CVS sometimes forces people to use its pharmacies. Now the Supreme Court will weigh in

Photo by Marty Schladen, Ohio Capital Journal.

[Editor’s note: In September, North Carolina Gov. Roy Cooper signed Senate Bill 257 into law — a measure that will increase state regulation of “pharmacy benefit managers” in hopes of better protecting consumers. As the following story by reporter Marty Schladen of the Ohio Capital-Journal makes clear, however, many PBM practices remain controversial and will soon come before the U.S. Supreme Court.]  

It’s a practice long complained of in multiple states.

CVS Health and other massive corporations often use their pharmacy middleman subsidiaries to force people to get the most expensive class of drugs from the businesses’ own mail-order pharmacies. Some call the practice “patient steering.”

CVS and companies such as UnitedHealth and ExpressScripts/Cigna say the arrangements save patients money. But some patients, oncologists and other health providers say it threatens lives.

Now the U.S. Supreme Court is poised to weigh in. In a little more than a month, it will hear arguments in a California case in which AIDS patients are claiming the practice discriminates against them.

Known as “pharmacy benefit managers” or PBMs, the middlemen work with insurance companies or government programs like Medicare and Medicaid to facilitate prescription-drug transactions. They negotiate rebates with drugmakers, decide what drugs are covered and they determine how much to reimburse pharmacies that dispense drugs as part of their health plans.

But the function that’s in dispute in the California case is how PBMs structure their pharmacy networks.

Each of the big three PBMs is affiliated with a major insurer and each is part of a corporation that is among the 13 largest in the United States. And the combined PBMs are estimated to control well over 70% of the pharmacy-middleman marketplace.

They’re also frequently in direct competition with the retail pharmacies whose reimbursements they control. CVS owns the nation’s largest retail chain and each of the big three owns a mail-order pharmacy for “specialty drugs” — the most expensive class of medicines, which can cost upward of $100,000 a year.

Increasingly, the big-three PBMs have been saying they won’t cover super-expensive specialty drugs if patients get them at their oncology centers or their AIDS clinics. It’s increasingly the case that the only way PBMs will cover them is if patients get them through the mail from a PBM-owned pharmacy.

Critics say the point is to pad profits, but the PBMs maintain that they do this to help their customers. Read more

Assistant Director of NC State Environmental Health & Safety resigns as complaints from students, faculty continue

The assistant director and lab safety manager of N.C. State University’s Environmental Health and Safety office, has resigned.

In an e-mail last week to Chemistry department professors and lab safety officers, Mahdi Fahim said he would leave the position after 15 years.

Madhi Fahim, assistant director of Environmental Health and Safety at N.C. State University. (Photo: NC State)

“I apologize if I have not always been able to provide the quality service you need and deserve,” Fahim wrote.

The resignation comes amid mounting questions about and dissatisfaction with the office’s handling of the possible exposure of students and faculty to volatile organic compounds at Dabney Hall, home to the Chemistry department. Policy Watch reported on the long history of the building’s problems last week.

Graduate students, faculty and safety officers said the the Environmental Health and Safety office had been slow to respond or even do proper testing despite students reporting headaches, nausea and vomiting while working in the building, whose aging and inadequate HVAC system has been a problem for many years.

Ken Kretchman, director of Environmental Health & Safety, told Policy Watch that the chemistry students, staff and faculty have “bad information” based on faulty analytical methods. Kretchman told Policy Watch that his department’s own air sampling, which he said adheres to the EPA standard for industrial workplaces, has found no concerning levels of VOCs, with all of them registering well below the recommended exposure limit. 

In an e-mail to Chemistry professors and safety officers following Fahim’s resignation, Kretchman defended Fahim’s performance and the office’s work.

“Due to one statement in Mahdi’s announcement, I feel the strong need to add to his short message,” Kretchman wrote. “Madhi has been one for whom I have received nothing but compliments over his years of service. Again, just recently, he tackled a customer need in a manner which was beyond expectations. He subsequently indicated to me he did not see it that way.”

“He will be missed and I wish him all the best with the rest of his career,” Kretchman wrote.



State legislature ignores real reproductive healthcare needs, showers funding on destructive fake clinics

As the legislature muddles its way through another contentious and lengthy budget process, one thing that remains painfully clear is that comprehensive reproductive healthcare — including affordable access to contraception and pre- and postnatal care — is still not a priority for some elected officials. This unfortunately seems to be what we can expect from a gerrymandered legislature that continues to treat this vital form of healthcare, especially for women and people who can get pregnant, as a political and ideological issue rather than an issue of health, safety, and economic security for families across the state.

As one of only 12 states that still stubbornly refuses to expand Medicaid, North Carolina received a “D” on the status of women’s healthcare in a 2019 report, with 13% of women in the state uninsured and the 11th highest infant mortality rate and 10th highest sexually transmitted infection rates in the country. Our state also has lost at least 10 labor and delivery units since 2013, particularly in rural areas, during the decade that our legislature has not meaningfully addressed the lack of access to affordable healthcare.

