In The News | Pharmacies Flood Medicare Patients With $3 Billion of Extra Drugs

Excessive prescription refilling by mail-order pharmacies leaves piles of unneeded pills; 'Every time, there are 15 extra'

The Wall Street Journal

Reporters: Christopher Weaver, Tom McGinty, and Anna Wilde Mathews

UnitedHealth Group’s pharmacy mailed Medicare recipient Bill Zielinski so many refills of the cholesterol drug atorvastatin that his unused stash could last a year on the pill-a-day regimen his doctor ordered.

Excessive refilling is common practice at U.S. mail-order pharmacies, a Journal analysis of Medicare prescription data found, flooding the homes of seniors with extra drugs. Too-frequent refills by all U.S. pharmacies cost Medicare and patients $3 billion between 2021 and 2023, the analysis found.

“It’s awful how much waste that is,” said Pamela Schweitzer, a pharmacist and former assistant U.S. surgeon general. And for seniors, she said, “it’s a terrible idea to have all that medication sitting around that you’re not taking.”

Some of the extra pills, which include millions of doses of muscle relaxants and antipsychotics, could lead to accidents such as taking too much of a medication or taking the wrong one, pharmacists said.

The cost of excess refilling increased during the pandemic after regulators relaxed rules limiting early refills and consumers increasingly turned to mail-order pharmacies.

Mail-order pharmacies filled just 9% of Medicare prescriptions in the three-year period examined by the Journal, but accounted for 37% of the excess dispensing, the analysis showed. Such pharmacies often send 90-day refills automatically when patients near the end of their earlier supplies.

Many people who take prescription drugs find it convenient to get three-month supplies, and to get refills before they are down to the last few pills. The problem arises when repeated early refilling causes the oversupply to keep growing, resulting in a one-pill-a-day patient, for example, getting more than 400 pills a year.

The Journal’s analysis counted as excess only dispensed prescription drugs that exceeded a month’s supply over up to three years’ worth of prescriptions. 

The largest U.S. mail-order pharmacies are owned by conglomerates that operate health insurance businesses as well. Those include UnitedHealth, Humana and Aetna owner CVS Health. Some of the pharmacy operators said their goal was to ensure patients get needed medications on time and adhere to their prescriptions. They said patients must opt-in to automatic refills, are notified before orders ship and could pause prescriptions if desired.

UnitedHealth said its efforts can result in occasional medication overages. “The alternative—members becoming gravely ill due to lack of medication—is far more harmful to patients and costly to the health system,” a company spokesman said. He said early refills aren’t waste because members can retain the medications and decline future refills.

Pharmacies make money through fees for dispensing the drugs and markups on their cost, so they have an incentive to dispense more. While walk-in pharmacies don’t make money until customers show up for their drugs, mail-order ones process the transactions when the automated shipments go out.

The Journal analysis is based on Medicare prescription records accessed under a research agreement with the federal government. The records include details of each individual prescription for more than 50 million Medicare recipients between 2021 and 2023, but don’t identify individuals.

Doctors and patients said such earlier-refilling practices aren’t limited to Medicare patients, and that it also happens with people covered by employer-sponsored plans. The Journal analysis doesn’t cover those private plans.

Medicare spends more than $100 billion a year on drug benefits. The Journal’s analysis showed substantial excessive refilling of several common drugs. In the three-year period, pharmacies dispensed to Medicare patients more than 30 extra days of diabetes treatment Jardiance almost 200,000 times, costing taxpayers and patients $111 million. Cheaper generics added up, too, with extra atorvastatin supplies costing $15.6 million... Continue Reading