Medicare: Growing Concerns about Mail Order Pharmacy Waste

By Kevin Schweers

Federal Medicare officials are preparing new policies for Medicare Advantage and Medicare Part D prescription drug plans in 2014. In doing so, the U.S. Centers for Medicare and Medicaid Services (CMS) may partially address several problems raised by independent community pharmacists and the patients they serve.

Mail order pharmacy waste
For some time, patients have complained to their community pharmacists about wasteful auto-shipping of unneeded drugs by mail order pharmacies. NCPA members and staff have repeatedly relayed those concerns to health plan sponsors and policymakers, including those at Medicare. In its Feb. 15 policy proposal, Medicare officials indicated that they are highly concerned with the potential for waste generated by such practices.

“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,” the agency observed.

“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. While proponents of these programs tout improved adherence, it remains unclear to us that permitting such programs would be cost-effective.”

Agency officials added, “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.”

As a result of these and similar concerns, Medicare proposes for 2014 a requirement obtaining patient consent prior to each new or refilled prescription. CMS added an admonition to “strongly encourage” plans not to wait, but to implement such requirements in 2013.

Make your voice heard

At the moment, these proposals are just that, proposals. Patients, pharmacists and others interested in making them permanent, should weigh in with Medicare no later than this Friday, March 1. You can do that simply by clicking on this link and a submitting a personal statement.

Incidentally, CMS’ Feb. 15 comments mark the fourth time in 10 months that federal health care officials have affirmed patient complaints and wasteful spending generated by mail order health care providers. An April 2012 Medicare report alluded to waste generated through mail order diabetes test supplies. In May 2012, a top CMS official addressed NCPA’s Legislative Conference meeting and reiterated those concerns. A November 2012 report by The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) provided further evidence of this problem. All of this echoes NCPA’s “Waste Not, Want Not” compilation of mail order waste now exceeds 100 pictures and continues to grow.

1 Response to “Medicare: Growing Concerns about Mail Order Pharmacy Waste”

  1. 1 Namron Sivad February 27, 2013 at 5:34 pm

    I can’t help wondering what happened during the open comment period last year when the changes for 2013 were, or should have been, announced. The effects of changes of the magnitude which have been experienced, audits, preferred pharmacy networks to which no one in independent pharmacy is allowed to participate, differential copays, automatic mailorder refills, etc. In short, those who write and market the contracts have been allowed to require

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