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:2/11/2016)... The primary goal of this research is ... the usage of liquid biopsy. Key information the survey ... Timeframe of liquid biopsy adoption amidst future users - ... type - Sample inflow to conduct liquid biopsy tests ... and so on. - Correlation analysis of sample type ...
(Date:2/11/2016)... OAKLAND, Calif. , Feb. 11, 2016  Walgreens ... stores across 39 states and Washington, D.C. ... in a move that was commended by shareholder advocacy organization ... President at As You Sow. "Many people hold on to ... options, which can have tragic consequences." --> ...
(Date:2/11/2016)... 2016  MiMedx Group, Inc. (NASDAQ: MDXG ), ... and other birth tissues, human skin and bone, and ... advanced products and therapies, announced today that it will ... Conference in New York , NY.  ... J. Senken , Chief Financial Officer and Chris ...
Breaking Medicine Technology:
(Date:2/12/2016)... Angeles, CA (PRWEB) , ... February 12, 2016 , ... ... With a hectic schedule, a demanding job, and no time to decompress, Rabinowitz found ... she dedicated herself to meditation for its impact on her life, implementing a 20-minute-per-day ...
(Date:2/12/2016)... ... February 12, 2016 , ... The ... Zuckerberg San Francisco General Hospital on April 5-7. The series is a multi-day, ... new habits. The workshops cover a broad range of topics, including coaching skills, ...
(Date:2/12/2016)... ... February 12, 2016 , ... Fisher House Foundation Chairman and CEO Kenneth Fisher ... Military Support Alliance president Scott Bensing, and Peggy Kearns Director, VA Southern Nevada Healthcare ... System. This will be the first Fisher House in Nevada, and will provide ...
(Date:2/12/2016)... ... ... Vail knee specialist Robert LaPrade, MD, PhD was named one of ... of physicians establishing, leading and partnering with ambulatory surgery centers across the United States. ... also known as an ASC, is a modern health care facility focused on providing ...
(Date:2/12/2016)... ... February 12, 2016 , ... Donor Network West, the organ procurement organization ... a partnership with San Ramon Regional Medical Center. Under the collaboration, the first of ... way to accommodate a more certain time frame for donor families for the recovery ...
Breaking Medicine News(10 mins):