U.S. Rep. Joe Courtney let the Federal Trade Commission know he strongly opposes the proposed merger of two of the three biggest companies that manage pharmacy benefits, Express Scripts and Medco Health Solutions.

The merger is reportedly valued at about $25 billion.

“Like many of my colleagues, I have concerns that the proposal will lead to further market concentration in an industry—where there are already few choices—without realizing cost savings for consumers,” Courtney wrote in a letter   to FTC Chairman Jon Leibowitz. “At the same time, this concentration will squeeze community pharmacies, forcing some out of business and creating job losses.”

He’s not alone in his opposition.

“Our members are very concerned about what this proposed merger will mean to patients, employers, state government and pharmacists,”  Margherita R. Giuliano, executive vice president of the Connecticut Pharmacists Association, said in July when the merger was announced.

“These large Pharmacy Benefit Managers already have too much power when it comes to controlling health care dollars and they have clearly placed their own corporate earnings first and foremost. This merger will only broaden the power they wield which will ultimately lead to increased prescription drug costs,” Giuliano said.

Appearing before a House antitrust subcommittee two weeks ago, Express Scripts Chief Executive George Paz and Medco Chief Executive David Snow said the market for PBMs was rapidly evolving and includes more competitors than the top three.

But what worries independent pharmacies the most is not only the management of pharmacy benefits for many insurers, governments, and employers, but also the fact that Express Scripts and Medco own their own mail order pharmacy.

According to a Wall Street Journal article, Medco’s Snow reassured independents at a Sept. 20 Congressional hearing that the company wouldn’t have more leverage to steer customers to fill prescriptions by mail order.

But in Connecticut a deal brokered between the state and the labor unions forces the more than 45,000 state employees to get their maintenance drugs, such as blood pressure medication, through mail order.

And while the state gave independent pharmacies a chance to join the mail order program, it was unable to negotiate any rate since the savings were already locked in as part of the labor agreement.

In Connecticut, pharmacies are looking at potentially losing thousands of state employees as patients, Guiliano said.

“The recent SEBAC agreement negotiated with the state mandates that state employees receive their chronic medications through the mail or at a CVS pharmacy,” Giuliano said. “In the latest proposal, any willing pharmacy will be allowed to participate in the mandatory mail order program at the same reimbursement as the CVS/Caremark owned mail order pharmacy – a situation that in most cases will not be affordable to small

Rick Carbray, a CPA member and owner of Apex Pharmacy in Hamden, went on to add that “we are also deeply concerned that this PBM merger could mean the further closure of many Connecticut community pharmacies.“

“This is a sad day because there is a world of difference between the personal one-on-one, face-to-face care that community pharmacies offer. It will ultimately also be a loss for the many state residents who are these pharmacies’ patients, as well as a loss for the State of Connecticut due to the lack of revenue and increased unemployment if pharmacies close. We will be working to do everything we can to convince Congress and the FTC that this merger must not be allowed to go forward.”

Click here to read more about the impact of the SEBAC deal on independent pharmacists. And here to read about the Maintenance Drug Network set up by state Comptroller Kevin Lembo.

Since our last story on the number of pharmacies participating in Connecticut’s mail order program, a few more have signed up. The list of the new participating pharmacies is as follows:

Big Y
Price Chopper
Stop & Shop
Bordornaro’s Pharmacy in Portland
Hope Street Pharmacy in Stamford
Manchester Pharmacy in Manchester