Mail Order Pharmacy Waste Highlighted at Congressional Hearing

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.

An example of unused mail order prescriptions

An example of unused mail order prescriptions


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?

2 Responses to “Mail Order Pharmacy Waste Highlighted at Congressional Hearing”

  1. 1 Jim Cammack September 29, 2011 at 6:43 pm

    this is right on. as a Pharmacy with state approved drug take back program.

    It was started by 2 Pharmacies, in Clallam County. In th first week, in the drugs retutned, were 2 orders of a Bio tech drug costing over $4000. That $8000 worth of drugs, on just 2 prescriptions.

    Now we have boxes and boxes of returned drugs ( not all Mail order), but the toatal weight is over 3000 LBS of drugs. All at a cost of the Pharmacy to package to have destroyed, not put down the drain to return to water table.

    Mailorder nay be fine, but Community Pharmacy, chains or Indepentent can reduse this waste of millions and ,illions of un used drugs

  2. 2 philip bieni April 4, 2012 at 2:24 am

    Yes, the merger is really anti-competitive in nature. Their attempt is to wipe out the community pahramacies encourage and applaud unemployment and enrich their purses. Infact the PBM recently implemented in the state of Texas beginning March 1st, have convinced me that their main attempt is to wipe out the community pharmacies. Reason: almost 50% of all prescriptions filled in the state of Texas are being reimbursed below cost. I would appreciate it if congress can exercise their power to stop this merger.

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