During his questioning before the House Judiciary Committee subcommittee on Intellectual Property, Competition and the Internet, Express Scripts CEO George Paz was asked what was the best way to reduce prescription drug costs. Reducing waste, fraud and abuse, he said. A good place to start would be mail order pharmacies, such as those owned by Express Scripts.
Express Scripts’ own mail order system, along with the mail order systems of the other two “Big 3” PBMs CVS-Caremark and Medco, are purveyors of such waste along with the mail order facilities of smaller PBMs. In just a few weeks between August and September, 25 community pharmacists across the country contacted NCPA to share information related to over $100,000 in mail order drugs that had been returned to them through the NCPA Dispose My Meds program. Talk about waste from mail order!
One pharmacist shared a photo of over $6,000 worth of medication sent to a patient that was never used. The patient is since deceased, but his (or her) spouse noted they tried several times to get Express Scripts to stop sending these medications. According to this patient, despite his (or her) efforts, the PBM continued sending unwanted or unnecessary medication.
Even more egregious, another pharmacist alerted us to $17,000 worth of waste for one patient through Medco due to a patient’s non-adherence to their prescription regimen. This pharmacist astutely noted, “I hate to see what this person’s company paid for these meds and what it did to his company’s health premiums. Mail order facilities can shout from the rooftops about compliance all they want but just because you mail a person his/her meds, that doesn’t mean they are taking them.” While these combined examples of ESI-Medco problems total over $20,000 in estimated drug waste, this is only about a third of the $61,000 example we received regarding unused mail order drugs shipped to a patient from CVS-Caremark. The pharmacist noted that these were sent to a cystic fibrosis patient who had passed away and the patient’s parents had brought the medications to his pharmacy to be properly disposed.
While these are examples from the “Big 3” PBMs in regards to private plans, government plans were also sources of waste. We received several examples of Medicare Part D patients and Tricare patients who returned unused medication they received through mail order to their local pharmacy for disposal. Waste in government programs does not just affect the beneficiary of that program who receives unnecessary refills through the mail; it is waste that is paid for by every taxpayer. (Note- no cost estimates were provided with these photos)
These and many other cases were highlighted by NCPA member Joe Lech, RPh, who testified at the Congressional hearing on behalf of community pharmacists and their patients. These and other examples are part of a “Waste Not, Want Not” brief that NCPA staff provided to the Subcommittee.
Granted, these examples are strictly anecdotal and only cover a one-month period. Nevertheless, these examples should raise concerns among members of Congress and regulators, particularly as it pertains to the proposed merger between ESI-Medco. How does combining these companies (which would collectively control nearly 60% of the mail order market and presumably face more incentive to push their own mail order business) reduce waste when there is compelling evidence that the mail order facilities under their control today are a significant part of the problem?