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Specialty Pharmacists Urge FTC to Block PBM Merger

Author: Kate H. Gamble, Senior Editor

Editor's Note: On August 4, the National Association of Chain Drug Stores and National Community Pharmacists Association expressed formal opposition to the proposed Express Scripts-Medco merger in a letter to the Federal Trade Commission. The organizations voiced joint opposition to the proposed merger on the ground of its “anticompetitive impact on patients, consumers, the market and the entire healthcare delivery system.” To read the letter, click here. Please check back to Pharmacy Times' Web site for continued coverage of this critical issue.


The Independent Specialty Pharmacy Coalition (ISPC), a group of community-based specialty pharmacies based in the United States, is asking the Federal Trade Commission (FTC) to block Express Scripts’ proposed acquisition of Medco Health Solution. The companies are two of the three largest pharmacy benefit managers (PBM) and specialty pharmacies in the United States.

Both Express Scripts and Medco have large specialty pharmacy businesses, which ISPC leaders say “creates a clear conflict of interest with their drug authorization duties as a pharmacy benefit manager.” The coalition maintains that Express Scripts and Medco have failed to lower drug costs and have instead used their control of specialty pharmacies to prevent patients from using their pharmacy of choice. By inhibiting the use of community pharmacies for specialty prescriptions, PBMs are contributing to the increasing health care costs facing Americans, according to ISPC.

“The ISPC is requesting that the FTC immediately address this merger and protect the most vulnerable patients,” said Executive Director Russell Gay. “Allowing any PBM to acquire a dominant position in the specialty drug market, will be a giant step backwards in our nation’s efforts to improve healthcare and manage drug costs.”

The proposed merger, he added, “poses tremendous risks to all consumers, especially those dependent on vital specialty drugs. Allowing a PBM to dominant the management of specialty pharmacy care in the US is the wrong prescription to control drug costs.”

The cost of specialty drugs—which are used to treat critical conditions such as hemophilia, multiple sclerosis, Crohn’s disease, HIV/AIDS, and certain forms of cancer—make up an overwhelming portion of today’s drug cost increases. According to the Express Scripts 2010 Drug Trend Report, the specialty trend for 2010 came in at 19.6%, compared to just 1.4% for typical pharmaceuticals.

Moreover, the trend is only projected to increase in the future. By 2013, the report estimates the specialty trend will reach 27.5% due to factors such as increased utilization and new products entering the market, according to ISPC.

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