Think of this senerio:
The owners of 3 independant pharmacies go out for dinner. During the dinner they talk about how (for a very accurate yet hypothetical example) low MedImpacts MAC’s are compared to other insurance companies. During the discussions they rabble on about how they cannot do business at COST + $0.75 and jointly decide to fax their contract termination letters into MedImpact. That, right there, violates the Anti-Trust laws.
Now think of this:
CVS/Caremark (a pharmacy/PBM merger) decides that MedImpact doesnt cut the mustard. They threaten to terminate their contract which will effect a couple hundred stores. MedImpact tries to play the hero and refuses to negotiate, and now 300+ stores are off of MedImpacts provider list.
Three independent pharmacies get dinged for Anti-Trust behavior, while CVS/Walgreens/Rite-Aid(?) can nix hundreds of their stores without violating anything. Tell me if that was the intent or spirit of that law.
Since we’re talking about the exploitation of the Anti-Trust laws that were made to protect citizens from such behavior; lets take CVS/Caremark. Now a while ago we (meaning every independent in town) underwent a Caremark audit. Now considering those auditors are paid by the infraction, and they will cancel out any prescription that was written for tablets but filled will caps (even if the medication did not come in cap dosage form) among other totally bullshit non-fraudulent-act (like the MD instead of the NP checked off), do you really think CVS gets held to the same exact standards by Caremark as us non-CVS stores? Have you ever thought about how shady and corrupt a PBM looks taking money away from the direct competitors of their affiliated pharmacy (probably in a futile hope of putting them so far under they will sell out to *their* affiliated Pharmacy chain)? CVS Pharmacists: Do the Caremark auditors come into your store and audit your records? Since you’re affiliated, aren’t they just taking away from themselves? Or do you guys write off the store losses by filling ‘fraudulent prescriptions’ thereby making your store less profitable and thereby pay less taxes? Marvel at my TinFoil hat and how its shiny!
I wonder if Medco audits its mail order pharmacy, god knows they love to audit us independants. I wonder if all of the big PBM/Retail anti-trusters have some sort of unspoken fraternity-boy truce going around leaving the independants/grocery-outlets/walmarts on the audit chopping block.
Naaaaah, that would be in violation of the anti-trust laws that prevented 3 small pharmacies from speaking out against a dont-give-a-shit-about-you PBM.