NCPA: Mail Order Waste All Too Common; Documented by Federal Officials

PRESS RELEASE

Alexandria, Va. March 5, 2013 - Pharmacist and Senior Vice President for Government Affairs John Coster, RPh, PhD of the National Community Pharmacists Association (NCPA) issued the following statement regarding a study on the role that mail order waste plays in unnecessary health care spending that was released today by the lobby for pharmacy benefit managers (PBMs, which own the vast majority of mail order pharmacies):

"Community pharmacists, one of America's most-trusted professionals, have repeatedly voiced our concerns and those of our patients regarding wasted medications and other health care products furnished by mail order facilities. In many of these instances, patients complain about being unable to turn off the mail order spigot despite their requests. More recently, pharmacists began documenting scores of these episodes in a compilation entitled 'Waste Not, Want Not,' that is related to a voluntary drug disposal program run by community pharmacists (Dispose My Meds).

"PCMA has a lot of words about this issue, but we have the evidence. Talk to people who have dealt with mail, and more often than not, they will tell you about their own personal story—or that of a relative—having a closet full of medications that they didn't order and can't use—all because of mail order companies' desire to pump as much medications into the mail—including controlled substances—to collect reimbursement for the cost of the unwanted or unneeded drugs from the plan sponsor, dispensing fees, and lucrative manufacturer rebates.

"Medicare officials, reflecting their concerns and those raised by pharmacists, attested just last month to consumer complaints regarding mail order waste. This follows previous statements and reports by federal health officials affirming mail order waste, such as in the provision of diabetes test supplies.

"The study released by the PBM lobby today actually provides fresh evidence of the outsized role that mail order plays in pharmaceutical waste. While mail order accounted for 19 percent of Medicare prescriptions reviewed in the study, those prescriptions accounted for 32 percent of the waste. In other words, mail order prescriptions continue to generate considerably more wastage per prescription than other pharmacy options.

"While mail order waste may be alive and well, the good news is that policymakers and plan sponsors can adopt simple steps to mitigate this problem. For starters, patients should be able to choose a pharmacy that best meets their own health needs, without co-pay incentives for mail order. A face-to-face health care experience makes it far less likely that patients would be auto-shipped medications that they didn't request and don't need."

Federal officials document waste through mail order auto-shipping:

• Medicare has received complaints from beneficiaries about auto-shipping of excessive or unneeded medical products, noting that: "CMS has received complaints that beneficiaries have had medications delivered that had been previously discontinued or were otherwise unwanted and unnecessary at the time of delivery. ... Once the prescription is delivered, pharmacies are unable to return the medication to stock and generally do not reverse the claim if the patient does not want the prescription. Consequently, automatic delivery practices are potentially generating significant waste and unnecessary additional costs for beneficiaries and the Part D program overall. ... In a related issue, CMS has received complaints indicating that some mail-service pharmacies automatically deliver new prescriptions that were phoned in or e-prescribed from the physician's office without confirming that the patient wants the prescription filled and delivered."
• The Office of Inspector General has documented similar incidences in the provision of diabetes test supplies (DTS). Recently, in front of the House Small Business Committee, a Medicare official testified that from a selected group of beneficiaries that ceased ordering DTS in 2011, 60 percent of these beneficiaries had over 10 months' worth of diabetes testing supplies on hand, likely as a result of mail order auto-shipping.

Study Shows Medicare Savings when Local Pharmacies Fill 90-Day Prescriptions, Compared with Mail Order. A study examining millions of Medicare Part D prescription drug event (PDE) data has 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. Read more here.