This blog features information about the political campaign nationally and in the state of Pennsylvania. it will discuss congressional races western PA, but it won't restrict comments to those jurisdictions. On many occasions, it will feature humor, but its main purpose is to "cut the legs off" political jihad. This is a site for political grown-ups of all ages.

Location: Ambridge, Pennsylvania, United States

I have a Ph.D. from the University of Rochester (English and American Literature). I taught for 10 years at various educational institutions (Univ. of Rochester, my alma mater, College of William and Mary, and University of Georgia, where I was also Asst. Ed. of the Georgia Review. Later, I worked as a speechwriter and "thinker" at various large companies, including Phillips Petroleum, Gulf Oil, Aetna, Merck (consultant), and Eli Lilly (consultant), among many others. I'm a full-time writer and political commentator/analyst. Favorite company: AudioTech Business Books. Favorite female: my wife, Patricia Ann Maloney. Favorite politcal candidate: Diana Lynn Irey (PA's 12th congressional district)

Saturday, January 27, 2007

John Ryan of CVS: Please Resign or Stop Engaging in Reverse-Robin-Hoodism

My wife and I traveled out to the Wal-Mart Pharmacy in Chippewa Falls, PA (near Beaver Falls, home of Joe Namath) to buy pharmaceuticals. We no longer purchase prescription drugs at our old haunt, the CVS Pharmacy at the corner of 8th and Merchant in Ambridge, PA.

We don't go there anymore because we're tired of wildly overpaying. In fact, if we keep avoiding the local CVS and going to Wal-Mart, we'll eventually save enough money for an extended trip to Hawaii.

First, though, you might ask who this John Ryan is, the man whom I'm asking either to resign or stop ripping off customers. He's the head of CVS, a company headquartered in Rhode Island. Ryan operates a highly profitable enterprise, one that may be too profitable now for the company's long-term good. He has a reputation as a far-sighted leader in the pharmacy business, once having called for the American FDA to allow for the legal importation of cheaper Canadian drugs. (The head of Walgreen's made similar noises, although he wasn't as decisive as Ryan.)

Now, however, CVS is continuing, along with most other chains, to control drug prices at artificially high levels. It's refusing to follow the examples of Wal-Mart, Target, and Giant Eagle (a PA/Ohio chain) in lowering the prices of many generic drugs. In standing pat, it's (1) keeping overall health care costs higher than they should be; (2) ripping off people, mainly the poor, elderly, and disabled, who can't travel to Wal-Mart, Target, or Giant Eagle -- and in many cases are unaware of the lower prices at those stores.

For my family, the local CVS is convenient, a three-minute walk from home. The people there are amiable, which is unusual in my experience with other CVS outlets. But their drug prices are too high, and that interferes with their supposed mission of providing patient care. If such are is more costly than it should be, people tend to forgo it.

Example: my step-daughter Beth lives with us. She's a hard worker but a slow learner (the result of a traumatic birth) and her employer is McDonald's, which offers her no health care insurance. Thus, she pays retail prices for her prescription medications. Actually, my wife and I usually pay for them, and we aren't exactly in the class of Jay Rockefeller or Nancy Pelosi.

My stepdaughter's income before taxes (actually, before her Social Security and Medicare costs, since she doesn't make enough money to pay federal income taxes) is about $7,600.00 per year. She applied for Medicaid and she got rejected for reasons known only to God and Medicaid (but presumably because she makes "too much money"). She also got turned down for the free drug program supposedly offered by the pharmaceutical industry, the one touted endlessly on TV by Montel Williams.

Last month, I bought for Beth at CVS 30-day supplies of Lovastatin (generic version of Mevacor, an anti-cholesterol drug) and Paroxetine (generic version of Paxil, an anti-depressant). The retail price of the Lovastatin (20 mg.) was $28.29, nearly one dollar per pill, and the retail price of the Paroxetine (40 mg.) was $58.59, nearly two dollars per pill.

Today, at Wal-Mart the cost for a THREE-month supply of Beth's 20 mg. Lovastatin was $27.00, or $9.00 per month -- 30 cents per pill -- the lowest price allowed in this state. The price of a THREE month's supply of 40 mg. Paroxetine was $94.32, roughly half as much as the 40 mg cost at CVS.

