Free Republic
Browse · Search
News/Activism
Topics · Post Article

Skip to comments.

The Growing Turf War over Who Can Fill Prescriptions
Townhall.com ^ | June 8, 2014 | Devon Herrick

Posted on 06/08/2014 4:01:37 PM PDT by Kaslin

Drug therapy is growing more complex and costly! So-called specialty drugs are gradually displacing traditional drugs as the primary component of drug spending. The market is expanding rapidly. Only about 10 such drugs were available 20 years ago but today there are more than 300.

These drugs typically treat medical conditions that are life-threatening, chronic and often rare. Cancer treatments are the most common type of specialty drugs, making up one-third of total. Drugs for autoimmune disorders, rheumatoid arthritis, and Crohn's disease, medications for HIV and drugs for multiple sclerosis are responsible for another third of specialty drug spending.

Although only about 1 percent of drugs prescribed, specialty drugs now account for more than one-quarter prescription drug spending. This is expected to grow to 50 percent by 2020.

Specialty drug therapy costs from at least $15,000 per year, to as much as $750,000 per year. Most have no close substitutes, rendering health plans’ traditional efforts by to control costs by encouraging generic substitution largely ineffective. Due to these medications’ high cost, health plans carefully manage the procurement and administering of these drugs. For instance, health plans are increasingly relying on exclusive preferred pharmacy networks to reduce costs and ensure the quality of specialty drug therapy.

When drug plans create preferred pharmacy networks they negotiate for the lowest possible prices. Negotiated prices are the result of bargaining power — the ability of the drug plan to deny business to a firm if their bid isn’t favorable. Bargaining power also strengthens the ability of drug plans to demand quality-enhancing safeguards and patient protections.

As you might expect, when a new market segment displaces an old one, stakeholders in the old market understandably don’t want to be shut out. As preferred pharmacy networks have become more common, so too have the calls for lawmakers to enact laws that restrict the ability of health plans to partner with exclusive pharmacy networks. The less competitive drug providers lobby CMS, Congress and state legislatures to restrict the ability of drug plans to effectively negotiate for lower prices. This past January the Centers for Medicare and Medicaid Services (CMS) tried to ban preferred pharmacy networks in Medicare drug plans. CMS had been under pressure from pharmacy interests shut out of Medicare Part D drug plans.

Numerous states already have regulations that interfere with negotiations between drug plans, drug makers and pharmacies.So-called, any-willing-provider and freedom-of-choice laws reduce the drug plans’ power to bargain for lower prices or ensure quality by making it harder to exclude high-cost (or low-quality) pharmacies from their preferred networks. According to the Federal Trade Commission (FTC), such consumer protection laws are actually costly to taxpayers, employers and patients. Not only do such policies boost patients’ costs, they also compromise safety and invite fraudulent providers who jeopardize the effectiveness of specialty drug therapies.

So what’s the problem? Dispensing and administering specialty drugs requires a level of experience and expertise that most traditional pharmacies simply do not possess. A specialty drug pharmacy doesn’t resemble the corner drugstore most consumers have come to know. These new drugs represent the latest high-tech therapies, including large-molecule biologics (essentially derived from organic substances or living organisms) — most of which may require careful handling. Stocking and dispensing biological agents require sophisticated logistical planning, climate-controlled shipping, meticulous storage — with specific protocols and documentation. Patients who receive these therapies require extensive monitoring, risk evaluation, mitigation strategies for side effects and the close support by a physician.

Physicians are in a position to evaluate the expertise and capabilities of the specialty pharmacy providers their patients patronize. In a recent survey, two-thirds of the physicians agreed that “some” traditional pharmacies are competent to handle and dispense specialty medications, but three-fourths also agreed that “most” pharmacies do not possess the expertise and capability to manage complex drugs.

After intense lobbying by a diverse group of stakeholders, CMS backed away from its proposed ban on preferred pharmacy networks — at least for now. However, the federal agency never officially withdrew its proposed rule change. Unfortunately, this isn’t the end of the debate about whether health plans have the right to lower enrollees’ costs using exclusive networks. When there’s money at stake, politicians (both state and federal) are often receptive to constituents’ pleas for help. Small businesses like community pharmacies often get a sympathetic reception when they descend on the state capitols lobbying for protection against health plans that force them to compete on price. However, Congress and state legislatures should avoid these bogus consumer protections.


TOPICS: Culture/Society
KEYWORDS: obamacaredrugs; prescriptions

1 posted on 06/08/2014 4:01:37 PM PDT by Kaslin
[ Post Reply | Private Reply | View Replies]

To: Kaslin

I am disgusted by one development. The drive by insurance companies to force people to get their meds via mail pisses me off to no end.


