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Leading Antitrust Senator Raises Serious Doubts About Proposed Express Scripts-Medco PBM Merger
Date:2/2/2012

ad to higher drug costs for patients, the government and employers."

On Dec. 6, 2011, Chairman Kohl's subcommittee held a hearing on the matter, entitled "The Express Scripts/Medco Merger: Cost Savings for Consumers or More Profits for the Middlemen?" and at which NCPA member Sue Sutter, RPh, testified. At the outset of the hearing, Chairman Kohl noted that the subcommittee had heard concerns about the merger from a number of large employers, who declined to testify for fear of retaliation by Express Scripts or Medco.

Additional key points from Chairman Kohl's letter include the following:

On competition from smaller PBMs:  "In sum, it seems unlikely that there are significant competitive alternatives to the big three PBMs for large plan sponsors.  Indeed, even Medco's CEO admitted as much in an investor phone conference in July 2010.  When asked if 'everyone's always focused on your two primary competitors [that is, Express Scripts and CVS/Caremark],' Mr. Snow replied that '[at] the best and finals I go to, I'm not seeing a lot of secondary PBMs in the mix at all.  I'm really not.  You may see a name pop up here and there, but that's not really common at all.'"

On the cost savings claims of pro-merger advocates:  "It seems highly unlikely that the merger will result in any substantial increase in buying power to attain such cost savings.  The merging parties admitted as much at our antitrust subcommittee hearing ... So it is clear that obtaining greater drug price discounts from manufacturers cannot be an argument to justify this merger."

On high-cost, specialty pharmacy:  "This merger may give the combined PBM increased market power to demand exclusive distribution arrangement with large manufacturers, freezing out other competitors.  In the alternative, the concern exists that its competitors will have to contract with the combined PBM to gain access to these specialty drugs.  Gi
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SOURCE National Community Pharmacists Association
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