If she could get by with a 20 mg. dosage of Paroxetine, the cost would have been $27.00 for a 90-day supply. (As I've suggested before, there's little rhyme or reason to drug prices. In fact, making a double-dose of Paroxetine should cost, at most, a few pennies more. It shouldn't cost three times as much.

In the future, we will find a way --I won't tell exactly how -- to get Beth the 20 mg. Paroxetine price, meaning that both her drugs combined will cost her roughly $27.00 a month. That will beat the heck out of the $87.87 we paid for a month's supply of the two drugs at CVS.

In an earlier column, I estimated that making a small bottle-full of generic drugs probably costs roughly as much as making a bottle-full of M&Ms. A gentleman at Wal-Mart told me they were making money on the $4.00 and $9.00 generics, although he admitted some of them were loss leaders to get people into the stores. In general, pharmacies make a higher margin on generics than they do on branded drugs.

With some drugs, a "double dose" (twice the number of milligrams) costs the same as a single dose -- or less. If you want to check that, look up Simvastatin (generic Zocor) on The 80 mg. size of that anti-cholesterol med costs LESS than the 40 mg. version. If you can explain that, you're wiser than I, and I used to work for the company (Merck) that developed Zocor.

My suggestion: if you're on Simvastatin and your physician is a sane person and understands anything about the vicissitudes of drug pricing, get him or her to write you a script for the 80 mg. pill. Then, if your prescribed dosage is 40 mg., cut the 80's in half. If your daily dosage should be 20 mg., cut it in four EQUAL pieces. Your local CVS (or, better, Wal-Mart) will sell you a pill guillotine that will be great for tablet splitting.

The guillotine will cost you about three bucks. Your savings on the costs of the drug will add up to many hundreds of dollars per year, thousands of dollars (remember Hawaii?) over a normal lifetime. Say what!!??? You can do the math yourself.

My stepdaughter can't afford to buy Lovastatin at Godiva Chocolate prices. On one occasion, her response was to stop taking the drug, because she didn't like spending 3-4 days pay for four weeks of medicine. But if she doesn't take the Lovastatin, her trigylcerides raise to a very high level. Over time, that could damage her pancreas, which is not something her body needs.

Why does CVS charge so much for Lovastatin and Paroxetine when Wal-Mart charges so little? Only Mr. Ryan knows the full answer, and apparently he's not telling.

My local CVS pharmacist told me his company did a study, and it found out their "average" customer was paying roughly $5.50 (out-of-pocket) for generic drugs. Thus, the company saw no reason to lower prices.

When I used to get several generic drugs at CVS, my out-of-pocket cost was $6.00 per bottle, and my insurance company (through Medicare Plan D) paid the rest, so I understand something about from whence the $5.50 number cometh.

In fact, everyone with decent insurance either pays a low co-pay for generics -- or, in the case of gold standard health plans, pays "nothing." (Actually, they pay in indirect ways, such as through lower paychecks or pensions or reduced employment security.) Some poor people stop taking their meds. Others, the very poor, may throw themselves on the mercy of the welfare system.

Does my stepdaughter, who is learning disabled and poor, pay $5.50 for generics at CVS? Obviously, she doesn't. In fact, she makes minimum wage but pays top dollar for CVS drugs. In effect, she's subsidizing the people (you may be one) who have "excellent drug plans." That doesn't make any sense. It's reverse-Robin- Hoodism, robbing the poor and giving to the rich.

CVS head Ryan might be a good man for all I know. But in the words of Ricky Ricardo, he "has a heap of 'splaining to do."

My "congressperson" (his trendy term), Jason Altmire, claims to be "an expert on health care." I fear that most of what I've been saying in recent weeks will come as news to him. Of course, Jason has the best health insurance the taxpayers can buy, so it may be all a moot point with him.

Note: As always, media outlets are free to re-print this article, as long as they cite me as the author and Campaign2008 as the source. Someone said: "But Steve, what if you get sued?" Me: "I don't believe it's yet illegal to tell the truth."


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