PharmExec Blog

Medco CEO Champions Robots Over Pharmacists

The role of the pharmacist in positive health outcomes – and drug company profits – is often cited in discussions around adherence to medication regimens, holistic prescribing practices and the navigation of insurance payment structures.David Snow, CEO, Medco

In an attempt to demystify that role, Medco CEO David Snow told attendees at the Cleveland Clinic’s Medical Innovation Summit last week that pharmacists are not in fact doling out health information to patients. “I’m not dissing retail [pharmacy], but…there’s a fiction that a pharmacist comes out and dialogues with you,” said Snow. “In reality, a high school student hands you a script from the shelf.”

In a follow-up dis to retail pharmacists, Snow added that Medco’s “robots” are “twenty-three times more accurate” than human pharmacists, in terms of errors in dispensing prescriptions. Physicians were also taken to task during Snow’s talk, titled “The Case for Smarter Medicine.” A large majority of the labels on drugs dispensed by Medco contain genetic information relevant to patient outcomes, and yet, “no one is doing the recommended testing or screening,” said Snow. “We call physicians who don’t prescribe correctly,” which is a more difficult telephone call to make than the one to non-adherent patients, he said.

Among chronic disease patients, 65% stop adhering to medication within 12 months, and poor management of chronic and complex disease leads to “$350 billon in excess healthcare costs annually,” said Snow, citing a statistic from a 2005 RAND Corporation study.

Responding to Snow’s comments, Chrissy Kopple, VP media relations for the National Association of Chain Drug Stores (NACDS), said in an email: “If there were any doubt about [Medco's] intent to impose mandatory mail order on more patients, depriving patients of their choice of pharmacies, then these comments should erase such doubt at this point.” Kopple wrote that “Americans trust their community pharmacists and find them highly accessible,” and cited three national surveys as evidence. For a view of the pharmacist contrary to Snow’s portrait, see the New Yorker’s recent profile of Dr. Don.

Medco and Express Scripts, the first and third largest pharmacy benefit managers (PBMS) in the country, respectively, are currently awaiting Federal Trade Commission (FTC) scrutiny on a proposed merger, which retail drug stores and pharmacists have sought to prevent. In testimony before the FTC, Dennis Wiesner, a pharmacist and member of the NACDS, said there is “only one stakeholder that would benefit [from the merger]: the new mega PBM.” Citing cases brought by “over 30 State Attorneys General,” Wiesner said PBMs have “accepted rebates from [drug] manufacturers in return for placing higher priced medications on prescription drug plans’ formularies,” among other things, and that an even larger mega PBM would “have even greater ability to dictate one-sided, unfavorable contract terms to pharmacies, health plans and employers, ultimately harming consumers.”

“Pharmacists help to ensure that patients understand their medications and take them as directed,” and they “collaborate with doctors and other local healthcare providers to assist in medication decisions,” said Wiesner in his FTC testimony. “Community pharmacies also provide critical, cost-effective services like immunizations, disease state management and monitoring, and health education and screening programs.”

In his own testimony before the FTC, David Snow argued that Medco depends on retail pharmacies, since “more than 85% of prescriptions filled for Medco customers are filled through our networks of more than 60,000 retail pharmacies…Medco is dependent on the continued existence of strong independent retail pharmacies.”

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  1. Jose Navarro
    Posted October 12, 2011 at 11:35 am | Permalink

    It is unthinkable that this merger is allowed to take place. Nothing good can come out of such a large PBM.

  2. SalMott
    Posted October 12, 2011 at 3:45 pm | Permalink

    Man, David Snow is so ignorant.
    The truth is:
    1) Counseling a certain percentage of patients by pharmacists in every retail pharmacy is required by the OBRA 90 Act. Retail pharmacists counsel on a regular basis, and encourage their interns to do so as well. This is enforced by the States, and expected of pharmacists by employers.
    2) High School students working in retail pharmacies aren’t the norm. They are the exception. Many chains don’t even allow anyone under 18 behind the counter. Those that do hire high school students are limited as to when they can use their help due to scheduling conflicts and labor laws.
    3) No one hands anyone “a script off the shelf” in a retail pharmacy. Mr. Snow wants people to think he’s hip by knowing the lingo. Not only does he NOT know the lingo. He makes himself sound ridiculous to anyone who has spent a day behind a pharmacy counter. A “script” is slang for the actual prescription document issued by the prescriber. It is not sitting around on shelf waiting to be handed out.

