Merger of ESI and Medco


It's become clear that the distribution of prescription drugs is a commodity business in almost everybody's eyes -- except the community pharmacist.

I was on vacation a few weeks ago when I awoke to the headlines announcing the Express Scripts, Inc-Medco Health Solutions proposed merger. The reaction from the pharmacy profession against the merger has been loud and apparently unified. NASPA, NCPA, and NACDS released a letter that can be used to communicate to the FTC opposition to the merger along with talking points against the merger.

Why is the merger happening? A story in the North Carolina newspapers announced that NC Blue Cross was terminating their PBM contract with Medco and that Medco was losing market share. Maybe that is why they are willing to entertain a merger discussion. Adam Fein, PhD, of Drug Channels has been the one blogger who seems to favor the merger and thinks it will eventually receive FTC approval.

I don’t know if this is really good for consumers and if it will keep their prescription drug costs down, as Adam Fein believes, or that in the end community pharmacy will really be hurt financially, as the pharmacy community believes—but what does seem apparent is that the distribution of prescription drugs has become a commodity business in almost everybody’s eyes, except the community pharmacist. Four dollar generics, 15-minute filling guarantee, coupons to switch prescription filling sites (all activities promoted by some community pharmacy groups) have helped to fuel the impression that prescription drug dispensing is just a commodity activity.

Maybe pharmacists, instead of complaining to the FTC, should think about changing their practice model to focus on managing drug therapy outcomes instead. Am I thinking wrong?

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