Pharmacy benefit managers (PBMs) have long been arguing and advocating for mail order prescriptions. They have tried to make the case that mail order is cheaper than local pharmacists. However, a study recently conducted by Dr. Norman Carroll, a Professor at Virginia Commonwealth University (sponsored by the National Community Pharmacists Association), found that this isn’t the case.

The study found that community pharmacies had a lower cost per unit of medication for 90-day prescriptions. However, patient costs were actually higher because of higher co-pays at retail pharmacies (as opposed to lower co-pays to incentivize the use of mail-order pharmacies). In addition, the study found that the appropriate substitution of generic drugs happened more frequently at retail pharmacies as opposed to mail-order pharmacies.

Of course , the results of this study should come as no big surprise as there’s an inherent conflict between mail order and PBMs as those mail order pharmacies are owned by the same PBMs that mandate and/or incentivize the greater use of mail-order pharmacies.  It should also be noted that PBMs have paid $370 million over the last few years to settle claims on fraud and deceptive practices.

The study also made the following recommendations:

  • “First, allow local pharmacies to fill 90-day prescriptions. Currently, Medicare Part D drug plans are only required to have some retail pharmacies in their networks provide 90-day supplies. Instead of expanding 90-day mail order, as the PBMs would advocate, this study suggests the opposite—that providing 90-day supply at retail is the right policy to save Medicare money. Those plans that rely solely on mail order for 90-day supplies may very well be overpaying for prescription drugs both in terms of total costs and foregone generic drug savings.
  • “Second, do not adopt co-pay levels that incentivize the use of mail order pharmacies based on exaggerated and illusory cost-savings claims. Promoting the use of mail order pharmacies did not save either Medicare or third-party payers one penny, according to this study. Instead, plans should implement neutral co-pay designs that foster competition among all pharmacies based on service , to the benefit of patients.
  • “Third, support patient choice and access to local pharmacies. They offer additional health services like immunizations and make vital contributions to local jobs and tax revenue.”


Read more: Study Shows Medicare Savings When Local Pharmacies Fill 90-Day Prescription