  3. Tom Lauterio
    Posted October 13, 2011 at 12:33 pm | Permalink

    I have worked with tons of pharmacists around different products and they give misinformation more often than information. Some pharmacists are telling patients to take NSAIDs for chronic conditions which makes outcomes and adherence worse, increases AEs and costs the health system more. Everyone in the world seems to know NSAIDs should be relegated to a few days, especially with all of the new literature and FDA summit. But pharmacists are totally oblivious of dangers and that is supposed to be their forte. Used to be a big supporter, but now I wonder if the impact of robots would be helpful.

  4. nil d
    Posted October 13, 2011 at 2:50 pm | Permalink

    Why are they partnering with FDU in opening a pharmacy school? And if I may ask how many times has this CEO dispensed a medication.

  5. JSkelton
    Posted October 13, 2011 at 2:57 pm | Permalink

    Wow. Stunningly ignorant. Boggles the mind how he could rise to the level of CEO. Unlike robots…and Medco…pharmacists actually care about the health and well-being of their patients. The profession of pharmacy and many of your employees that legally allow your company to dispense medications await your apology.

  6. Jesse
    Posted October 13, 2011 at 4:58 pm | Permalink

    David’s “Robots” sure don’t know how to run an effective pharmacy help desk… if the request is anything outside of their pre-determined scripts they are clueless. I can only imagine how helpful those robots are at counseling patients.

  7. Richard Einhorn
    Posted October 13, 2011 at 10:58 pm | Permalink

    What happens if the patient has a complaint? For example, generic furosemide is dispensed automatically instead of branded Lasix, yet some patients may not get the full diuretic benefit because of an idiosyncratic reaction to the substitute.

  8. Robert Frankil
    Posted October 14, 2011 at 9:16 am | Permalink

    Mr. Snow’s comments are incredible. How can his robots at his mail order houses handle patient care? How long do patients have to wait on hold to get an answer at his mail order pharmacies? How many after hours emergency deliveries do his robots make to care for needy patients? When is the last time Mr Snow actually cared for a patient? Mr Snow takes credit for programs that Medco has, but who are the people who actually implement those programs and care for patients? We do, the pharmacists on the front line of care! We all must stand up and speak out against the Express/Medco merger!!!!

  9. Kimberly Evans
    Posted October 14, 2011 at 9:51 pm | Permalink

    What would be the positive results of this merger,…besides robots…??? None!!!

  10. Mel Brodsky
    Posted October 15, 2011 at 10:22 am | Permalink

    Just look at David’s smile – I would not buy a used car from him. Hail Hail to Mail-Order, the most deceptive category in modern medicine. Let him explain his pricing to those companies paying for their mail-order service because the documentation they receive is flawed, not showing what they actually pay to community pharmacy. Let him explain what happens to all the rebates they receive that are called “stocking fees’, “educational fees”, “shelf fees” – Are the payers of his services seeing any of this?
    Let him explain why a high priced Branded product is dispensed to the patient rather than the lower priced generic equivalent (rebate driven). I could go on & on.
    Solution: One price to all from all drug manufacturers – It would lower pharmacy costs country wide (Billions of dollars) and then let the consumer decide where they obtain their prescriptions. Most Pharmacists are not as pretty as David, but they are cuter and easier to talk to than his robots. Why are American’s paying 2-3 times the price compared to what is paid in Canada or Europe? Because our government is not watching the deceptive practices of the drug manufacturers or the PBM’s & their Mail-Order divisions. WAKE UP WASHINGTON!!! Stop thinking about your next re-election campaign & start thinking about your constituents and this great country and the problems in hand caused by special interests and their checks.
    Medco is for sale – $29.1 Billion – Profits are ridiculous for a compamy that says they are saving their customers money. Transparency would show their deceptive practices to all concerned.
    A good place to start for the “Super Committee” looking to save Trillions. Stop using PBM’s.
    Give the consumer the “CHOICE” – level the playing field – and then we could say BYE BYE to Mail-Order.
    Let’s take that smile off of David’s face……Move your patients away from Medco administered programs…

