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The Cigna-Express Scripts merger has gotten a go-ahead from the Department of Justice, but DOJ has not ruled on the CVS-Aetna merger at press time...Both deals have shareholder backing... I think it’s part of an overall trend...Effects on Pharmacists...Frederick S. Mayer...CEO of Pharmacists Planning Services Inc...fears that they could result in loss of pharmacy jobs due to closures of independent pharmacies that can no longer compete. Chain pharmacists could also have less job security as locations may close. Mayer also says consolidation could lead to higher prices, lower quality, and less choice for consumers...Pharmacists...trained eight years for their PharmD, and now they are counting, pouring, and typing due to mergers,” says Mayer, who adds that pharmacists in larger settings don’t have adequate time for patient counseling...Over the past 10 years, mergers have resulted in poorer choices of medication for consumers and patients...Chains that are in one of these vertically integrated systems have guaranteed volume without competition on price...Perry Cohen, CEO of The Pharmacy Group...Companies responding to the need for new care models for healthcare services. The marketplace needs new care models and wants to embrace these companies that get ahead of the curve...More Mergers Coming... more vertical mergers and acquisitions...The horizontal is being driven a lot by the reimbursement pressure...The vertical is much more strategic around the control of the overall person’s healthcare...

...Pfizer is offering early retirement to U.S. workers ahead of layoffs early next year, it announced internally to employees…The company...employs more than 90,000, didn't say how many people it plans to cut. But it told employees…that all business units and divisions will likely lay off nonunion workers, according to materials outlining the workforce reduction program…As we prepare for growth we are creating a simpler more efficient structure which will affect some managerial roles and responsibilities. We are offering enhancements to certain benefits to lessen this effect...Overall, its workforce will shrink by "a couple percentage points,"

The Trump administration took one of its more combative moves on drug pricing Monday, when Health and Human Services Secretary Alex Azar introduced a proposal requiring drugmakers to disclose list prices in television advertisements...The proposal sets up what is expected to be a confrontation between the drug industry and the federal government. It also raises a slate of legal, political and regulatory questions that will be debated in the coming months. Here are five of the most pressing, and what experts are saying about them:

• Can the administration actually do this?
• Would putting prices in TV ads actually help?
• Will PhRMA sue?
• Why did the Trump administration choose to make this a signature proposal?
• Which drugmakers would hate this most?

....the FDA released a statement announcing that it issued a warning letter to China-based vape company HelloCig Electronic Technology Co. Ltd over several violations of FDA regulations...the company produces two products containing undeclared tadalafil and/or sildenafil, the active pharmaceutical ingredients in erectile dysfunction drugs...Such drugs are approved by the FDA as pharmaceutical drugs but not approved to be included in vape liquids, and are therefore considered illegally sold. Further, the agency learned that the company is marketing the products in such a way that may mislead consumers into thinking that the adulterated vape liquids are FDA approved, placing Cialis bottles and pills alongside their product...

What I’m(Michael Hogue, president-elect of the American Pharmacists Association) hearing from these recent graduates, as well as from seasoned pharmacists, is:

• Public and private payers are looking to pay the lowest price for prescription drugs;
• The community pharmacy business model no longer supports sufficient staffing, leaving little time for patient care, and in some cases jeopardizing patient safety;
• Pharmacists, now largely employed by a corporate entity rather than through private practice, feel they have little control over their practice environment and professional judgment;
• The number of pharmacists in many markets is leading to fear among some of losing their jobs or experiencing lower wages if they do not meet productivity metrics as more technical tasks are delegated to technicians;
• Full-time employment is sometimes hard to come by as a pharmacist; and
• Young pharmacists have tremendous personal debt from college.

The American Pharmacists Association...adopted a policy on the pharmacist workplace environment and patient safety. The policies serve not only as guiding statements and principles for the profession, but are frequently referenced when key policy and legal decisions are at play. In addition...APhA board of trustees has incorporated pharmacist well-being initiatives as core to our strategic plan. Among other efforts, we are building tangible resources to assist individual pharmacists with practice challenges, professional satisfaction, recognition and personal well-being...APhA is working with other professional organizations and employers to seek legislative changes at the state and national levels that will result in recognition of pharmacists as providers of care. Coupled with changes that remove unnecessary barriers to the use of technologies and technicians, this will lead to new opportunities for the patient care we are capable of providing, allowing the business model to shift.

Laura Joszt, Managing Editor at The American Journal of Managed Care. Welcome to This Week in Managed Care from the Managed Markets News Network

Pharma might have thought it could fend off the Trump administration's bid to get drug prices into consumer advertising, but it was wrong...Even a last-ditch set of concessions—announced by PhRMA Monday morning—couldn't forestall HHS Secretary Alex Azar's own proposal Monday afternoon. The pharma plan was "a small step," Azar said, before saying he'd require DTC television ads to include the list price on all $35-and-up drugs covered by Medicare or Medicaid, which is essentially every drug in the pharmaceutical universe...And Azar didn't just counter. He took direct aim at the just-announced PhRMA idea.

...FDA launched a Drug Competition Action Plan that focuses on three key areas designed to facilitate more generic competition, promote patient access, and improve the economics of developing generic medicines...While we’ve made substantial progress in fostering more competition by resolving obstacles that can make it difficult to win approval of generic versions of certain complex drugs, increasing the speed of generic approvals, and closing down ways that branded companies game the system to prolong drug monopolies, there’s still more work to be done...So we’re opening up some new policy fronts when it comes to our Drug Competition Action Plan. And we’re re-launching that plan for 2019 with some additional initiatives. Chief among them is a new effort that FDA has proposed to the International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use (ICH), a key international body comprised of other regulatory authorities and the pharmaceutical industry: The pursuit of common global development standards for generic drugs...The ultimate goal of this global harmonization of scientific and technical requirements would be the attainment of a single global generic drug development program that can support simultaneous regulatory filings across multiple markets. Harmonization of these requirements is foundational to achieving a future goal of enabling global approval for high quality generic drugs.

Nicole Grassano, PTNN, Pharmacy Week in Review, this weekly video program provides our readers with an in-depth review of the latest news, product approvals, FDA rulings and more.

Walgreens Boots Alliance CEO Stefano Pessina says Walgreens is a "true health-care company."... Amazon has already stolen sales of everyday items and is in the process of acquiring online pharmacy Pillpack...Walgreens wants to be seen as more than a retailer...Its competitor, CVS Health, has been touting itself as a health-care company dedicated to transforming the patient experience and lowering costs in the process. To help its case, CVS is acquiring insurer Aetna...It's not that being a retailer is a bad thing. But investors want drugstores reinvent their businesses as Amazon already steals sales of everyday items like toilet paper and will soon enter the prescription drug delivery business with its acquisition of online pharmacy, Pillpack...