Navigation Links
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.

(Logo: http://photos.prnewswire.com/prnh/20100106/DC33253LOGO)

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 other sponsor of a health care plan that blindly accepts the recommendations of PBMs when it comes to drug benefit design and incentivizing mail order utilization," said National Community Pharmacists Association (NCPA) CEO B. Douglas Hoey, RPh, MBA.  "Mail order is not for everyone and its appeal as a cost-saver is severely undermined by Medicare's analysis. Instead, health plans should allow patients to choose the pharmacy that best meets their health needs and helps them get the most out of their prescription drug regimen."

The CMS analysis comes on the heels of an earlier 2013 study by the agency finding that prescriptions filled at "preferred pharmacies" sometimes result in higher costs to Medicare than prescriptions filled at non-preferred pharmacies, such as independent community pharmacies left out of the preferred network. NCPA continues to advocate that any pharmacy willing to accept a health plan's terms and conditions, including reimbursement, should be allowed to do so and serve the plan's patients.

Moreover, an independent analysis of millions of 2010 Medicare prescription drug event records found that community pharmacies provide 90-day medication supplies at lower cost than mail order pharmacies and that local pharmacists substitute lower-cost generic drugs more often when compared to mail order pharmacies.

In addition, a first-of-its-kind patient survey, Medication Adherence in America: A National Report Card, finds that the biggest predictor of patients properly taking their prescribed drugs (or medication adherence) is a patient's personal connection (or lack thereof) with a pharmacist or pharmacy staff. Patients of independent community pharmacies reported the highest level of personal connection (89 percent agreeing that the pharmacist or staff "knows you pretty well" compared to just 36 percent of mail order users). Previous surveys have documented that patients are more satisfied with independent community pharmacies than mail order facilities.

The National Community Pharmacists Association (NCPA®) represents the interests of America's community pharmacists, including the owners of more than 23,000 independent community pharmacies. Together they represent an $88.7 billion health care marketplace, dispense nearly 40% of all retail prescriptions, and employ more than 300,000 individuals, including over 62,000 pharmacists. To learn more go to www.ncpanet.org or read NCPA's blog, The Dose, at http://ncpanet.wordpress.com/.


'/>"/>
SOURCE National Community Pharmacists Association
Copyright©2012 PR Newswire.
All rights reserved

Related medicine technology :

1. SI-BONE Minimally Invasive Sacroiliac Joint Fusion Could Save Medicare an Estimated $660 Million
2. RealTime Medicare Data Helps Propel Reluctant Change in Healthcare:
3. 2014 Medicare Drug Plans Vary Widely in Availability of Drugs and Restrictions on Their Use
4. PCMA Supports Bipartisan Legislation Creating Safe Pharmacy Networks to Reduce Prescription Drug Abuse in Medicare
5. Blue Cross Blue Shield of Arizona Advantage Adds Scottsdale Healthcare to Medicare Advantage Network
6. Medicare Procurement Program Creates Extreme Hardships For North Carolina Patients, Says AAHomecare
7. Medicare Procurement Program Creates Extreme Hardships for Patients without Options, Says AAHomecare
8. PCMA: Eight Ways to Reduce Federal Health Spending and Improve Prescription Drug Benefits in Medicare and Medicaid
9. New Research Finds Many Seniors Wrongly Think Public Health Insurance Exchanges Are Replacing Medicare Plans
10. Breakthrough AffloVest now reimbursed by Medicare and private health insurance
11. Express Scripts Acquires SmartD Medicare Prescription Drug Plan; Adds to Industry-Leading Medicare Offering
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:7/13/2017)... ROCKVILLE, Md. , July 13, 2017  New York ... watchers of pharmaceutical markets should be aware of.  From new ... These trends are detailed in a recently completed study, ... following: 1.  Age-Driven ... years, we have been aware of the impact the growing ...
(Date:7/12/2017)... and Company (NYSE: LLY ) has entered into ... litigation in the U.S. District Court for the Eastern District ... (tadalafil) unit dose patent. This patent was previously set ... agreement, Cialis exclusivity is now expected to end at the ... patent for Cialis is valid and infringed by companies seeking ...
(Date:7/11/2017)... 11, 2017  Bayer has awarded grants totaling more than ... of its prestigious Bayer Hemophilia Awards Program (BHAP). Four U.S. ... Philadelphia and Uniformed Services University of the Health ... winners. Grant recipients were announced last night during a reception ... Congress, Berlin, Germany . ...
Breaking Medicine Technology:
(Date:7/21/2017)... ... July 21, 2017 , ... The most common surgical techniques ... of life five years after injury, according to research presented today at the ... Canada. The study followed patients for five years following surgery. , “Orthopaedic surgeons ...
(Date:7/20/2017)... ... July 20, 2017 , ... Acute myeloid ... cancer that progresses rapidly without treatment. Newly diagnosed patients face intense chemotherapy regimens ... reoccurrence and relapse. With such a challenging diagnosis that requires immediate action, ...
(Date:7/20/2017)... ... July 20, 2017 , ... Remote ... which their iMedSecure™ comes included with each system installation. RMT’s iMedHD2™ ... remote participants for real-time collaboration and immediate decision-making requirements. While never sharing ...
(Date:7/20/2017)... (PRWEB) , ... July 20, 2017 , ... ... about the introduction of bipartisan House and Senate legislation in support of providing ... Congresswoman Robin Kelly (D-IL) introduced H.R. 2408, the “Protecting Girls’ Access to Education ...
(Date:7/20/2017)... ... July 20, 2017 , ... There’s a lot of confusing lingo out ... are the same thing. But it’s crucial to understand both the differences and similarities ... to Kaixuan Liu, MD, PhD, founder and president of Atlantic Spine Center . ...
Breaking Medicine News(10 mins):