NCPA: Taxpayers Protection Alliance Report on Mail Order Waste Provides Further Evidence for Patient Pharmacy Choice, PBM Reforms



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Alexandria, Va. May 7, 2013 - The Taxpayers Protection Alliance (TPA) has issued a report called "The Expensive Truth Behind Taxpayer-Funded Mail Order Pharmaceuticals." It offers a critical analysis of how federal prescription drug programs (such as in Medicare, Tricare, and Federal Employees Health Benefits Program) are susceptible to waste, fraud, and abuse because of the lack of transparency and oversight of mail order pharmacies and their owners—typically pharmacy benefit managers (PBMs). In response, the National Community Pharmacists Association (NCPA) is drawing further attention to the report as it advocates for patient choice of pharmacy and PBM reform with policymakers and health plan sponsors.

"The mission of the Taxpayers Protection Alliance is to hold the government accountable when taxpayers who fund government programs are being ill-served, so mail order waste is a fitting area of focus. As the TPA report notes, unused or unneeded medication shipped from mail order warehouses is a prime source of taxpayer-funded waste that policymakers should address," said NCPA CEO B. Douglas Hoey, RPh, MBA.

Based on documented instances of mail order waste, questionable PBM business practices and the results of a survey it conducted of hundreds of community pharmacists, TPA delivers a strong case for PBM oversight and reform in its report. It noted:

  • "[W]e urge more oversight on behalf of the taxpayer-funded public health programs. Evidence points to serious concerns and potentially millions if not billions of dollars in waste created by these large middlemen."

  • Noting that "PBMs have been largely unregulated" and "have a direct conflict of interest" as both the administrators of drug plans and, in many instances, the owners of mail order pharmacies, TPA argued "the relationship between a PBM and the mail-order prescription companies is a simple one, but the damages this inflicts on taxpayers is complex" and that "taxpayers are the ones left on the hook to pay." Moreover, it said "PBMs greatly contribute to higher insurance costs for consumers."

  • "TPA supports legislation that would establish broader oversight of PBMs and perhaps contemplates a fiduciary duty to their health plan clients."

NCPA member pharmacists have documented scores of examples of individual patients bringing in for disposal as much as $30,000 worth of unused medication. The pictures and descriptions are available in an online narrative, "Waste Not, Want Not." The TPA report included a new survey of several hundred community pharmacists asking about their experiences with patients' mail order waste problems. TPA's results included the following examples:

  • "People bring or try to bring in drugs after patient dies and it is unbelievable the amount of unused drugs sent to them and a lot of children say parents tried to stop them from sending drugs, but just kept sending so they piled up."

  • "Medications came frozen, they come weeks late, they come wrong, or the Doctor has changed them and they will still send old script on auto fill. All these waste our time as well since we have to get them what they need so there is no interruption of care."

  • "We have had patients bring in thousands of dollars of medication that was sent to them that they had stopped taking and never ordered."

Hoey added, "Egregious instances of waste such as these mail order mishaps would be far less likely to occur if these patients received their medications from a local pharmacy, where they can have a face-to-face interaction with pharmacists. Moreover, another recently conducted analysis found that community pharmacies provided 90-day medication supplies at lower overall cost to Medicare and more effectively substituted generic drugs where appropriate compared to mail order. Once again, NCPA urges policymakers and plan sponsors to refrain from mandates or other inducements to steer patients to mail order. Instead, let patients choose a pharmacy that best meets their needs and force pharmacies to compete on serve, to the benefit of patients."

The TPA report concludes, "Given the significant and disconcerting shortcomings of the mail-order delivery programs, policy changes must be implemented to address the issues discussed in this report. For starters, PBMs must adhere to and provide commonsense forms of disclosure. Protecting patients and their ability to access the pharmacy of their choice is of great importance. Taxpayers, the ones left to pay for these bills, deserve transparency. One way to achieve this is by implementing and holding PBMs accountable to requirements that foster an open and complete flow of information."



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The National Community Pharmacists Association (NCPA®) represents the interests of America's community pharmacists, including the owners of more than 23,000 independent community pharmacies. Together they represent an $88.5 billion health care marketplace, dispense nearly 40% of all retail prescriptions, and employ more than 300,000 individuals, including over 62,000 pharmacists. To learn more go to www.ncpanet.org or read NCPA's blog, The Dose, at http://ncpanet.wordpress.com/.

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