2 posted on 06/08/2014 4:04:39 PM PDT by catfish1957 (Face it!!!! The government in DC is full of treasonous bastards)
[ Post Reply | Private Reply | To 1 | View Replies]

To: Kaslin
I have Rheumatoid Arthritis and now have no insurance. The drug prices have soared unbelievably. Can't even remotely "dream" of being able to afford the "biologics" (like Humira) and can hardly pay out of pocket for the old standards like azulfidine, plaquenil, methotrexate and (for rescue purposes) the occasional prednisone.

This is just a shout-out to anybody who has any good ideas. What the heck can I do?

3 posted on 06/08/2014 4:17:31 PM PDT by Mrs. Don-o (THX.)
[ Post Reply | Private Reply | To 1 | View Replies]

To: Mrs. Don-o

Are there any trial research projects you can sign up for


4 posted on 06/08/2014 4:18:47 PM PDT by morphing libertarian ( On to impeachment and removal (IRS, Taliban, Fast and furious, VA, Benghazi)!!!)
[ Post Reply | Private Reply | To 3 | View Replies]

To: catfish1957

I am curious as to why you feel this way.

I find it to be much cheaper and a lot more convenient than having to go to the pharmacy for refills.

Am I missing something?


5 posted on 06/08/2014 4:21:51 PM PDT by berdie
[ Post Reply | Private Reply | To 2 | View Replies]

To: Mrs. Don-o

The pharmaceutical companies often have discount programs for hardship cases. Also, companies such as Walgreens, Kroger, Walmart, etc. have programs which allow you to buy generics at reduced prices, sometimes as low as $4. There are also Mexican and Canadian companies which sell online.

Good luck.


6 posted on 06/08/2014 4:26:03 PM PDT by Jeff Chandler (Conservatism is the political disposition of grown-ups.)
[ Post Reply | Private Reply | To 3 | View Replies]

To: morphing libertarian; Jeff Chandler

All good ideas. I’ll check it out. Thanks!


7 posted on 06/08/2014 4:28:08 PM PDT by Mrs. Don-o (THX.)
[ Post Reply | Private Reply | To 4 | View Replies]

To: catfish1957

Why does this piss you off?


8 posted on 06/08/2014 4:31:20 PM PDT by Shimmer1 (The love that dare not speak its name is now the love that will not shut its *bleeping* mouth)
[ Post Reply | Private Reply | To 2 | View Replies]

To: Mrs. Don-o

God bless


9 posted on 06/08/2014 4:32:06 PM PDT by Shimmer1 (The love that dare not speak its name is now the love that will not shut its *bleeping* mouth)
[ Post Reply | Private Reply | To 7 | View Replies]

To: Mrs. Don-o

I have seen lists on the internet, but maybe a doctor or specialist can let you know.

Another issue us proximity. Usually during a trial you have to go in once in a while for a review.


10 posted on 06/08/2014 4:39:47 PM PDT by morphing libertarian ( On to impeachment and removal (IRS, Taliban, Fast and furious, VA, Benghazi)!!!)
[ Post Reply | Private Reply | To 7 | View Replies]

To: Mrs. Don-o

Contact the companies that market the molecule(s) you need and explain your situation. They may provide the item at a discount or no cost.


11 posted on 06/08/2014 4:40:14 PM PDT by NittanyLion
[ Post Reply | Private Reply | To 3 | View Replies]

To: Mrs. Don-o

Try contacting the manufacturers directly and explain your situation. Many have programs for uninsured folk.


12 posted on 06/08/2014 4:41:16 PM PDT by griswold3 (I was born heI're in America. I will die here in a third world country. Obama succeeded.)
[ Post Reply | Private Reply | To 3 | View Replies]

To: Mrs. Don-o

I found Meloxicam to be better than Celebrex and a hell of a lot less expensive.


13 posted on 06/08/2014 4:46:22 PM PDT by Random Access
[ Post Reply | Private Reply | To 3 | View Replies]

To: griswold3; Shimmer1; morphing libertarian; NittanyLion

Thank you. These are all good ideas, and I will be exploring the possibilities!


14 posted on 06/08/2014 4:46:37 PM PDT by Mrs. Don-o (THX.)
[ Post Reply | Private Reply | To 12 | View Replies]

To: Mrs. Don-o; Jeff Chandler
Mrs. Don-o, I am terribly disappointed to hear of this. #6 has excellent ideas; most of my Rx have been Wal-Mart $4 generics for quite some time. For those that aren't (and I'm a few years short of Part D eligibility also), GoodRX offers incredible free coupons affiliated with various RX discount programs. For example, my Venlafaxine ER would be around $150 cash price at a typical chain pharmacy; it is $17 with the coupon and I have never had any trouble getting them to accept the coupon, unbelievably. What profit margin must be built in at the retail pharmacy!

God bless you from me as well!