  11. Posted October 15, 2011 at 11:53 am | Permalink

    The main problem with Mr. Snow is that there is no R.Ph., MD., OS., or RN after is name. He hasn’t a clue how to be a healthcare provider, only a money hungry CEO of a PBM. Anyone who chooses a machine over a human being needs a gut check. I would bet my pharmacy that any independent study of patients regarding community vs. mail-order would want to have access to a community pharmacy/pharmacist over the mail man and the long wait time to ask the pharmacist a question at Medco or any other mail order pharmacy. I believe this merger would only make it worse for the patient.

  12. Posted October 15, 2011 at 2:46 pm | Permalink

    Mr. Snow is so wrapped up in his PBM state of mind, he cna’t remember the true facts. Who is more trusted, the pharmacist or that robot he is so proud of. Who can the patient easily talk to, the community pharmacist or the mail order telephone help line. Mr. Snow, do a realilty check. Good Pharmacy is when you have a caring pharmacist caring for thier patients.

  13. P Adams
    Posted October 17, 2011 at 8:25 am | Permalink

    I am amazed that Mr. Snow believes people want healthcare from robots. We want personal and direct care. True, robots can accurately place pills in a vial – and they do that at retail pharmacies too – but speaking face-to-face with a pharmacists is so important when it comes to your medicines. I am so surprised that employers don’t realize that the big three PBMs have put the corporate dollar, profits,and the extensive salaries of CEOs like Mr Snow first and foremost and are milking employers out of money. To let a merger of two giants like Medco and ESI go through would be almost criminal to the American public. This is exactly why our government enacted antitrust law years ago!

  14. Old Druggist
    Posted October 17, 2011 at 10:28 am | Permalink

    Maybe the pharmacist that when on a hunger strike in opposition to Medco’s company wide shortened verification time on new prescriptions dispensed could tell about errors. He stated that shortened time increased errors and put more stress on the pharmacist doing the dispensing. Medco is all about money they make. Developed a slick marketing approach and pulled the wool over the eye of the employers that they contract with and grew the business. Drug of choice at one time was the best drug for the disease state, Now its the one with the best rebate for PBM. If Snow ever did anything ethical or professional it was by accident. You can tell when he is lying cause his lips are moving. Maybe the employers will wake up and verify the true costs of their healthcare but I have been told by former PBM employeres that they rarely check. Interesting.

  15. Posted October 18, 2011 at 5:13 am | Permalink

    Pharmacists may have shot themselves in the feet by intervening and correcting problematic prescriptions too seamlessly. We are in a hurry, and tend to forget the self promotion which accompanies the life saving interactions with the physicians. It could happen too unobtrusively for Mr Snow to notice, perhaps. Eventually, this efficiency and attention to the details, at the expense of salesmanship, will spell the death of the practice of pharmacy.

    The main thing that Medco can’t replace is accessibility. Pharmacists actually see the patients and are able to function in the capacity of medical triage, telling he patients when it’s time to see the doc or go to the E.R.. Community pharmacists offer continuity of care that is impossible for the patient to obtain with physicians, The Medco machine does not replace this, and a good percentage of patients will know enough to miss it when it’s gone.

  16. T Balmer
    Posted October 18, 2011 at 10:22 am | Permalink

    I love it. People getting mad over capitalism in this country. This merger is not the monstrous demon that the media presents it to be. Read the sheets and KNOW the truth. Stop believing what you read in the news paper and see on TV. Maybe we should all focus on the real problem; Obama. Long live Express Medco Scripts!!

