Pharmacy Startup PillPack to Be Terminated by Express Scripts
forbes.com
forbes.com
> “We have historically been contracted with Express Scripts as a retail pharmacy, which is what we’re licensed as in the state of New Hampshire”–where the physical pharmacy is located–”and they want us to contract as a mail-order pharmacy,” he explains. Though the retail-vs.-mail order question isn’t a legal one, traditionally pharmacies that dispense 30-day prescriptions with typical copays are considered retail, and those with 90-day prescriptions and discounted copays are mail-order. Although PillPack does mail its medications to patients (that’s a major selling point), everything else about the business model hews closer to the definition of a retail pharmacy.
I would think mailing the meds to the customer is the defining characteristic of a mail order pharmacy.
Also, some retail pharmacies will do the 90 day benefits thing as well as the normal 30 days, I get the impression this is better for some benefits managers than setting up their own mail order pharmacy or contracting with someone like Express Scripts. If I remember correctly, the Humana only Wal-Mart plan does this, as well as others (I learn about this sort of thing every year when I examine Medicare Part D plans and chose one for the next year).
Most health plans let you go to the pharmacy of your choice for regular 30-day scripts, but require you to use a single provider (typically either Express Scripts or CVS) to get the 90-day discount.
Insurance companies love these services for the same reason we love Amazon -- high volume drives price efficiency, as does eliminating the need for a retail storefront with lights and chairs and Muzak and the like.
The retail pharmacy business is a race to the bottom these days. Most small players have been pushed out by declining reimbursement rates, and the big guys barely disguise how little they care about customer service. It's clear that the benefits companies don't want to see another name brand come onto the scene and demand to take some of their profits,especially one with the possibility to gain a loyal national customer base by providing an innovative service.
That sure seemed to be my experience with all the little CVS stores I used in the D.C. area in the '90s, but it's not what I see with Wal-Mart in the last decade in the heartland. Of course, Wal-Mart goes for fewer, much bigger stores, and benefits from higher volumes than a small CVS which is often only staffed with one overworked pharmacist (I was always extra careful to check for dispensing errors when using them).
As for "race to the bottom", well, it sure looks tough. For example, Target offered upscale pharmacy service, but has given up on doing it themselves in favor of farming that out to CVS.
high volume drives price efficiency, as does eliminating the need for a retail storefront with lights and chairs and Muzak and the like.
And putting yourself in the likely presence of infectious people or the air they just exhaled is another reason to avoid the retail pharmacy experience if you can.
I take 18 pills a day to manage some kidney issues I have, and Express Scripts doesn't have a good track record with getting your meds to you on time. If I don't have some of my medications, I could die. Not to mention, it's going to be a big pain in the ass to count out all those pills, AND take up a ridiculous amount of space with all the pill bottles, and pill trays.
Incredibly pissed off about all this...
Edit: forgot to mention my amazing feelings towards Pillpack. TJ (the CEO) has contacted me directly multiple times to make sure everything has been great, and every interaction I've had with them is phenomenal. If your insurance supports it, I highly recommend it.
Surprised the HN crowd doesn't get more riled up about this, given the implications for science, opiate abuse, and other opportunities missed for improving the health system.
They are also a specialty pharmacy and a mail-order pharmacy. I'm sure there are a few other services they offer as well.
The lack of ability to (legally) import from Canada too?
And the fact all prices are becoming geared only for people with insurance to milk the system.
I don't have insurance and my script went from $4 to $80 when Target cancelled support for people without insurance. Walmart is the last place now and how long will that last when they figure out there is no competition.
The drug companies were represented by Billy Tauzin [1] who, as I am told by insiders that worked directly with him, was able to get the Pharmacos to not fight the ACA. Their support was not just critical, but a necessary factor in getting anything done.
It was a trade-off, whether or not is was worth it is hard to know.
As for your own care, I am sorry to hear about the lack of insurance. Some states (for often historical market reasons) make it hard for providers to sell or even give medications to their patients, which is also part of this problem.
If you look around, there are occasionally 'Direct Primary Care' providers or community clinics that stock generics for their own patients and will provide them at no or low-cost. Many organizations and states have processes for the uninsured to obtain medications at low cost as well. If you find a clinic with PCPs who are mission-driven, and they are out there, they perhaps can help you enroll.
It depends on whether you care about there being any new drugs developed in the future or not. ck2 is having trouble paying his current drug costs and would seem to be in one camp.