15 posted on 06/08/2014 4:49:39 PM PDT by steve86 ( Acerbic by nature, not nurture)
[ Post Reply | Private Reply | To 7 | View Replies]

To: Mrs. Don-o

My general physician had some drug discount cards in his office that were free to his patients. I took one and started using it several years ago. I too have rheumatoid arthritis and take methotrexate. The discount card knocks about $12-15 off the regular cost. I’ve seen other cards, some of them have been received in the mail; they’re from different phara companies.

You might ask your doctor or ask someone down at your local health clinic if they know of any drug discount cards available to people w/o insurance or those, like me, who are not on a lot of medication and do not subscribe to any drug plan.


16 posted on 06/08/2014 4:52:05 PM PDT by TurkeyLurkey
[ Post Reply | Private Reply | To 3 | View Replies]

To: griswold3

Sounds like the volume of such programs is going to have pressure put on them, however, by this circus-juggling game that is being played with America’s healthcare plans. In the end, most people still paid for their care; it’s just HOW they did so was the question.


17 posted on 06/08/2014 4:53:12 PM PDT by HiTech RedNeck (Embrace the Lion of Judah and He will roar for you and teach you to roar too. See my page.)
[ Post Reply | Private Reply | To 12 | View Replies]

To: steve86

There’s definitely going to be pressure all around. The old fashioned drug stores may become rare birds, if not extinct.


18 posted on 06/08/2014 4:54:24 PM PDT by HiTech RedNeck (Embrace the Lion of Judah and He will roar for you and teach you to roar too. See my page.)
[ Post Reply | Private Reply | To 15 | View Replies]

To: Shimmer1
Why does this piss you off?

In my relative's case, the following situations would not have occurred with a local pharmacy:

1) Delivery time from placing order unpredictably varies dramatically from 2 days to two weeks.

2) USPS left order on doorstep (too big to fit in mailbox), was stolen, customer out big money and didn't get medication on time. Appeals and complaints to both mail order pharmacy and USPS have failed.

3) So the next time she specified "signature required" and paid extra shipping charge. Sent USPS regular again.

Fed. Up.

19 posted on 06/08/2014 4:57:59 PM PDT by steve86 ( Acerbic by nature, not nurture)
[ Post Reply | Private Reply | To 8 | View Replies]

To: Mrs. Don-o
Genesis 1:29

The First Gift!

20 posted on 06/08/2014 5:00:10 PM PDT by rawcatslyentist (Jeremiah 50:32 "The arrogant one will stumble and fall ; / ?)
[ Post Reply | Private Reply | To 3 | View Replies]

To: steve86

Sounds like something that Uncle Sam would be on top of eventually, but that would require the Fedzilla to care about what is reasonable.


21 posted on 06/08/2014 5:00:56 PM PDT by HiTech RedNeck (Embrace the Lion of Judah and He will roar for you and teach you to roar too. See my page.)
[ Post Reply | Private Reply | To 19 | View Replies]

To: steve86

Is it possible for her to get a bigger mail box or have it sent to a PO box, or someone who is always home, put up a sign asking the mailman to take anything too big for the mailbox back to the post office for pickup, etc.?


22 posted on 06/08/2014 5:06:26 PM PDT by HiTech RedNeck (Embrace the Lion of Judah and He will roar for you and teach you to roar too. See my page.)
[ Post Reply | Private Reply | To 19 | View Replies]

To: Mrs. Don-o

You could try a patient assistance program to help you get the medication @ little to no cost. AbbVie does offer one for Humira (I take it for Psoriasis)

http://www.needymeds.org/papforms/abbpae0323.pdf

There’s a form you can print & fill out and also an 800 number to call. Best of luck...


23 posted on 06/08/2014 5:56:37 PM PDT by bamahead (Few men desire liberty; most men wish only for a just master. -- Sallust)
[ Post Reply | Private Reply | To 3 | View Replies]

To: catfish1957
I am disgusted by one development. The drive by insurance companies to force people to get their meds via mail pisses me off to no end.

For the disabled with complications and elderly nothing can really replace the one on one oversight of a good local pharmacist. We use mail order for two Asthma Nebulizer inhalants due to billing issues. The company sending is careful to coordinate shipment with us. Wife's Pulmonary doc writes the script and it stays the same so were reasonably safe.

On the other hand stuff like Thyroid hormone which can vary each visit based on her blood work results gets filled by a local independent owned pharmacy we've been doing business with for about 20 years.

We live in a secluded rural community so theft of stuff isn't an issue in general. Were usually home and the dogs tell me a delivery person is there.

