Who Really Knows Best?

Specialty Pharmacy TimesJuly/August 2013
Volume 4
Issue 4

Why are limited distribution networks found only in the United States? Does pharma know best?

Why are limited distribution networks found only in the United States? Does pharma know best?


You have heard the saying “Mother Knows Best” but did you know that pharmaceutical manufacturers think “Pharma Knows Best”? A child can be raised, educated in undergraduate studies, advance in post graduate studies, and even can become “Commander and Chief of the richest, most powerful country in the world,” but according to pharma must use a limited distribution network (to access medication) for their own good. Really?

In a country that was built on the fundamental principle of “freedom,” do you really expect that our founding fathers wanted to exclude our health care from this freedom? Should we really believe that a pharmaceutical manufacturer wants to limit access, control supply and distribution, change the reimbursement formula used by CMS and Medicaid—all in the name of helping patients because they can’t help themselves?

When you think of all these questions you can’t help but ask “Why?” Why is it so important to limit the distribution of brand name medications only? What happens to these distribution networks once a medication loses its patent? Why is an oral oncolytic used to treat cancer viewed differently from an oral medication used to treat atrial fibrillation? Why is an injectable medication used for ulcerative colitis categorized differently from insulin injected by a diabetic? Why are limited distribution networks found only in the United States?

These networks are not selling vintage Patek watches, so when you peel the onion back, the one obvious factor for these networks and their “limitations” is the cost. A limited-distribution oral oncolytic have a wide range of pricing, that is, it can go from a wholesale acquisition cost (WAC) of $4500/month (at launch) to a WAC of more than $10,000/month within a 4-year period.

With universal health care right around the corner and the United States government being the largest payer of health care, a concerned citizen should worry about allowing these networks to continue and who is going to fund them. How can Congress, knowing we are facing the largest deficit of all time, not be concerned? Pharma spends more money than any other lobbyist group in Washington to defend their industry. But we cannot forget that our government receives its revenue from taxpayers, all of Congress is elected, and all of us make up the government!

As a businessman, I can see the importance of manufacturers wanting to limit distribution and control pricing over a patented lifespan of a medication. But since I am a pharmacist first and a businessman second, I am a staunch advocate for my patients and the outcomes they receive from medication. I want to treat all our patients with the same dignity, respect, and care regardless of whether their prescription order is for a $4 generic or a $10,000 brand name cancer medication.

I want to believe that all practitioners have the simple, common value of wanting to help people. Why else get into health care? I am very fortunate in never having to answer to shareholders or any equity board that would influence or compromise any decision affecting patient care. These limited distribution networks are not in the patient’s best interest, they delay access, they do not address patients living in skilled nursing facilities under Medicare Part A benefits, and they restrict patient freedom.

Health care should be simple. Our government and other payers should allow access to all patients and any willing provider, while ensuring strict standards for all providers to optimize the best possible care. Manufacturers should concentrate their efforts of drug development, allowing their scientists to develop life-changing and/or life-saving medications that will help patients all over the world devastated by disease and illness.

Specialty pharmacies should continue to provide ancillary services and programs to help patients receive reimbursement assistance, manage side effects, and maximize compliance and adherence. These services should be offered to our physician partners in the front line of health care and ultimately to our patients, who really know best!

About the Author

Nicholas Karalis, RPh, is president of the board at Community Specialty Pharmacy Network and a pharmacist with Elwyn Specialty Care.

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