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Pharmacists go to Washington: Bemidji's Paul Iverson part of delegation protesting Express Scripts/Medco merger

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Grand Rapids pharmacist Mike Brandt is so alarmed by the proposed merger between two major pharmacy-benefit managers that he took his case to Washington.

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So did Andrew Feld, a student at the University of Minnesota School of Pharmacy's Duluth campus. And his classmate, Allison Scott, is part of a delegation leaving for Washington today for the same purpose.

At issue is the proposed merger between Express Scripts Inc. and Medco Health Solutions Inc., two of the three largest pharmacy-benefits managers in the country. The companies say the merger would provide economies of scale and produce savings that could be passed on to consumers.

But pharmacists and pharmacy students allied under the banner of Preserve Community Pharmacy Access NOW! say the big pharmacy managers already wield too much control over the prescription drugs we take and the prices we pay for them.

"The main issue is currently many of the PBMs hold a ton of power," said Brandt, who owns Globe Drug and Medical Supply. "They dictate pretty much everything in terms of reimbursement, what the costs are going to be, what your premiums are going to be, what's on the formulary (the list of drugs available through a health plan)."

In an Oct. 21 opinion page column for the News Tribune, Feld wrote that the $29 billion merger would produce a company that would control prescriptions for 100 million Americans.

But Brian Henry, a spokesman for St. Louis-based Express Scripts, said it would be far from a monopoly. The two companies are among more than 40 pharmacy-benefit managers nationwide, Henry said.

"It's by no means just us and Medco. There are 12 PBMs that serve the Fortune 100."

Bemidji's Paul Iverson, owner of Iverson Corner Drug and former president of the Minnesota Pharmacists Association, will also be bringing his case to Washington, D.C. Iverson is part of the delegation urging the Federal Trade Commission to oppose the Express Scripts/Medco merger.

"This just gives them more power, and the ability to negotiate rates with these companies is nearly impossible," Iverson said. "Bigger is not better."

Pharmacists are on both sides of the fight. Express Scripts and Medco sent 50 of their pharmacists to lobby congressional offices earlier this month, The Wall Street Journal reported in a blog. They concentrated on the Senate, where an antitrust subcommittee is expected to hold hearings in December.

Feld and Brandt were part of a small Minnesota delegation that lobbied against the merger earlier this month, speaking to Sens. Amy Klobuchar and Al Franken and Rep. Chip Cravaack, R-North Liberty, among others. Scott is joining another small group today.

Congress is being asked to weigh in even though the authority to approve or deny the merger rests with the Federal Trade Commission.

Scott, 23, said her goal is to eventually own a community pharmacy of her own, preferably in the Twin Cities suburbs. But she sees the future of community pharmacies, and her plans, endangered if Express Scripts and Medco combine to become even more dominant.

Brandt said the pharmacy-benefit managers already are hurting his business because they keep most of the profit for themselves.

"There's no negotiation," he said. "They say, 'This is the contract; do you want it or not?' If I tried to negotiate with them, they would laugh at me."

He also loses out to the mail-order pharmacies run by the benefit managers. Brandt said he had three patients within the past week who didn't get needed drugs in the mail. A diabetes patient in his 70s was "coerced" into mail order, he said. "They call, they coerce, they push him into the system. He goes without his diabetes medication because it doesn't show up in the mail."

But Henry said home delivery is safe and convenient, with a 99.9 percent accuracy rate, compared with 98.4 or 98.5 percent for retail. And if you use several prescription drugs, "it's more cost-effective for you to get that medicine in a 90-day home delivery than to go to the retailer," he said.

If approved, the merger could take place as early as next year.

Ben Karkela of the Bemidji Pioneer contributed to this story. The Duluth News-Tribune and the Bemidji Pioneer are both owned by Forum Communications Co.

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