Dear Judge Leon,
My name is Teresa Dickinson, and I am an independent pharmacy owner in Phoenix, AZ. I am also the president of Pharmacists United for Truth and Transparency (PUTT), a coalition of more than 1,200 independent and community pharmacies across the U.S. I am writing on behalf of my organization and small business pharmacy owners everywhere to express our full opposition to the CVS-Aetna merger. We are greatly encouraged to know you are carefully considering the merger of these two excessively large corporations that together control a disproportionate share of the healthcare marketplace.
Sir, you mentioned feeling as though you are “in the dark” with regard to the merger. We promise you are, as are most Americans about the true nature of the pharmacy benefit manager (PBM) industry. CVS, along with Express Scripts and OptumRx, control nearly 80% of all prescriptions filled in the U.S. All 3 are either owned, or poised to be owned, by extremely large health insurance companies who also seek to control and serve as the gatekeeper between patients and pharmacy, medical providers and other sectors of the healthcare system.
Here are some things you may not know about CVS:
Your Honor, these are just a few examples of why independent and community pharmacies are vehemently opposed to the merger between CVS and Aetna. I promise there are many more reasons beyond those listed here.
You may be wondering why, if it’s so difficult for a small business pharmacy to work within the CVS pharmacy benefits plan network, any of us would choose to do so. The reality is, if we are to have patients to serve we are forced to sign contracts with CVS. This goes for the two other PBM giants Express Scripts and OptumRx. These 3 PBMs alone hold nearly 80% of the covered lives in the U.S. and as such are our primary access to patients. The contracts we are offered are “take it or leave it” - if we want to have patients to serve we must take the contract as presented. We are in a caregiving profession and we wish to serve, so we take the contracts because we have no alternative.
Your Honor, we cannot understate the degree to which the giant corporate PBMs have abused the trust and goodwill of patients, consumers, taxpayers, medical providers and small business pharmacies. We speak of small business as the “backbone” and the “engine” of the U.S. economy. Many of us in the nation’s healthcare system are small businesses who depend on the government to help keep the playing field level so we can effectively care for our patients and still compete with the mega-corporations.
Our fear is the merger of the nation’s largest pharmacy chain and pharmacy benefits manager with one of the largest health insurers in the country will result in continued, possibly exacerbated abuse of small providers that only serve to drive us to the brink of closure and prevent us from being able work in the profession for which we trained, and took entrepreneurial risk, in order to serve patients. Our fear is our patients will be forced to choose between the relationships they’ve had with us for generations and the seemingly better financial incentives (which in reality are perverse incentives) offered by a conglomerate who sees them not as people but as little profit centers to be exploited.
To further illustrate our point, enclosed are examples of the business practices mentioned here, including reports of CVS’ “Squeeze and Buy” tactics; illustrations of how CVS reimbursed pharmacies around the country between September and November 2018; real-time examples of negative reimbursements from CVS plans and recent examples of spread pricing that happened in Arkansas and Florida.
Thank you for your consideration of the information provided here. On behalf of the small business pharmacies who are at the effect of CVS’ anticompetitive business practices, we hope you will rule against the merger and protect the relationship between patients and their community pharmacies.
L. Teresa Dickinson, RPh
President and Pharmacy Owner