Get Into Politics or Get Out of Pharmacy

As a young pharmacist, I was given some sage advice: “Either get into politics or get out of pharmacy.” This was long before Medicare Part D, pharmacy benefit managers (PBMs), spread pricing, and direct and indirect remuneration fees.

Peter A. Kreckel, RPh

My first discussion with an esteemed politician was with Governor Richard Thornburgh (R, Pennsylvania) in 1983. I was a practicing pharmacist with 3 years of experience. The story of that meeting appeared in the July 2023 issue of Drug Topics and described how senior citizens are a formidable group of people that the politicians respect and fear.¹

Back in the early 1980s, Pennsylvania began offering a drug benefit program for senior citizens: the Pharmaceutical Assistance Contract for the Elderly (PACE). The program began with a co-pay for participants of just $4. I told Thornburgh that this was not sustainable, given rising drug costs. He agreed and said that within a few years, the co-pays would rise to $20. Today—40 years later—PACE co-pays for that population are $6 for brand medications and $9 for generic.

Meanwhile, dispensing fees have been cut with each contract along the way. Virtually every contract from the inception of PACE to today has reduced the fees paid to the pharmacist. Mess with us pharmacists, OK…but don’t mess with senior citizens.

I joined the Senior Citizen gang in May 2023. My wife and I chose a standard plan that had more coverage. We picked an inexpensive drug plan, as we do not have any expensive maintenance medications and my blood pressure medications are usually a $0 co-pay when processed through my mail order program from CVS Caremark. Then CVS Caremark did the unthinkable: They messed with a senior citizen, and that senior citizen was me.

Social media and television frequently share stories warning senior citizens about scams. People selling bogus insurance, aluminum siding, blacktopping, and funeral scams. The scam I am about to describe is different. It is a government-approved scam that is ripping off senior citizens every day. Unfortunately, this scam purported by CVS Caremark was pulled on me, a pharmacist who is advocating for changes in the Medicare system for both patients and pharmacists. I will not let CVS Caremark off the hook, and I am busy informing our representatives who need to be aware of this situation.

READ MORE: Pharmacy in the Digital Age

In June 2024, I presented to my family physician with a persistent cough that seemed to get worse. The doctor recommended that I take a proton pump inhibitor such as omeprazole (Prilosec) or esomeprazole (Nexium) due to potential reflux causing the cough. Because of potency, I selected esomeprazole, a drug that has a generic available. I bought a 30-day prescription at Nickman’s Drug for $7 using my employee discount. At my follow-up appointment, I told my physician how pleased I was with generic esomeprazole. He agreed to send me a prescription for 90 capsules and 3 refills.

As a pharmacist, I wanted to see what the cost would be (Table). I started with my mail-order plan provided by CVS Caremark. I received a communication from CVS Caremark that this drug was not on the formulary, so my cost would be $408.28 for a 90-day supply. CVS Caremark has my credit card information on file, and I could have been 1 click of the mouse away from being “ripped off.”

Table. Cost of 90-Day Supply of Esomeprazole 40 mg

Next, I went to GoodRx and downloaded a coupon that brought my costs, if I filled the same prescription at a CVS drugstore, to $30.97. When I went to work the following week, I ran the prescription through my prescription plan at the store level, where my co-pay was $63.63. Having access to these cost data, I filled the prescription for $18 using my Nickman’s Drug employee plan.

CVS Caremark was ready to stick it to me with a $393.79 dispensing fee for using their mail-order service.

I have sent this story to every one of my representatives and senators, in both Pennsylvania and Washington, DC. I invite you—beg you—to share your horror stories with your politicians. In meeting with several representatives over the past 3 months, the common thread is that they just don’t know what is going on with medication costs.

Our representatives have PBM lobbyists breathing down their necks. Now they need to hear stories from us. Remember: Either get into politics or get out of pharmacy. The clock is ticking.

Peter A. Kreckel, RPh, practices pharmacy part time in Lemont Furnace, PA.

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Reference

1. Kreckel PA. The senior citizen vote is feared with good reason. Drug Topics. July 21, 2023. Accessed July 15, 2024. https://www.drugtopics.com/view/the-senior-citizen-vote-is-feared-with-good-reason