When lawmakers want to pass legislation, they usually do two things: 1) find the warmest, fuzziest frontmen to call into hearings and 2) slap some catchy acronym on it like the H.O.P.E. Act, which in this case could stand for Help Opioid Pushers Everyday. Recently, Democrats and Republicans have jointly decided to pin the blame for the high cost of medication on a convenient fall guy and they’re doing it with the help of your friendly neighborhood pharmacist, who’s actually covering for giant pharmaceutical wholesalers. This must stop.
Drug wholesalers have been a major part of the opioid epidemic, which now kills more than 80,000 Americans annually, according to the NIH. Many people get addicted by taking prescription pain pills and then move on to fentanyl, which is even more lethal. This national scourge is devastating the American family.
After thousands of lawsuits were filed against the drug companies by local and state governments, as well as Native American tribes, the three biggest distributors—AmerisourceBergen, Cardinal Health, and McKesson—agreed to pay up to $21 billion. Drug wholesalers shipped unreasonably large quantities of pills to small communities, even, in internal emails, laughingly referring to addicts as “pillbillies.”
In addition, under the Controlled Substances Act, pharmaceutical distributors must monitor orders for controlled substances from pharmacists and report any they deem suspicious to the Drug Enforcement Agency. That hasn’t been happening.
The Justice Department has filed suit against AmerisourceBergen saying it failed to report “at least hundreds of thousands” of suspicious opioid orders. McKesson has twice paid large settlements for the same type of “alleged” violations, including $150 million in 2017 and another million only last year. Not to be left out, Cardinal Health paid $44 million to resolve DOJ allegations that it, too violated the CSA.
When they’re not pushing massive amounts of opioids to community pharmacists across the country, the “Big Three” wholesalers are responsible for 95% of U.S. prescription drug distribution, with revenues of nearly half a trillion dollars. That’s trillion, with a T. So you’d think that when Congress is looking into the high cost of the medication you actually need and want, they would look into these massive players.
But instead, Congress has decided to focus on Pharmacy Benefit Managers, which work with your insurance company to administer your pharmaceutical benefits. When you give the pharmacist your insurance card and you get your prescription for $8 instead of $80, that’s your PBM at work. Yet, a number of congressional committees have reported out legislation targeting PBMs, and it’s expected they will be combined into a big bill this fall—possibly the H.O.P.E. Act?
In the spring, there was a bill out of the Senate HELP Committee—Health, Education, Labor, and Pensions, that’s one of the acronyms!—led by Chairman Bernie Sanders. And at a recent House Oversight Committee hearing, four of the five witnesses represented Pharma and Pharma-backed trade associations. One was the National Community Pharmacists Association. The community pharmacist? That’s just like grandma and apple pie!
Unlike grandma, NCPA’s corporate sponsors include 18 pharmaceutical manufacturers and the Big Three drug wholesalers. Because they’re basically pariahs, the wholesalers have deployed community pharmacists as proxies for Capitol Hill hearings and D.C.-based lobbying efforts. Indeed, about a third of pharmacies nationally are really franchises of the Big Three: McKesson’s are Health Mart, Cardinal Health’s are Medicine Shoppe, and AmerisourceBergen’s are—you can’t make this up—Good Neighbor Pharmacy.
The drug wholesalers maintain D.C.-based lobbying teams for community pharmacy interests. AmerisourceBergen dedicates an entire D.C.-based public affairs team to community pharmacy matters and runs a website for community pharmacist advocacy ironically called “Our Independent Voice.” Their website states that “by leveraging our resources in Washington, working with all stakeholders and policymakers, we advocate on your behalf to ensure issues important to independent pharmacists’ have a voice.” On the Health Mart website, McKesson senior VP for government affairs states, “You are the most powerful asset we have when it comes to legislative advocacy, and we need you now more than ever.”
AmerisourceBergen’s and McKesson’s PACs donated $50,000 to the NCPA PAC during the 2016, 2018, and 2020, election cycles, constituting more than 90% of all PAC to PAC contributions NCPA received. Between 2019 and 2021, they collectively donated more than $1.2 million to NCPA’s Legislative/Legal Defense Fund, making them two of the largest donors to the Fund. In addition, the Big Three drug wholesalers are all dues-paying members of NCPA, and their collective dues total $457,450 annually.
In D.C., community pharmacists are really the frontmen for the wholesalers, thanks to the financial support they’ve received from the Big Three. And Big Pharma is also directly funding them. Both industries—the very players who brought us the opioid epidemic—are heavily lobbying Congress, testifying before key Capitol Hill committees, and spending massive amounts on advertising to target PBMs and push legislation to regulate them out of existence.
To put all of this in context, a recent study showed PBM revenues made up less than 5% of the total U.S. expenditures on prescription drugs, while pharmaceutical manufacturers and wholesalers raked in 71% of the money. A recent Brookings paper concluded that the proposed legislation is “unlikely to meaningfully benefit payers.” In fact, research shows that PBMs save the average American nearly $1,000 per year.
Either lawmakers are blissfully unaware that community pharmacies and their trade association receive support from the giant corporate pharmaceutical distributors, or they themselves are influenced by the massive amount of lobbying and campaign donations. Whatever the reason, they need to stand up for the American family and quit pretending these “community” pharmacist witnesses and lobbyists are anything other than shills for drug wholesalers. Congress must S.T.O.P.—Stop Tangoing with Opioid Pushers.
Terry Schilling (@Schilling1776) is the president of American Principles Project, a conservative nonprofit group dedicated to putting the American Family at the heart of public policy.