There were two new mail order pharmacy studies that were recently published. If you’re in the PBM / pharmacy space, you’ll want to dig into both of these.
The first one is from Kaiser which looked at outcomes for patients on cholesterol lowering medications based on their use of mail order or retail pharmacies (both of which are part of Kaiser). This study builds on their study last year which looked at medication possession ratio differences between mail order and retail.
After adjustment for demographic, clinical and socioeconomic characteristics, as well as for potential unmeasured differences between mail-order and in-person pharmacy users, 85 percent of patients who used the mail-order pharmacy achieved target cholesterol levels, compared to 74.2 percent of patients who only used the local Kaiser Permanente pharmacy.
Separately, there was a study published on adherence based on whether mail order was a requirement or a choice.
Pharmacy benefit designs dictate pharmacy access, drug cost, and formulary coverage and thus are an important public health tool with the potential to improve population health. Offering a mail-service pharmacy option is an important benefit design tool that helps to control pharmacy costs and may facilitate medication adherence among those who successfully transition to 90-day-supply prescriptions. However, restricting pharmacy choice by requiring the transfer of prescriptions from retail to mail-service pharmacy causes some members to discontinue therapy early. When members choose to eschew therapy rather than switch to a lower cost alternative, the unintended consequence is a reduction in medication adherence and the potential for increased medical expenses.
While one might see a contradiction between the two and prior studies, I think the point is that 90-day prescriptions do appear to increase adherence even after adjusting for many factors. BUT, if you require people to move to 90-day especially at mail, it’s important to have a clear transition path for them so that they (a) understand their benefit; (b) realize how to move; and (c) don’t end up simply missing refills or stopping therapy.