Give patients a real choice for their pharmacy needs

A report commissioned by Express Scripts, Inc. (ESI), a $45 billion pharmacy benefit manager and mail-order pharmacy, estimates $403 billion in prescription medication-related “waste” in our healthcare system each year (“Report: Patient apathy is pricey,” April 8). The company’s No. 1 recommendation for dealing with this problem is to steer patients, whether they like it or not, to distant mail-order facilities, such as those it operates.

Yet, according to Express Scripts’ own data, requiring patients to only use slow, impersonal mail-order pharmacies would reduce this “waste” by just 1.9 percent, while angering many patients and harming local economies and jobs.

Express Scripts is one of three major, billion-dollar pharmacy benefit managers (PBMs) that face one of the most significant conflicts-of-interest in healthcare. They operate profitable mail-order pharmacies and are also responsible for administering (on behalf of employers and health plans) prescription drug benefits, including setting the rules and reimbursement rates that they apply to rival, community pharmacies. As a result of this dynamic, these PBMs have been forced to pay $370 million to settle lawsuits alleging fraud and deceptive conduct.

The real pharmacy savings for America’s healthcare system — the 98 percent of the $403 billion identified in Express Scripts report— are in altogether different areas, where community pharmacists are primed to play a leading role. 

First, ensuring patients take their medication properly, known in scientific circles as “adherence,” is estimated by this report to be as much as a $308 billion problem. Local pharmacists are among America’s most trusted and accessible professionals and can interact with patients face-to-face to reduce these costs. 

Second, we must promote the appropriate use of low-cost, generic medications. The Express Scripts report estimates these savings to be as high as $87 billion. The irony here is that in 2010, Express Scripts mail-order dispensed generic drugs just 60.2 percent of the time and only 51 percent of the time in a Department of Defense program it manages. By contrast, community pharmacists achieved a 72.7 percent generic drug-dispensing rate. Such a difference is serious money; researcher IMS Health calculated that every 1 percent increase in generic drug use equates to a 2 percent reduction in healthcare costs.

In sum, patients should be allowed to utilize the pharmacy of their choice — be it a neighborhood pharmacy or a mail-order one — without impediment or discrimination. Open patient-pharmacist relationships are quite simply the best way to ensure that the benefits of prescription drugs are maximized and that low-cost, generic medications are utilized to the greatest extent possible.

Alexandria, Va.

Americans should pay for healthcare directly

From Adam Hyams

I completely agree with Republican presidential candidate Haley Barbour (“Barbour: Consumers need to take on more healthcare costs,” April 12) when he states that consumers need to take a greater responsibility for their healthcare costs. One of the major flaws of the American healthcare system is that patients are insulated from cost. Americans who have health coverage are willing to pay any price for procedures, because insurance will pick up the tab. Thus, there are massive variations in healthcare costs between different cities. 

In addition, since millions of Americans do not have health insurance, they get unnecessarily expensive treatment in emergency rooms. This shifts the burden of cost onto everybody else. Doctors and hospitals are unsure of the actual cost of care because insurance companies’ reimbursement rates are often arbitrary and skew the price. 

A more efficient healthcare system would provide universal coverage. It would recognize a role for government in aiding the poor and the infirm. Furthermore, if the majority of Americans directly paid doctors and hospitals for their services, they would be much more cognizant of the price. As Haley Barbour explains, this may be the only way to control rising healthcare spending.

Jericho, N.Y

Keep Medicare in place for our senior citizens

From Norm Grudman

Republicans plan is to do away with Medicare and Medicaid as we know it. They want a voucher system where seniors get a stipend to buy coverage from private insurers. Can you imagine the turmoil as private insurers add in their profit and reduce coverage? The rates can be whatever they want and many won’t be able to afford insurance while many are rejected for prior illness. 

Pre existing medical conditions for seniors over 65 are a certainty. For those Americans that voted for these corporate lackeys because they profess religious and moral principles, you have been fooled my fellow Americans .Jesus wouldn’t deny care to the aged and the poor. Rep. Paul Ryan (R-Wis.) would. 

The only entity to benefit will be insurance companies. Seniors will be left behind. This is not the American way when all we need do is raise the tax rate on the richest 2 percent and we will have a TRILLION dollars added to the Treasury. The country does not need these charlatan Republicans fooling us into debt and poverty for the sake of their corporate masters. Wake up, America. We owe our seniors a healthy, safe life in their declining years.

Boca Raton, Fla.