CMS: Mail order costs more than pharmacies

Wednesday, December 4, 2013

ALEXANDRIA – It costs Medicare up to 83% more to fill prescriptions through mail-order pharmacies than through community pharmacies, a new analysis has found. Examining millions of claims from March 2012, CMS found that 21 prescription drug plans (PDPs) routinely paid more to fill prescriptions by mail. “Mail order is not for everyone and its appeal as a cost-saver is severely undermined by this analysis,” said Douglas Hoey, CEO of the National Community Pharmacists Association (NCPA), in a release. A possible reason for the increased costs: The pharmacy benefit managers (PBMs) that administer the PDPs own most mail-order pharmacies, the release states. “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 Medicare program,” the release states.