24 posted on 06/08/2014 6:47:57 PM PDT by cva66snipe ((Two Choices left for U.S. One Nation Under GOD or One Nation Under Judgment? Which one say ye?))
[ Post Reply | Private Reply | To 2 | View Replies]

To: Mrs. Don-o

https://www.cheapodrugs.com/

Been using these guys for years. Tried others, but always came back for price and customer service.

They sell Canadian and Brit drugs generic and name brand. Savings range from 20 to 90% over what you pay US.

Legal and fast. Don’t know if they have your needs, but worth a check. Obviously they will not do pain killers, but anti-inflammatory arthritis should pass muster.

Good luck.


25 posted on 06/08/2014 6:56:07 PM PDT by Lowell1775
[ Post Reply | Private Reply | To 3 | View Replies]

To: catfish1957

I gladly use Expresscripts and get 3 months supply for what a local pharmacy charges for 2 plus it’s free shipping and they arrive within 3 days.


26 posted on 06/08/2014 7:09:59 PM PDT by dalereed
[ Post Reply | Private Reply | To 2 | View Replies]

To: steve86

Get a mailbox that locks. I did after a little finagling with the local post master. And I live in the hills...


27 posted on 06/08/2014 7:20:54 PM PDT by DB
[ Post Reply | Private Reply | To 19 | View Replies]

To: Mrs. Don-o

A lot of the pharmacy companies have patient assistance programs for those like you who cannot afford their medications. Ask your doctor to help or find out if there is a medical social worker or RN case manager available to help you find the programs/file for them.


28 posted on 06/08/2014 7:31:00 PM PDT by Mom MD
[ Post Reply | Private Reply | To 3 | View Replies]

To: catfish1957

“I am disgusted by one development. The drive by insurance companies to force people to get their meds via mail pisses me off to no end.”

So I guess you don’t shop on-line for anything else?


29 posted on 06/08/2014 8:27:03 PM PDT by vette6387
[ Post Reply | Private Reply | To 2 | View Replies]

To: Mrs. Don-o
If you can make do with generics, I buy lots of things from ALLDAYCHEMIST.com. They ship from India, but many of the drugs are manufactured in the UK or other European countries. I get lots of things shipped to me here in the Philippines, and have found them to be trustworthy and effective. I got the referral from a friend. Many others that I know have used them to provide inexpensive alternatives.

They have an 800 number and offices in California.


30 posted on 06/08/2014 8:38:35 PM PDT by WVKayaker ("Every American should feel outrage at any injustice done to our veterans " -Sarah Palin 5/26/14)
[ Post Reply | Private Reply | To 3 | View Replies]

To: vette6387
So I guess you don’t shop on-line for anything else?

So I guess you haven't had to try to fix a mistake (meds) made by bureaucratic on-line company?

31 posted on 06/09/2014 12:19:25 AM PDT by catfish1957 (Face it!!!! The government in DC is full of treasonous bastards)
[ Post Reply | Private Reply | To 29 | View Replies]

To: bamahead

Thank yuou very much for this information.


32 posted on 06/09/2014 5:38:33 AM PDT by Mrs. Don-o (Therefore, as God’s chosen people, holy and dearly loved, clothe yourselves with kindness. (Col 3:1)
[ Post Reply | Private Reply | To 23 | View Replies]

To: Mom MD

I appreciate these ideas. Grateful to your input!


33 posted on 06/09/2014 5:39:13 AM PDT by Mrs. Don-o (Therefore, as God’s chosen people, holy and dearly loved, clothe yourselves with kindness. (Col 3:1)
[ Post Reply | Private Reply | To 28 | View Replies]

To: WVKayaker

Sounds good -— I’ll look into it.


34 posted on 06/09/2014 5:40:05 AM PDT by Mrs. Don-o (Therefore, as God’s chosen people, holy and dearly loved, clothe yourselves with kindness. (Col 3:1)
[ Post Reply | Private Reply | To 30 | View Replies]

To: Mrs. Don-o

Most welcome.


35 posted on 06/09/2014 6:30:40 AM PDT by bamahead (Few men desire liberty; most men wish only for a just master. -- Sallust)
[ Post Reply | Private Reply | To 32 | View Replies]

To: catfish1957

“So I guess you haven’t had to try to fix a mistake (meds) made by bureaucratic on-line company?”

I only take one BP med and it has never been a problem. But I would rather be able to deal directly with a local pharmacist than some floozie over the phone. It completely destroys your relationship with a key caregiver in the name of saving a buck. It’s just another VA-like government/big business intrusion into what should be a personal decision.


36 posted on 06/09/2014 7:43:30 AM PDT by vette6387
[ Post Reply | Private Reply | To 31 | View Replies]

Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.

Free Republic
Browse · Search
News/Activism
Topics · Post Article

FreeRepublic, LLC, PO BOX 9771, FRESNO, CA 93794
FreeRepublic.com is powered by software copyright 2000-2008 John Robinson