MESSAGE
| DATE | 2025-12-28 |
| FROM | Ruben Safir
|
| SUBJECT | Subject: [Hangout - NYLXS] Those 90 days fills are killing patients
|
The insurance companies, PBMs and the brainwashed MDs they have badgered
to death have been pushing us to fill 90 day supplies for patients and
the patients are stockpiling drugs, selling expensive drugs on the
street, and suffering with huge stocks of the wrong meds when there is a
change in thearapy. When I try to cut it back to 30 days, they THREATEN
me. Enough of this.
Get the PBMs out of the medical business.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The Wall Street Journal
1.1M Followers
Pharmacies flood Medicare patients with $3 billion of extra drugs
Story by Christopher Weaver, Tom McGinty, Anna Wilde Mathews
• 20h • 9 min read
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.
The Medicare agency requires drug plans to set limits on early
prescription refills. Some insurers require patients to wait until they
are 75% of the way through a prior supply, or day 68 for a 90 refill.
The federal government relaxed its rules for refills for Medicare
recipients as part of its response to the Covid pandemic starting in
2020, allowing pharmacies to refill drugs earlier for a time.
The Journal analysis found that over the three-year period,
UnitedHealth’s mail-order pharmacies sent refills sooner than the 68-day
threshold 11% of the time, almost nine times the rate of all other
Medicare pharmacies.
Risk factor
For some drugs, UnitedHealth sent early refills more frequently than
that. More than 30% of the roughly 89,000 90-day refills of the muscle
relaxant tizanidine shipped by UnitedHealth’s Optum pharmacy arm were
processed sooner than 68 days after the prior shipment. UnitedHealth
also sent other muscle relaxants, including the generic form of
Flexeril, early.
Doctors often prescribe muscle relaxants, which carry the risk of abuse
and dependence, to be taken as needed. Excessive refilling means
patients who take the medicines infrequently could amass even bigger
surpluses.
The federal Medicare agency declined to comment on the Journal’s
analysis but said it viewed early refills of drugs like the muscle
relaxants as a “potential safety and program integrity signal that
warrants careful monitoring.”
UnitedHealth and rival insurer Humana’s CenterWell pharmacy both sent
early refills of some psychiatric drugs like Seroquel, an antipsychotic,
at higher rates than many other drugs.
UnitedHealth sent $142 worth of excess medications per Medicare
recipient served during the three-year period, the highest amount of any
major pharmacy operator. Humana ranked second, with $90 worth of extra
medication per Medicare recipient.
Both companies said that after the pandemic-era emergency rules ended in
2023, they denied more early refills than in the period the Journal studied.
UnitedHealth said it blocked up to five times as many early refills in
2024 as in 2021 and 2022. “The data does not reflect current practices,”
the spokesman said.
Humana said its current protocols “strike the right balance, allowing
sufficient time to fill and ship prescriptions and supporting medication
adherence without encouraging stockpiling.”
A Walgreens spokeswoman said the store-based pharmacy company has
controls to prevent refills beyond physicians’ orders. CVS Health
declined to comment.
Joe Mulvehill, a New York doctor who visits many elderly patients in
their homes, said he regularly finds drawers or shoeboxes full of pills,
often sent by mail. One patient had more than 50 bottles stashed around
her apartment, mostly from mailed prescriptions received by her and her
late husband. After his first visit, Mulvehill typically hauls away bags
of medications that are no longer current to ensure patients aren’t
taking the wrong drugs or dosages.
“They just get piled on, they keep getting them,” he said. “The more
they have, the more confused they are about what they are taking.”
Pharmacists and doctors said the piles of old mail-order prescriptions
pose risks to older patients, particularly those with memory or vision
challenges. Elderly patients with extra pills might keep taking a drug
or a dosage that their doctor no longer prescribes, said Donna Bartlett,
a geriatric pharmacist and professor at the Massachusetts College of
Pharmacy and Health Sciences.
They also might mistakenly double up on a medication if a mail-order
pharmacy switches generic manufacturers and a drug begins coming in a
different-colored pill that appears to be a different prescription.
Some seniors have multiple family members or caregivers who might be
mistaken about which prescriptions are current.
“Oversupply can really be a problem,” Bartlett said. Taking too much
Seroquel, the antipsychotic the analysis found was often refilled early,
can cause blood pressure to drop.
Daniel Duffy, a 55-year-old Texas construction-materials salesman who
gets health insurance through his wife’s employer, said he noticed last
year that a mail-order pharmacy operated by Cigna unit Express Scripts
was sending him too many bottles of pills, including the antidepressants
trazodone and duloxetine.
“I’ll get my 90-day supply, then I get my next refill at day 75. Now I
have 15 extra,” he said. “Every time, there are 15 extra pills.”
Duffy shared records showing that Express Scripts sometimes sent him
pills at an even higher rate, including 360 days’ worth of lamotrigine
over 169 days last year. The extras accumulated in part because his
doctor upped his dosage in October, seven days after he received an
autoshipped 90-day refill. The company sent 90 more pills 72 days later,
in early December.
