11/30/2011 5:00 PM 

In a simple and powerful statement, the American Antitrust Institute (AAI) wrote in a letter to the Federal Trade Commission (FTC):  "Express Scripts' acquisition of Medco poss a threat to substantially lessen competition in the provision of pharmacy benefit manager services throughout the United States."

AAI explained its concerns in the following areas, supporting its urging that the FTC enjoin the merger:

• The merger is likely to harm competition in the market for the provision of PBM services to large plan sponsors;
• the proposed merger is likely to lead to the exercise of enhanced buyer market power in the market for specialty and mail order pharmacy distribution;
• the merged firm would have the ability and incentive to exclude rivals in the provision of specialty pharmacy services; and
• the merged firm would have the ability and incentive to exclude rivals in the provision of mail order pharmacy services.

Among other serious concerns, AAI added its voice to the strong skepticism expressed by consumer groups, members of Congress and others that the mega PBM would pass any savings on to employers, health plans and consumers.  In fact, AAI laid out its strong case that prices for consumers could rise as a result of the merger.

On the specific topic of specialty drugs, AAI wrote, "The proposed merger thereby increases the ability and incentive for Express Scripts-Medco to engage in anticompetitive conduct and threatens to increase specialty drug prices and limit patient access to critical medications."