Medicare Reveals Seniors' Mail Order Pharmacy Nightmares

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National Community Pharmacists Association

Dec 17, 2013, 12:19 ET

Cases of Waste Highlight Need for Increased PBM Oversight

ALEXANDRIA, Va., Dec. 17, 2013 /PRNewswire-USNewswire/ -- Nearly 1,200 seniors have complained to Medicare this year about a litany of problems with mail order pharmacies, including shipping unneeded medication and going without medication due to delayed shipments, according to documentation recently released by the U.S. Centers for Medicare & Medicaid Services (CMS).

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Starting Jan. 1, 2014, CMS will require Medicare Part D prescription drug plans (PDPs) to ensure that their contracted pharmacies affirmatively obtain consent from a beneficiary (or their caregiver) prior to shipping or delivering a new or refill prescription. The change comes in response to CMS receiving complaints from patients and cases documented by the National Community Pharmacists Association (NCPA) of individuals turning vast quantities of unused or expired medication (often provided through mail order auto-refills) into community pharmacies for disposal. Most mail order pharmacies are owned by pharmacy benefit managers (PBMs).

"We commend Medicare officials for acknowledging mail order waste and for responding to the concerns of patients and community pharmacists by implementing this new policy," said NCPA CEO B. Douglas Hoey, RPh, MBA. "The complaints chronicled by CMS speak for many patients and underscore the fact that mail order is not for everyone. Patients deserve a choice to opt for the pharmacy provider that best meets their individual health care needs. The new policy CMS is implementing should benefit patients and reduce medication waste through mail order."

The need for CMS' new policy is further illustrated by the newly released patient complaints. Documented by the PDP or PBM involved, the concerns raised by patients (or plan "members") included:

Medication waste
- Many patients reported receiving medication that they did not order and could not return.
- One patient complained of already having a 15-month supply on hand.
- "Member is concerned because she asked [mail order] not to send any more medication and they did 50 days early."
- Physicians changing prescription drug regimen and patients continuing to receive supplies of the old drug or dosage and mail order would not reverse the transaction.
Surprise charges
- "Member is on limited funds and needs to decide when refills can be afforded" but was automatically charged without first authorizing it.
- "Member is not satisfied that a medication with a high copay was sent without her consent."
Favoring costlier brand-name drugs over generics?
- "Member upset that [mail order] filled brand med when doctor and patient expected generic."
- "Member is disputing being charged for a medication that she verbally refused when contacted by [mail order] since she wanted generic only and cannot afford the bill."
- "Patient upset she received the brand medication and charged the brand copay when generic should have been sent."
Shipping problems
- Patients repeatedly lamented going days or weeks without their medication due to delays or shipments to the wrong address.

"Community pharmacists often hear firsthand about patients' unfortunate experiences with mail order," Hoey added. "Most of these problems cited by seniors are avoidable in community pharmacies where a patient talks to a health care provider face-to-face. Patients don't accumulate 15-month supplies of excess medication and then walk in to ask for another refill. Community pharmacists intervene so patients don't go days or weeks without their medication."

Despite these and other patient complaints, Medicare and other health plan sponsors often subsidize the use of mail order pharmacy even when their charges to the plan are higher than those of a community pharmacy. A recent Medicare analysis found that mail order prescription costs exceeded those of community pharmacies in certain instances nearly 40 percent of the time. A study released earlier this year of Medicare claims 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. Neither analysis accounted for the expense of wasted mail order medication and the associated claims that are not reversed.

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