“I know her company is paying for it,” Duffy said of his wife’s
insurance. “I’m like, why?”
Soon after, he canceled the mail-order refills, and when his stash ran
low months later, he started picking up his pills at a local Walmart,
pharmacy records show.
An Express Scripts spokeswoman said the company is committed to reducing
healthcare waste, “so our refill process also accounts for the
cumulative amount of medication that a patient has on hand.” She said
the company requires patients to sign up for automatic refills and
notifies them before each shipment.
Owned by insurers
In Medicare, private insurers oversee taxpayer-funded drug benefits. In
recent years, those insurers, including UnitedHealth and Humana, have
bought up pharmacies, doctors offices and other health-services providers.
That means that insurers increasingly are paying their own pharmacy
units for the drugs they send out. In the process, revenue shifts from
their closely regulated insurance arms, where profits are effectively
limited by federal law, to their pharmacy arms, where profits aren’t
restricted.
Some former UnitedHealth executives and insurance-industry actuaries
said early prescription refills could help improve the performance of
health plans in industrywide quality ratings, including ones that
measure whether patients are taking medicines as prescribed and whether
customers are satisfied.
UnitedHealth said medication adherence is important to the quality
ratings, but that its priority is its members’ health.
Congress requires private insurers that oversee Medicare’s drug benefit
to cover 90-day prescription refills at bricks-and-mortar pharmacies as
well as mail-order pharmacies, but long-term refills are less common at
walk-in facilities. The requirement was intended to level the playing
field between the competing businesses, lawmakers said at the time.
The portion of Medicare prescriptions filled by mail-order pharmacies
increased to 9.1% at the end of 2023, from 7.7% at year-end 2018,
Medicare data shows.
Safely disposing of excess prescription pills isn’t a simple matter.
Government regulations prevent nursing homes, assisted-living facilities
and others from throwing them out with normal garbage. So-called reverse
distributors contract with healthcare facilities to collect extra,
unused pills for disposal.
RemediChain, part of a nonprofit, gets hundreds of bottles a month full
of patients’ unused, sealed medications, which it offers free to people
who have prescriptions and are in need. Many donations are from people
getting rid of extra prescriptions shipped by mail-order pharmacies, or
from the families of patients who have died, said Phil Baker, a
pharmacist who leads the charity.
“They know they’re valuable, so they just pile them up,” said Baker.
“They don’t want to flush them down the toilet, they don’t want to throw
them in the trash.”
The Journal’s analysis concluded that Medicare patients who died from
2021 to 2023 left behind refill overages worth $240 per person. Patients
who died after receiving drugs from UnitedHealth’s pharmacy arm left
behind $357 worth, on average.
Insurers are supposed to obtain opt-in agreements from Medicare patients
for prescriptions to be automatically refilled.
Zielinski, the retiree getting early refills of atorvastatin, said he
didn’t recall whether UnitedHealth’s pharmacy arm asked him for
permission to start automatically refilling the drugs.
The 74-year-old retired mortgage officer in Oxford, Conn., said he
generally followed his doctor’s orders to take one statin pill a day. “I
might miss a day here and there,” he said, “but certainly not 300 times.”
During a 10½ month period ending earlier this year, UnitedHealth’s
mail-order pharmacy shipped him 450 of the pills, records show.
UnitedHealth said those orders included an early refill due to a glitch
in December 2024, and that Zielinski received an extra 56 pills during
that period. It said his refills for the statin prescription were set to
process 85% of the way through his prior prescription, per its standard
practice, and were otherwise shipped accordingly since 2017.
Refilling a 90-day prescription at the 85% mark would result in 13 extra
daily doses each time.
Zielinski noted that his automatic refills included only prescriptions
that are covered by his drug plan without any copay, so he doesn’t have
a strong financial motivation to slow the shipments.
Nevertheless, the waste got to him last year, and he logged on to a
UnitedHealth website and attempted to pause the refills. He said he
couldn’t figure out how to do so without canceling the orders altogether.
The company said members can adjust refills through its app, web portal
or by calling customer service.
Zielinski said UnitedHealth’s pharmacy arm also sent him excessive
supplies of a once-a-month tablet to increase bone density and an
inhaler that he uses only occasionally to relieve symptoms of a lung
disease.
UnitedHealth said it shipped those drugs according to his medical
providers’ orders.
Zielinski said he currently has more than six months’ worth of the bone
tablets and “probably a 10-year supply” of inhalers.
Write to Christopher Weaver at Christopher.Weaver-at-wsj.com, Tom McGinty
at Tom.McGinty-at-wsj.com and Anna Wilde Mathews at Anna.Mathews-at-wsj.com
--
So many immigrant groups have swept through our town
that Brooklyn, like Atlantis, reaches mythological
proportions in the mind of the world - RI Safir 1998
http://www.mrbrklyn.com
DRM is THEFT - We are the STAKEHOLDERS - RI Safir 2002
http://www.nylxs.com - Leadership Development in Free Software
http://www.brooklyn-living.com
Being so tracked is for FARM ANIMALS and extermination camps,
but incompatible with living as a free human being. -RI Safir 2013
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