CVS/Caremark Newsletter to Payer Clients – EPIPEN

CVS/Caremark admits to hiking up cost of Epipen with their communication to their clients (payers).  cvsepipenlettertoclients


Below is a response by PBM – CVS/Caremark (one of the Big 3 PBMs that control over 70% of the PBM market along with ExpressScripts and OptumRx/UnitedHealthcare).

How telling is this communication?  Jotted on the commentary are the obvious ridiculousness of this entire communication.

1.  First of all… Where does CVS/Caremark come up with the end retail price of a box of 2 Epipens costing $730?  We called a local CVS retail pharmacy and asked for the price of a box of Epipens and they said withOUT any drug coverage/insurance – the prescription would cost $649.
For every discussion that has ensued regarding the price hikes of Epipens:  Mylan CEO in front of congress, CNBC segments, news stories, etc.  $730 (price in their communication) – $649 (price quoted a cash customer) – difference of $81.
When CVS/Caremark and other PBMs do dog and pony shows trying to get the PBM business for various employer groups or even insurers themselves (as well as Medicaid managed care insurers and other government plans) – CVS/Caremark and other PBMs tout the “savings” that they payer will be able to access ONLY with their PBM.
$730, where did they get this number?  It is easy – they simply made it up!  So employer groups – what “savings” are you really accessing?  With these types of numbers the savings look very attractive – and it is these “savings” that they convince groups that they will NOT have if they don’t utilize their PBM (or any other one as they all do the same thing).  And when the presentations are done ALL of these numbers are based on false retail pharmacy numbers like this.
2.  The chart titled “Our clients costs for Epipen” shows EXACTLY what people are starting to figure out – that the PBM games of Rx Rebates with manufacturers are adding (unnecessarily) to the cost of the Epipens.  They couldn’t have outlined it better for people to understand.
3.  Using the same chart.  Imagine here….. that we went back to the good old days where patients paid for prescriptions and got reimbursed by their employer or plan – you have to imagine the ENTIRE system functioned like this (a world with NO PBM).  Wouldn’t we have enjoyed that lower red (consistent) line with no “negotiated discounts, rebates and price protections”?  Wouldn’t we be better off???  According to the CEO of Mylan the end price of Epipen withOUT the PBM games would be less than 1/2 of the final $608 final price.
4.  Aren’t PBMs supposed to “manage the pharmacy benefit”?  Aren’t PBMs the ones now who help employers implement cost effective strategies like tiered formularies?  Aren’t the more costly drugs reserved for the higher tier on the formulary (for just that reason)?  Doesn’t the copay card offerings by Big Pharma manufacturers enable patients to bypass the tiered formulary (while sticking the majority of the bill to the end payor)?  Hasn’t the PBM industry tried to fight back against this and has even gone as far as kicking off drugs from the formulary entirely to punish the companies (and their drugs) for this subversive system?  YES!  So why is this newsletter sharing the availability of the copay card as somehow being the answer to the high cost of EpiPens to the end patients?
5.  On the last page the newsletter says “as soon as there is generic competition for the Mylan Epipen, we will encourage plan members to use the lowest cost product”.  Every “client” who thought they trusted CVS/Caremark should be LIVID at this obvious falsehood.  Pharmacists/pharamcies (who know pharmacy day in day out and at this point are basically slaves to the PBMs) let go the (same – false) comment by the ExpressScripts Medical Director who said that there wasn’t a generic as hey, he’s a Doctor what does he really know?  Maybe no one told him.  But there IS a generic epinephrine autoinjector that is 2/3 the price (or even less) then the brand Epipen (who stills has a patent on the device itself).  Pharmacists can’t automatically substitute but pharmacists can do a function (that PBMs demand for other issues – even changing out entire drugs for similar drugs in the same class) – CALL the Doctor to switch if the Doctor didn’t specifically write the prescription for Epinephrine and instead used the phrase “epipen”.  We do that ALL day, every day!  PBMs know it, expect – heck they DEMAND we do it for other items for their “formulary management”.  Why are they acting as if a generic in that class doesn’t exist?
The reason, the REAL reason is there is NO rebate associated with the generic (or if there is it is insignificant) and therefore the PBM can’t play hide the rebate dollars with their end “clients” (remember the ones who they are supposed to be offering discounts and rebates)……
This communication shows how scared the entire PBM industry got when CEO Heather Bresch of Mylan started lifting the veil of pharmaceutical prices exposing their manipulation of these RxRebate dollars.  Pharmacists and others paying attention knew that their profits with the rx rebate scam were big, we never knew HOW big and thus how much this scam was adding to the cost of drugs in our country.  For that we can thank Mylan!cvsepipenlettertoclients