Prescription drugs obtained via preferred pharmacies and mail order often cost more for the Medicare Part D program and its beneficiaries than if the scripts were filled through nonpreferred pharmacies, according to a National Community Pharmacists Association cost comparison using the Medicare Plan Finder website.


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NCPA: Medicare Part D Rxs often cost more from preferred pharmacies, mail order

January 16th, 2014

ALEXANDRIA, Va. – Prescription drugs obtained via preferred pharmacies and mail order often cost more for the Medicare Part D program and its beneficiaries than if the scripts were filled through nonpreferred pharmacies, according to a National Community Pharmacists Association cost comparison using the Medicare Plan Finder website.

NCPA said Thursday that in the comparison, its staff chose one commonly purchased Part D prescripton drug plan, AARP Medicare Rx Preferred, and entered into Plan Finder four of the most-prescribed drugs: a Lipitor generic (atorvastatin calcium tablets, 20 mg, 90-day supply), a Plavix generic (clopidogrel tablets, 75 mg, 90-day supply), Diovan tablets (80 mg, 90-day supply) and Nexium capsules (40 mg, 90-day supply). The costs were then compared between preferred, mail order and nonpreferred pharmacies in nine cities across the country.

The NCPA analysis found that preferred pharmacy costs to Medicare were higher than those of nonpreferred pharmacies 89% of the time, and mail order costs to Medicare topped those of nonpreferred pharmacies 100% the time.

The following chart compiled by NCPA, based on data obtained via the Medicare Plan Finder website, shows the costs to Medicare through the AARP Medicare Rx Preferred drug plan for the four medications examined:

costs to Medicare

"This analysis suggests that neither preferred pharmacies nor mail order are the bargains for Medicare that their proponents claim," B. Douglas Hoey, chief executive officer of NCPA, said in a statement.

NCPA noted that the findings come in the wake of recently proposed requirements that Centers for Medicare & Medicaid Services (CMS) officials suggested for Medicare prescription drug plans in 2015.

"We commend CMS for its recent, enhanced scrutiny of both preferred pharmacy plans and mail order," Hoey commented. "We encourage the agency to follow through on its proposed changes, which should produce greater choice and pharmacy competition for beneficiaries in 2015."

Independent drug stores and other community pharmacies have expressed concerns about often being excluded from drug benefit plans' preferred pharmacy network. As a result, smaller pharmacy operators aren't able to offer patients the lowest advertised co-payment.

"Community pharmacy owners have contacted plans and offered to accept the same contract terms and conditions, including reimbursement, as preferred pharmacies, but are routinely rebuffed or ignored," Hoey stated. "This situation creates problems for patients because independent community pharmacies are frequently located in rural and other underserved areas, from which the closest preferred pharmacy may be 20 miles or further away."

According to NCPA, its latest comparison marks the fifth time in the last 12 months that an examination of Medicare data has shown that preferred pharmacies and/or mail order are frequently more costly for Medicare than non-preferred pharmacies.

Last November, CMS released an analysis finding that mail order in some cases charges Medicare as much as 83% more than community pharmacies. Four months earlier, the agency found that "prices are sometimes higher in certain preferred networks," compared to traditional plans offering patients wider choice.

In March, an NCPA staff analysis of the same four drugs in the latest comparison found that, in eight cities, Plan Finder full costs were higher 75% of the time at the preferred network pharmacy and 94% of the time at mail order compared with the nonpreferred pharmacy. And 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 when compared with mail order.

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