A Centers for Medicare & Medicaid Services (CMS) analysis of the cost of mail order pharmacies versus retail pharmacies for Medicare Part D is drawing diverging conclusions from the Pharmaceutical Care Management Association (PCMA) and the National Community Pharmacists Association (NCPA).


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PCMA, NCPA at odds over CMS analysis of Part D mail order cost

December 3rd, 2013

WASHINGTON – A Centers for Medicare & Medicaid Services (CMS) analysis of the cost of mail order pharmacies versus retail pharmacies for Medicare Part D is drawing diverging conclusions from the Pharmaceutical Care Management Association (PCMA) and the National Community Pharmacists Association (NCPA).

Each association pointed to different data from the study. PCMA said the CMS analysis shows that mail service pharmacies are more affordable than drug stores, while NCPA said mail order pharmacies often charge Medicare prescription drug plans (PDPs) more than community pharmacies for filling scripts.

PCMA said Tuesday that the CMS study, titled "Part D Claims Analysis: Negotiated Pricing Between General Mail Order and Retail Pharmacies," shows that mail-service pharmacies have lower overall costs.

The association noted that CMS identified 57 plan sponsors offering PDPs with mail order benefits and examined claims data for the top 25 branded and top 25 generic drugs dispensed at both mail order and retail pharmacies.

PCMA also pointed out that, according to the CMS analysis, overall costs at mail service pharmacies were 16% less than at retail pharmacies ($1.26 per pill at mail versus $1.50 at retail) across all drugs. The study also indicated that for generic drugs only, mail service pharmacies were 13% less expensive than retail pharmacies (21 cents per pill at mail compared with 24 cents at retail.

"CMS' data confirms what consumers have known for years: Mail service pharmacies offer a better deal than drug stores in Medicare Part D. This is unwelcome news for drug store lobbyists who want new regulations on their more affordable competitors," PCMA president and chief executive officer Mark Merritt said in a statement.

However, NCPA said Tuesday that mail order pharmacies frequently charge Medicare PDPs more — and as much as 83% more — than community pharmacies do for filling prescriptions, according to the CMS analysis.

CMS examined millions of claims from March 2012 and found 21 drug plans that routinely paid more for prescriptions filled through the mail compared with a community pharmacy, NCPA said.

"This analysis has shown that negotiated pricing for the top 25 brands and 25 generics combined at mail order pharmacies is higher than at retail pharmacies for selected PDPs," CMS stated in concluding its analysis, according to NCPA. "Thus, our hypothesis that mail order negotiated prices are lower than retail pharmacy negotiated prices was not confirmed. Instead, we are finding higher prices at mail order than at retail pharmacies for some PDPs. CMS continues to be concerned about the impact of these prices on the Part D program."

NCPA noted that Many PDPs are administered by pharmacy benefit managers (PBMs), which own most mail order pharmacies.

NCPA CEO B. Douglas Hoey commented, "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. 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."

The CMS analysis follows a study earlier this year by the agency finding that prescriptions filled at "preferred pharmacies" sometimes result in higher costs to Medicare than prescriptions filled at nonpreferred pharmacies, such as community pharmacies left out of the preferred network, NCPA noted. Also, an independent analysis of millions 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 compared to mail order pharmacies, NCPA.

The association added that a patient survey, Medication Adherence in America: A National Report Card, concluded that the biggest predictor of medication adherence is a patient's personal connection with a pharmacist or pharmacy staff.

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