Community pharmacy coalition calls on state attorneys general to block PBM merger

WASHINGTON — The Preserve Community Pharmacy Access NOW! coalition — formed in opposition of the proposed Express Scripts-Medco merger — Wednesday afternoon hosted a press conference making a direct appeal to attorneys general to block the ESI-Medco merger in the courts should the Federal Trade Commission approve the merger.

"There are few mergers I've ever seen that are as anticompetitive as this meger," said David Balto, antitrust attorney and former FTC policy director. "When the states think there's a problem, and they've already recognized there's a problem involving PBMs, they are as every bit as capable … litigators as the FTC," he said. "Ultimately, if [the states] bring a case, it isn't a bureaucrat in Washington who's going to make a decision whether or not this merger is anticompetitive, it is a federal court judge."

Balto pointed out that as many as 78 Congress members have written the FTC advocating that this merger be disallowed.

Balto outlined four reasons why an ESI-Medco merger would be detrimental to consumers of health care:

  • One, many consumers will lose access to their community pharmacies because they'll be forced into mail order;

  • Two, because more patients are pressured into mail-order participation, drug prices actually will rise because of a lower rate of generic substitution;

  • Three, $4-generics available through many retail pharmacies will disappear as the merged PBM will be able to significantly reduce reimbursements for these low-cost pharmaceuticals; and

  • Four, prices will increase across specialty pharmacy offerings as a larger PBM is able to dominate this marketplace through a greater buying power.

History has shown, Balto said, that when Express Scripts "gets exclusivity, they significantly ratchet up prices."

Balto and others project an Express Scripts-Medco merger will eliminate many community pharmacies. "How convenient — the pharmacies disappear and the PBMs take consumers from an open, competitive channel and funnel them into a closed, mail order [system]," said Steve Pociask, president of the American Consumer Institute.

Express Scripts earlier Wednesday filed a Form 8-K with the Securities Exchange Commission that they expect the proposed merger to close as early as next week, suggesting that an FTC decision may be imminent.

According to published reports, attorneys general in New York, Pennsylvania, Ohio, Texas and California already are considering filing suit to block the merger if it is passed without serious conditions.


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