I can pay mine---granted, they've all gone generic---but with a barely, maybe, kinda treatable genetic in my case but generally common condition for which nobody has come up with a cure including an effective drug, I'm in another camp (heck, if new drug discovery had been shut down before the mid-90s or so, I might well be dead, or suffering enough you wouldn't be blessed with my contributions to HN). And as more and more people die due to antibiotic resistance infections I suspect more people will shift into mine.
Ditto importing from Canada, with their small market the easiest thing for drug companies to do is simply cease exporting brand name drugs to them so they don't suffer from re-importation and still have something of a new drug development budget.
ex: Viagra> Uprima and Cialis
Sure, Pfizer for example does spend billions on R&D. But, far more of this is Development than Research. They also call a lot of dubious spending R&D.
Try again.
ADDED: Side note, apomorphine AKA Uprima is so old a drug Wikipedia tells us Agatha Christie featured it in a story in 1940.
Second, if we want to spend money on research then we can just fund that directly. Which we do. Subsidizing company's that spend more on advertising than research is stupid.
US government, Foundations, University's, Pharm all play a roll, but Parma's role in novel cures is actually the smallest. Granted, still vital as the others rarely pay for clinical trials.
Second, the only reason why a pharma company spends on advertising is because they get a return on it. That is, they spend $10M and get $10M + X in sales from it. Why else would you spend money?
And finally, most drugs are discovered by private companies, not by the gov't. It's about a 2/3rd private company and 1/3rd gov't split.
Second, people take a lot of unnecessary drugs with bad side effects. Sure, that's profitable for drug companies, but so is flat out robbing people. Considering how useless many widely prescribed drugs are robbing people may actually be better for society.
Finally, your flat out wrong on the drug numbers. Drug discovery is very different from bringing drugs to market. We get ~50 drugs per year, but we discover vastly more than that.
Is there any point at which the number of things you claim to be true that we can trivially point out to be false might cause you to reconsider your apparent total disdain for the ethical drug industry? The same one that keeps people like me functional, and joeskyyy alive?
While sildenafil improves some markers of disease in people with pulmonary arterial hypertension, it does not appear to affect the risk of death or serious side effects as of 2014.[5] https://en.wikipedia.org/wiki/Sildenafil#Pulmonary_hypertens...
I am going to call that a failure, you may disagree.
Down in the trenches, doctors don't pay so much attention to studies, as a new resident who's taken over the primary care of my condition noted. Instead, he depends on what his experienced supervising doctor has figured out over time, and of course what he's learning in the world of real patients and ... well, we really don't know how real the drugs are once they go generic, not when, for example, Indian companies, even when operating plants in the US, cargo cult their HPLC tests of batch purity and correctness. The supervising doctor I mentioned was always interested in my reports of apparent real world bio-equivalence as the two drugs he prescribed me went generic.
As to doctors listening to studies, IMO the good ones listen to meta studies. And specialists I have spoken with try and keep up with their area. Granted, there are only so many hours in the day, but there is also a fairly limited number of new drugs every year.
PS: The FDA has only approved ~1,500 novel drugs in it's history. That's a lot but many of them are fairly irrelevant to most doctors.
I don't think they'd consider this to be a legitimate point, the gravamen of the case is that this money is not being spent on truly new drug development. Which ignores the minor detail of how are doctors and patients going to learn about new drugs in the first place.
Of course, in their ideal system, there would be no new drugs, and I daresay there also wouldn't be 26 different types of antidepressants available to prescribe.
I meant to point out the Express Scripts-Surescripts connection (and CVS, other pharmacy stakeholders...), which is part of why I think they may have dropped PillPack.
PillPack, and some of the other startups and smaller actors in the space, are potetial threats to the established players, like Express Scripts, that essentially collude through Surescripts to protect their access to the patient-provider origination channel.
It's the Surescripts network that has the near-monopoly on prescription EDI, and it acts to protect it's members interests. The tech is ancient and entrenched in a way that I imagine would greatly upset the HN crowd if they looked at it more closely.
Regulatory actors have not been paying enough attention here IMHO, and the nature of the market has led to an opaque situation that's prevented opportunities to advance research on important questions for social issues and patient care.
[1] http://surescripts.com/support/faqs/general/detail/who-owns-...
Reading the article it's really hard to say what is really going on though as the journalist makes very little effort to uncover the real motivations behind the actions of the two companies.
Their adblock-checking seems very broken.