There has long been a clear and pressing need for access to quality, affordable reproductive health and maternity care in the state, but for the last decade legislative leadership has focused on:

  • Defunding reproductive safety net healthcare providers,
  • Attacking comprehensive sex education, and
  • Restricting access to both abortion and contraception.

One consistent budget allotment that makes clear the legislative leadership’s view of reproductive healthcare is the increasing amount of public dollars that have been funneled into anti-abortion fake clinics, otherwise known as “crisis pregnancy centers” or CPCs. While it’s often couched under the generic euphemism of “helping women,” the purpose of these fake clinics is unmistakable — toend access to all abortion by spreading anti-abortion and anti-choice propaganda and harmful myths and inaccuracies about sexuality, family, pregnancy, and gender roles.

CPCs deliberately misrepresent themselves as healthcare clinics, despite typically offering few substantive healthcare services. Having been provided direct funding from our state for almost a decade, it’s still unclear if or how they contribute to improved maternal and infant health outcomes. Their own reports to the state have often included broad, vague, and inconsistent metrics like the number of people seen, “educational events,” and referrals made; or generic “employee expenses” or the number of products and trainings purchased from anti-abortion organizations. Despite their claims, there is little evidence we’ve seen from these publicly funded fake clinics that they are improving actual healthcare outcomes.

Their websites often provide no additional evidence of their healthcare activities. While stating they provide “non-judgmental care,” what typically follows are pages of medically inaccurate information about abortion, pregnancy and contraception and language designed to shame people who have had abortions. While CPCs sometimes offer people access to baby care items, often used as incentives for their programs, these are not a substitute for quality prenatal and postpartum care. Coercing and shaming people into not accessing abortion or contraception, an obvious goal of CPCs, has no place in an equitable and patient-centered healthcare system.

One concrete number you may see from CPCs is how many people they claim to have diverted from accessing abortion. In addition to not knowing anything about how that outcome is measured, such actions do not constitute healthcare and tells us everything we need to know about CPC priorities – priorities they expect us to fund through our public health dollars. There is a longstanding and urgent need for affordable access to services for people in North Carolina who are experiencing an unplanned pregnancy, particularly people who have not had access to affordable and consistent quality, comprehensive healthcare. Surely the money being diverted to CPCs could be better used funding evidence-based, proven healthcare and safety net services.

Our goal as reproductive healthcare advocates is to make sure all people have the information, resources, and support they need to make decisions that are best for themselves and their families, including the decision to have an abortion. CPCs operate from an opposite stance. These fake clinics don’t take reproductive health any more seriously than the anti-abortion, anti-equity leaders at the legislature. Whether it’s false or co-opted narratives of reproductive oppression, misleading claims of providing actual healthcare, or moral justifications for the harm of deceiving or blocking people from seeking abortion, access to reproductive care is just one more political football anti-abortion lawmakers use to gain and keep power, creating a state that is neither responsive to the needs of its residents nor representative of its constituents’ priorities.

Tara Romano is the executive director of NARAL Pro-Choice NC.

How a Mississippi court case could pave the way for new abortion bans across the U.S.

Nationwide Women’s March ahead of new Supreme Court term; here’s where demonstrations will be held in NC

This Saturday women will be marching in every single state across the country ahead of the Supreme Court reconvening on October 4. Women’s March and more than 90 other organizations are organizing a national call to mobilize and defend reproductive rights. Learn more at

Local in-person events include:

Rally for Abortion Justice – Raleigh
Starts On Saturday, Oct 2 11:00am
Bicentennial Plaza. 1 E Edenton St Raleigh NC 27601

File photo. Demonstration for reproductive rights, Raleigh NC

Women’s March 2021 Durham NC
Starts On Saturday, Oct 2 1:00pm
City Square. 201 Corcoran St, Durham, NC 27701 Durham NC

Protest for Women’s Rights
Starts On Saturday, Oct 2 11:00am
Governmental Plaza. 110 S Greene St Greensboro NC 27401

Reproductive Rights March
Starts On Saturday, Oct 2 2:00pm
To City Hall Winston Salem. 650 W 4th St Winston Salem NC 27101

Women’s Rights Rally
Starts On Saturday, Oct 2 11:00am
First Ward Park. 301 E. 7th st Charlotte NC 28202

Rally Against Abortion Bans
Starts On Saturday, Oct 2 11:30am
Vance Monument Downtown Asheville. pack square Asheville NC

Reproductive Rights Protest
Starts On Saturday, Oct 2 1:00pm
East Carolina University- Student Center Lawn. 501 E 10th St Greenville NC 27858

Twilight Women’s March
Starts On Saturday, Oct 2 5:00pm
Craven County Courthouse. 302 Broad Street New Bern NC 28560