  17. Dawn
    Posted October 18, 2011 at 10:40 pm | Permalink

    Mr. Snow -
    Next time one of your mail order patients comes in with their bottle and wants to ask a question about their Rx and/or side effects/best time to take, etc. I’ll be glad to tell them what you think of us (robots) and will hand them the phone to your ridiculous 800 customer service number for help. Or better yet, I’ll give her your email/extension and you can have the pleasure. If your Board of Directors doesn’t call an emergency meeting to at least censure you, or apologize to the “robots” working hard on the front lines of healthcare (need I also mention helping to “bend the cost curve” – unlike the PBMs/mail order who are still pushing adherance programs for their Rx volume without regard to true patient care”), then you entire company and the stake of this merger is truly in trouble as the smoke has cleared, the curtain has been pushed back and the true “transparency” for what you all are looking to do is now EXPOSED…..

  18. ulli edwards
    Posted October 19, 2011 at 12:01 pm | Permalink

    mr snow, may 1000 crackheads demanding an early refill be on your door step tomorrow am
    and then you can tell them your robots can just crank that right out! We have to practice pharmacy by
    law….When does mailorder get inspected by state boards? person to person communication is the law
    in the retail setting……I think medco should give you a personal 800 number so that all of your mail order
    customers can call you personally for customer service…..wake up people….mail order is dangerous, expensive and wasteful! one man’s job isn’t as important as keeping the integrity of our healtcare system from deteriorating to the point we hope a robot will get us through chemotherapy because that’s all there is! in the mean time I will be answering any question a mail order customer has because I took an oath, and I will also be educating everybody who will listen mr snow, about what a dinosaur you think I am!

  19. LD50Placebo-effect
    Posted October 21, 2011 at 10:33 pm | Permalink

    Mr. Snow is only allowed to get away with this nonsense because as opined before, there is wide misperception of the registered pharmacists’ legal duty.Pharmacists are the only ones legally allowed to fill and dispense prescriptions.

    Mail-out pharmacies promote fragmentation of health care along with present issues such as lack of access.

    Mail-out pharmacies do not foster community and social involvement in health-care issues. They are often located in different parts of the country which go by different sets of laws as well as the time-zone, and mailing delays for changes in orders or new prescriptions, or even refill requests.

    Mail-out pharmacies are bad for the profession of pharmacy because they reduce registered pharmacists to little more than widget counters and dispensers in drug warehouses. When a retail or hospital registered pharmacist seeks information about and individuals’ prescription history for the health-care team, there seems to be company-wide policies that block pharmacists from talking to each other.

    Insurance companies promote an unfair advantage when refusing patients’ requests for more than a month supply at a time at a retail store, but offering different advantages to those enrolled in the mail-out pharmacy.

    Patients often do not know what they are taking when admitted to hospitals emergently as mail-outs don’t seem to have figured out how to provide their clients with adequate and readily retrievable information such as was touted in reconciliation of care records, and seamless transfer of care.

    Mail-out pharmacists are staffed only on weekdays between 8-5. There is no one to call after hours or on a weekend or holiday.

    Mail-out pharmacists can get away with minimal requirements of pharmacy services under the law because they can operate like mail-out catalog stores in New Jersey.

  20. Joe
    Posted October 24, 2011 at 11:05 am | Permalink

    To CEOs and Human Resource Directors:

    Think twice before selecting you next PBM. If you think the CEO of Medco is honest and will help your company save on health benefits, this article should change that. If you still need proof, research this guy just a little bit. Backroom deals with state retirement systems, dishonest testimony to Congress and now a merger that does not have your best interest at heart, all should add up to staying as far away from Medco as you possibly can.

  21. Posted October 26, 2011 at 2:23 pm | Permalink
  22. marybaldwin203
    Posted March 28, 2012 at 7:12 am | Permalink

    Nothing good can come out of such a large PBM.

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