My Unwelcome Visit to the ESI-lym | NCPA Executive Update | May 17, 2024

NCPA May 17, 2024

Dear Colleague,

Doug HoeyToday I am reporting to you from St. Louis, where I was proud to participate in a peaceful protest outside of Cigna-Express Script's headquarters coordinated by consumer advocate, Loretta Boesing.

I've been asked by a few people why I am in St. Louis.

I'm here because the business practices of all three of the largest PBMs are harmful to patients and pharmacies. However, the NCPA membership complaints about Express Scripts this year far outweighs its peers. As we said in our letter to Express Scripts and Cigna executives last month, Cigna-ESI was mentioned as being the most problematic of all PBMs in Medicare, 50% more often than the runner-up (usual “favorite” CVS-Aetna). Much of that unpopularity is due to the draconian Medicare contract rates members report to us.

I'm here because the PBMs'—and particularly ESI's—business practices are driving community pharmacies out of business. For over a year now, every day on average, one independent pharmacy is killed off by PBM business practices. Across all pharmacy categories, the carnage is even higher. That means choices for consumers are rapidly disappearing. One independent pharmacy a day is killed off by PBM business practices. It's not fair and it's not right.

PBMs paying pharmacies less than what they pay for the drug is a long-running scam. But this year, ESI is vying for the all-time record. Pharmacies are losing money on 80 percent of the prescriptions covered by ESI in Medicare!

I'm here because a year ago Express Scripts pretended, with crocodile tears, to be concerned about independent pharmacies. They even started an Independent Pharmacy Advisory Council. Since their announcement, ESI's business practices have not gotten better. They have not even remained typically bad. They've become much worse. Hundreds of independent pharmacies have closed since the ink dried on their press release. It was just for show.

I'm here for the blind, elderly wife of a military veteran. The independent pharmacy she went to for years personally delivered her prescriptions and put her medications in special packaging so she was confident in taking the right meds at the right time. She is now terrified because her pharmacy was forced to make the awful choice of rejecting ESI's TRICARE contract, because they would have gone out of business if they accepted it.

I'm here because companies like these, by hiring Express Scripts, are systematically eliminating an average of one independent pharmacy every day from communities across America:

These are just a few of the companies that probably don't realize they are aiding and abetting the extermination of small businesses—even some of their own customers and alumnus!

I'm here because I have to believe that most of ESI's biggest and most profitable customers would be appalled by its cold-hearted and destructive practices. Those customers and their employees don't want to be responsible for destroying small businesses and harming the millions of patients those pharmacy teams serve. It's time they knew what you know. ESI isn't the only ship in the pirate fleet, but it's fast becoming the most dangerous.


Doug Hoey

B. Douglas Hoey, Pharmacist, MBA