CMS Medicare analysis found mail order more expensive than community pharmacy across 21 plans

ALEXANDRIA, Va. — Mail-order pharmacies frequently charge Medicare prescription drug plans more — as much as 83% — than community pharmacies do for filling prescriptions, a new analysis by the U.S. Centers for Medicare and Medicaid Services has concluded.

CMS examined claims from March 2012 and found 21 drug plans that routinely paid more for prescriptions filled through the mail compared to a community pharmacy.

“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 Douglas Hoey, National Community Pharmacists Association CEO, in a release issued Tuesday. “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.”

An independent analysis 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, NCPA added.