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Medicare Analysis Finds Mail Order Pharmacies Often More Expensive than Community Pharmacies
Date:12/3/2013

ALEXANDRIA, Va., Dec. 3, 2013 /PRNewswire-USNewswire/ -- Mail order pharmacies frequently charge Medicare prescription drug plans (PDPs) more – as much as 83 percent more – than community pharmacies do for filling prescriptions, a new analysis by the U.S. Centers for Medicare & Medicaid Services (CMS) has concluded, calling into question the assumption many health plan sponsors rely on in subsidizing mail order utilization.

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CMS, the agency that oversees the Medicare Part D prescription drug benefit, examined millions of claims from March 2012 and found 21 drug plans that routinely paid more for prescriptions filled through the mail compared to a community pharmacy.

"[T]his analysis has shown that negotiated pricing for the top 25 brands and 25 generics combined at mail order pharmacies is higher than at retail pharmacies for selected PDPs," CMS notes in concluding its analysis. "Thus, our hypothesis that mail order negotiated prices are lower than retail pharmacy negotiated prices was not confirmed. Instead, we are finding higher prices at mail order than at retail pharmacies for some PDPs. CMS continues to be concerned about the impact of these prices on the Part D program."

Many PDPs are administered by pharmacy benefit managers (PBMs), which own most mail order pharmacies. PBMs can grow their profits by steering a plan's patients to a PBM's mail order pharmacy, regardless of the patient's preference or whether doing so results in higher costs to the drug plan or the taxpayer-funded Medicare program.

"This analysis should be a wake-up call to any employer, government agency or othe
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SOURCE National Community Pharmacists Association
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