Sorry, Patients: We Won’t Fill Your Prescription Here

What does this mean for every current patient, as well as all the rest of us potential patients?
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In case you missed it, last month pharmacy giant CVS announced it would terminate access to more than 30 new medications in 2017, including groundbreaking cancer and diabetes drugs. Shortly after the CVS announcement, Express Scripts – the nation’s dominant pharmacy benefits manager – followed suit with its list of drugs to be dropped in 2017.

What does this mean for every current patient, as well as all the rest of us potential patients?

CVS Health maintains more than 68,000 pharmacies nationally including the CVS Pharmacy Stores. It fills or manages 1.9 billion prescriptions per year and touches tens of millions of lives. The conglomerate’s own second quarter earnings report claims a savings of “more than $9 billion for clients without disrupting member care.” I’m sure those who will lose access to their cancer or diabetes medications might disagree.

To make matters worse, CVS’s announcement on the need to cut medications occurred the same day it beat Wall Street forecasts with a robust second quarter operating profit of $2.4 billion. Rather than telling hedge fund managers how many patients it is cutting off, shouldn’t CVS suggest ways to get patients the medicines they need?

Express Scripts, while not nearly as well-known as CVS, recently announced a growth in second quarter profits by nearly 21 percent with a net income of $720.7 million. The broker also announced its own 2017 formulary exclusion list – 85 drugs in all. What does that mean if you’re one of the many patients who needs one or more of those 85 medicines?

On its 2017 preferred drug exclusion list, Express Scripts provides the following instructions to patients: “If you’re currently using one of the excluded medications, please ask your doctor to consider writing you a new prescription for one of the following preferred alternatives.”

Basically, regardless of what your doctor determines is best for you, the final decision is in the hands of the of the pharmacy benefit manager and not your medical provider.

If this becomes standard operating procedure, we have likely taken a step from which there is no return.

In this potentially brave new world of a CVS on practically every street corner, this is what America’s anti-patient future looks like. If CVS can do this to patients, anyone can. Fictional characters who fear the future often say tomorrow will be a time when we have no control over our health, our finances, what we do and where we go.

But this is no paranoid delusion. It’s at least partly true right now if a doctor can prescribe a treatment, a patient can agree and a pharmacy benefit manager can overrule them both.

What is CVS going to tell the first patient who walks into one of its pharmacies on January 2nd and can’t get their medication?

CVS Caremark has more than 75 million members and has cleared billions of dollars in the health care business. It didn’t happen by selling oscillating fans, ice cream or wall calendars. It made those billions serving patients, and with this comes an obligation to those people. What are CVS’s ideas to make the system work better? Throwing up their hands and cutting patients? Is there really not a Plan B?

Of course we should hear these entities out and provide a fair opportunity to explain these controversial stands. But if the rationing of medicines goes forward, then we are at cross purposes.

Entities like CVS and Express Scripts can play a vital role, but they owe patients more than to silently and anonymously do things once unimaginable, but now outlined in black and white as financial corporate policy.

No one should begrudge either of these companies a strong balance sheet in the black. But is it too much to ask they do it without turning their backs on the millions of patients that enabled their billion-dollar bottom lines?

Walgreens, call your office. A million patients might be on the other line.

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