, he added that the merger has the potential of “widening the leverage gap which may lead to more independent pharmacies closing shop.”

Given the significant concentration that the merger represents, Rep. Dold wrote of his fear of it “potentially resulting in higher prices and less choice for consumers.” He later noted that, “Without competition, normal market forces that foster continued innovation and keep costs down are missing.”

“This merger is likely to have negative effects on a national scale on local pharmacies, local pharmacy jobs, and affordable and available access for patients to prescription drugs and other critical pharmacy services and offerings,” warned Rep. Rush.

“Market clout and consolidation at such outsized levels would threaten the viability of many smaller local pharmacies and the thousands of community pharmacists and pharmacy staff they employ,” he added. Concerned that “the most disadvantaged, needy and price-sensitive consumers” stand to lose the most, he noted that, “Without question, local pharmacies and pharmacists are often a community’s most accessible and affordable health care provider—this is especially the case in Illinois’ lower-income and minority communities.”

“Because of the significant potential impact of this merger on consumer choice and prescription drug prices, I request that you carefully consider how consumers would be impacted by this merger,” Rep. Kind advised the FTC. “In addition, I represent nineteen counties in rural Wisconsin where community pharmacies are a vital access point to health care. Therefore, while this merger raises important market competition issues that could increase prescription drug prices for consumers, I am equally concerned about patient access to local pharmacies in Wisconsin and throughout the country.”

NCPA commends these Representatives and all who have to date raised bipartisan questions and concerns about the merger.

4 Responses to “More Congressional Concern on Express Scripts-Medco PBM Merger”

  1. 1 Concerned Pharmacist March 19, 2012 at 3:15 pm

    Look at what MSN put on their website under 12 Machines That Want Your Job! This really frustrates me. MSN should be more responsible than this!

    If you’ve ever had the suspicion that pharmacists are overpaid for simply reading prescriptions and putting pills in bottles, now there are a few machines around that might agree with you…. More

    Of course, highly-trained pharmacists are also on the lookout for potentially dangerous drug interactions and can answer questions about medications. Never mind that doctors could be on top of this.

    Behind the scenes, though, mail-order pharmacies like Medco Health Solutions (MHS) are favoring machines over pharmacists to help get the pills in the bottles.

    “There’s a fiction that a pharmacist comes out and dialogues with you,” Medco CEO David Snow said at a conference last fall, according to, an industry website. “In reality, a high school student hands you a script from the shelf.”

    Snow says Medco’s robots are 23 times more accurate than human pharmacists. (The National Association of Chain Drug Stores responds that these comments are just part of campaign to convert more patients over to mail-order pharmacy services, and push aside the neighborhood pharmacist.) See less

  2. 2 Kathy Elliott March 20, 2012 at 6:18 pm

    A robot is smarter than David Snow, and George Paz, and the rest of the “CEO’s”- 3 or 4 TOTAL- of the PBMs!!!!!!!!!!

    • 3 DelrayCitizen March 22, 2012 at 6:14 pm

      I say, replace THEM with robots! Will save their share holders millions and millions in yearly bonuses!

  1. 1 Preserve Community Pharmacy Access NOW (PCPAN) The Dose: More Congressional Concern On Express Scripts-Medco PBM Merger Trackback on March 20, 2012 at 8:13 pm

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