1/27/2012 9:32 AM 

Perhaps it was deception, or perhaps it was denial, when Medco CEO David Snow dismissed the relationship between patients and community pharmacists as "fiction."  In any case, his words at an October healthcare conference at Cleveland Clinic have bitten him back again, this time with a member of Congress from Wisconsin citing his rhetoric in a letter to the Federal Trade Commission.

U.S. Rep. Reid Ribble (R-WI) called out Snow in the letter designed to express concerns about the proposed mega-merger of pharmaceutical insurance middle-men Express Scripts and Medco.  

As originally quoted by a Pharmaceutical Executive reporter, Snow told conference attendees, "I'm not dissing retail [pharmacy], but there's a fiction that a pharmacist comes out and dialogues with you. In reality, a high school student hands you a script from the shelf."

Rep. Ribble countered in his letter, "I have many constituents who would strongly disagree with that statement."

In addition to the views of Rep. Ribble's constituents, a July 2009 PricewaterhouseCoopers Health Research Institute report titled "Jammed access: Widening the front door to healthcare" found that survey respondents reported the least amount of difficulty in accessing care from pharmacists.  And North Carolina'sChecKmeds NC program is a well-known example of how face-to-face medication therapy management (MTM) services for Medicare patients have helped to deliver a return-on-investment of $13.55 for every $1 invested.

Rep. Ribble also noted that he has heard from "many constituents" who are "very concerned" about the proposed merger's potential anti-competitive and anti-consumer effects.

The National Association of Chain Drug Stores (NACDS), journalists and members of the blogging community have noted the revealing nature of Snow's remarks.  NACDS said, "These comments are a window into the true thinking of the companies that are seeking to merge.  If there were any doubt about their intent to impose mandatory mail order on more patients, depriving patients of their choice of pharmacies, then these comments should erase such doubt."

NACDS continued, "When it serves their purposes, such as under tough questioning at a ... Congressional hearing, these companies speak of their partnership with community pharmacy.  Then, they turn around and devalue and disparage community pharmacy.  One has to wonder about what their true intent means for patients, employers and health plans."

Rep. Ribble also noted in his letter comments by Express Scripts CEO George Paz, who said during Congressional testimony that he "can't stop certain pharmacies from going out of business."

Correcting Snow's and Paz' comments has required vigilance, as evidenced by the comprehensive rebuttal to their Congressional testimony that NACDS issued shortly after a proposed hearing on the mega-merger. 

Summarizing his take on the proposed merger, Rep. Ribble wrote, "This merger will drive up prices for patients, as the new PBM will operate without significant competition, the only mechanism that keeps prices in check.  Given the current economic climate, higher prices and less access for patients and consumers is more bad news than the people of Wisconsin can take."